IP Journal of Otorhinolaryngology and Allied Science

Print ISSN: 2582-4147

Online ISSN: 2582-421X

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IP Journal of Otorhinolaryngology and Allied Science (JOAS) open access, peer-reviewed quarterly journal publishing since 2018 and is published under the Khyati Education and Research Foundation (KERF), is registered as a non-profit society (under the society registration act, 1860), Government of India with the vision of various accredited vocational courses in healthcare, education, paramedical, yoga, publication, teaching and research activity, with the aim of faster and better dissemination more...


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Shaik, Raju, and Priya: Profile of ENT manifestations among COVID - 19 patients


Introduction

In China, Wuhan city, Hubei province, 41 patients with pneumonia of unidentified cause were detected at the end of December, 2019.1 Throat swab samples were sent for culture on 7th January 2020 at Chinese Center for Disease Control and prevention (CCDC) and causative microorganism for the disease is named as severe acute respiratory syndrome, Corona virus-2 (SARS- COV-2). This illness was named as COVID-192 by World Health Organisation (WHO) in February 2020. Millions of people were infected and hundreds of thousands were dead all over the world during this pandemic and it remains as a threat to the mankind.3 COVID-19 patients currently remain the primary source of infection. The disease spectrum varies from mild to life-threatening symptoms. To forestall spread of contamination and for isolation, it is critical to assess the prescient indicators of the illness. For COVID-19 assessed incubation period is up to 14 days from exposure, with a median of 4 to 5 days.4 The onset of disease, span of viral shedding and the period of transmission are not characterised. Among asymptomatic or pre-symptomatic individuals with SARS-CoV-2, viral RNA may be detected in upper respiratory specimens.5 The following symptoms were present among inpatient cases are fever, fatigue, cough, dyspnoea, myalgia, diarrhoea, chest pain, Nasal obstruction, Anterior nasal discharge, posterior nasal drip, headache, sorethroat, dysphagia, anosmia, hyposmia, dysosmia, ageusia, hypogeusia, dysguesia.6, 7 Significant increase in the cases presenting with ENT manifestations were noticed. An European multicenter study inferred that olfactory (85.6%) and gustatory (88%) anomalies are common side effects in European affirmed COVID-19 cases, who might not have other nasal objections.8 In mild casesanosmia and ageusia were present alone. It is therefore necessary to test or quarantine those individuals with these complaints.

Materials and Methods

In teriatary health care facility which is recognised to provide Covid services, a retrospective study was conducted during August and September 2020 among positive COVID-19 patients. The aim of study is to analysis the prevalence of all ENT manifestations at the time of admission of the patient ie, Nasal obstruction, Anterior nasal discharge, posterior nasal drip,, headache, cough, dyspnoea, sorethroat, dysphagia, anosmia, hyposmia, dysosmia, ageusia, hypogeusia, dysguesia. The study included a questionnaire about fever, cough, Nasal obstruction, Anterior nasal discharge, posterior nasal drip, headache, dyspnoea, sorethroat, dysphagia, anosmia, hyposmia, dysosmia, ageusia, hypogeusia, dysguesia. History was taken from patients telephonically and those who were not responding to call thrice were excluded from the study.

Inclusion criteria

All COVID-19 positive patients admitted irrespective of severity, with no previous history of smell and taste dysfunction and who are willing to participate in study are included.

Exclusion criteria

All children <10 yrs and elderly people who cannot tell their symptoms, who have previous history of smell and taste dysfunction and individuals who haven’t agreed for study have been excluded.

Results

Demographic profile among Covid – 19 inpatients

Patients were predominantly seen in 6th decade of life with M:F ratio=1.8:1

2% patients were smokers and 17.8% were alcoholics

6% patients were hypertensives and 25.2% patients have diabetes

Table 1

Demographic profile among Covid – 19 inpatients

Variables

   Frequency

%

Age Group

10 – 19

27

2.5

20 – 29

95

8.9

30 – 39

134

12.5

40 – 49

206

19.3

50 – 59

264

24.7

60 – 69

216

20.2

70 – 79

109

10.2

80 – 89

19

1.8

Gender

Male

689

64.4

Female

381

35.6

Smoking

Present

56

5.2

Absent

1014

94.8

Alcohol

Present

190

17.8

Absent

880

82.2

HTN

Present

317

29.6

Absent

753

70.4

DM

Present

270

25.2

Absent

800

74.8

Among 1070 patients 901 patients (84%) were symptomatic and 169 patients (16%) were asymptomatic. Significantly cough (44%), fever(39.3%), dyspnoea (32.4%) and anterior nasal discharge (12%). We have observed that other symptoms were seen in less than 10%.

Table 2

Prevalance of ENT manifestations among Covid-19 inpatients

Symptom

Frequency

%

Nasal obstruction

Present

40

3.7

Absent

1030

96.3

Anterior nasal discharge

Present

128

12

Absent

942

88

Posterior nasal drip

Present

49

4.6

Absent

1021

95.4

Sorethroat

Present

98

9.2

Absent

972

90.8

Headache

Present

94

8.8

Absent

976

91.2

Dysphagia

Present

87

8.1

Absent

983

91.9

Dyspnea

Present

347

32.4

Absent

723

67.6

Anosmia

Present

78

7.3

Absent

992

92.7

Hyposmia

Present

34

3.2

Absent

1036

96.8

Ageusia

Present

73

6.8

Absent

997

93.2

Hypogeusia

Present

67

6.3

Absent

1003

93.7

Fever

Present

421

39.3

Absent

649

60.7

Cough

Present

471

44

Absent

599

56

P Value is significant if the value is less than 0.05

With this study we have observed that Women were more likely to present with Anterior nasal discharge, sore throat, hypogeusia and Men were more likely to present with dyspnoea and cough.

Table 3

Frequency of symptom versus Gender

Symptom

Male frequency (%)

Female frequency (%)

Chi square statistic

P value

Nasal obstruction

3.75

0.05

Present

20(2.9)

20(5.2)

Absent

669

361

Anterior nasal discharge

11.74

0.00

Present

65(9.4)

63(16.5)

Absent

624

318

Posterior Nasal drip

1.17

0.27

Present

28(4)

21(5.5)

Absent

661

360

Sorethroat

5

0.02

Present

53(7.6)

45(11.8)

Absent

636

336

Headache

2.16

0.14

Present

54(7.8)

40(10.5)

Absent

635

341

Dysphagia

2.69

0.10

Present

49(7.1)

38(10)

Absent

640

343

Dyspnea

16.25

0.00

Present

253(36.7)

94(24.7)

Absent

436

287

Anosmia

1.37

0.24

Present

55(8)

23(6)

Absent

634

358

Hyposmia

0.16

0.68

Present

21(3.1)

13(3.4)

Absent

668

358

Ageusia

0.25

0.61

Present

45(6.5)

28(7.4)

Absent

644

353

Hypogeusia

4.60

0.03

Present

35(5.1)

32(8.4)

Absent

654

349

Fever

1.67

0.19

Present

281(40.8)

140(36.8)

Absent

408

241

Cough

4.08

0.04

Present

319(46.3)

152(39.9)

Absent

370

229

Discussion

Patients with Covid-19 disease can encounter a scope of clinical appearances, from no symptoms to critical illness. In United States, a report on more than 370,000 affirmed COVID-19 cases - 70% of patients experienced fever, cough, or shortness of breath, 36% had muscle aches, and 34% had headaches.9 Issues during the pandemic COVID-19 emergency are Chemosensory dysfunctions and are the indicators for early diagnosis. Hu et al10 studied the cellular distribution of taste cells and ACE2 receptor distribution. They found that the percentage of ACE2 positive cells are more in taste cells, which indicated that SARS-CoV-2 might invade them and lead to ageusia in these patients. Olfactory dysfunction is generally found to be the initial symptom.11 Taste disturbance along with smell abnormality is that both chemosensory senses are intimately correlated.12 The analysed sample size is 1070. Among them 901 patients (84%) exhibited symptoms and prevalence was cough (44%), fever (39.3%), dyspnoea (32.4%), Nasal discharge (16.6%), sorethroat (9.2%), headache (8.8%), dysphagia (8.2%), anosmia (7.3%), ageusia (6.8%), hypogeusia(6.3%), hyposmia (3.2%) and 169patients (16%) were asymptomatic. No patient presented with dysguesia and dysosmia. Olfactory and gustatory alterations were found in 10.5% and 13.1% respectively. Among 1070 patients, 150(14%) patients ie; 89 males and 61 females had only smell and taste alterations irrespective of other symptoms. Speth et al. reported that the predominance of olfactory dysfunction was 61.2%.13 Paderno et al. demonstrated that the olfactory and gustatory dysfunctions were seen in 83% and 89% of patients, respectively.14 There have been not many investigations on the event of olfactory and gustatory dysfunction in Asia, only one study reported hyposmia as a symptom of the COVID-19. 15 In our study, nasal obstruction is present in 3.7% of patients. In an investigation of 1099 patients Guan et al. revealed a prevalence of nasal obstruction in 5% of patient.4 In this study 128 patients (12%) had Anterior nasal discharge and 49 (4.6%) had posterior nasal drip. Chen et al. reported four patients with rhinorrhea (4%) in a case series of 99 patients.16 The limitation of this study is purely subjective study, didn’t register the time of onset and time taken for resolution of symptoms.

Conclusion

In this single centre, retrospective study, fever, cough and dyspnoea were the most common symptoms. It was discovered that the incidence of the ENT manifestation at the time of admission in the hospital among COVID-19 patients is not as high as cough and fever but 14% had only smell and taste alterations but preventive care and screening must be offered for such patients to avoid further spread. Sudden olfactory or gustatory alterations need to be recognised as an important symptom, for better prognosis and self isolation. With this study we also observed that woman were more presumed to present with anterior nasal discharge, sore throat, hypogeusia and men were more presumed to present with dyspnoea and cough. As the epidemic still continues better understanding of the ENT manifestations in Covid-19 is important in controlling the disease.

Conflicts of Interest

All contributing authors declare no conflicts of interest.

Source of Funding

None.

References

1 

H Lu CW Stratton T Yi‐Wei Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracleJ Med Virol 2020924401210.1002/jmv.25678

2 

WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11Internet World Heal Organ2020519

3 

E Mahase Covid-19: WHO declares pandemic because of ‘alarming levels’ of spread, severity, and inactionBr Med J Publ Group20206310

4 

W J Guan Z Y Ni Y Hu Clinical characteristics of coronavirus disease 2019 in ChinaN Engl J Med202038218170820

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Y Pan D Zhang P Yang LLM Poon Q Wang Viral load of SARS-CoV-2 in clinical samplesLancet Infect Dis2020204411210.1016/s1473-3099(20)30113-4

6 

Z Wu J M Mcgoogan Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and PreventionJAMA202032313123942

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Z Wang B Yang Q Li L Wen R Zhang Clinical features of 69 cases with coronavirus disease in Wuhan ChinaClin Infect Dis2019116

8 

J R Lechien Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coron- avirus disease (COVID-19): a multicenter European studyEur Arch Oto-Rhino-Laryngol20201111

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EK Stokes LD Zambrano KN Anderson EP Marder KM Raz SE Burai Felix Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020MMWR Morb Mortal Wkly Rep202069247596510.15585/mmwr.mm6924e2

10 

H Xu L Zhong J Deng J Peng H Dan X Zeng High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosaInt J Oral Sci202012110.1038/s41368-020-0074-x

11 

R Kaye CW David Chang K Kazahaya J Brereton JC Denneny COVID-19 Anosmia Reporting Tool: Initial FindingsOto- laryngol Neck Surg 20201631132410.1177/0194599820922992

12 

Dana M. Small John Prescott Odor/taste integration and the perception of flavorExp Brain Res 20051663-43455710.1007/s00221-005-2376-9

13 

M M Speth T Singer-Cornelius M Obere I Gengler S J Brockmeier AR Sedaghat Olfactory dysfunction and sinonasal symptomatology in COVID-19: prevalence, severity, timing, and associated characteristicsOtolaryngol Neck Surg2020116

14 

A Paderno Olfactory and gustatory outcomes in COVID-19: A prospective evaluation in nonhospitalized subjectsOtolaryngol Neck Surg20201110

15 

L Mao M Wang C Setal Neurological manifetations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study202110.1101/2020.02.22.20026500

16 

N Chen M Zhou X Dong Epidemiological and clini- cal characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive studyLancet102233951022350713



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Article type

Original Article


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Authors Details

Ali Shaik, M Ravi Kumar Raju, K.G.G.L Shiva Priya


Article History

Received : 28-01-2021

Accepted : 12-04-2021

Available online : 20-04-2021


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