Sinonasal complications of severe acute respiratory syndrome coronavirus‐2: A single center case series

Background The emergence of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has resulted in an unprecedented global pandemic. Most infected patients are either asymptomatic or have mild upper respiratory infection symptoms. However, life‐threatening sequelae have been observed. In this...

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Published in:	Laryngoscope investigative otolaryngology Vol. 8; no. 1; pp. 16 - 24
Main Authors:	Lee, Saangyoung E., Ghodke, Ameer N., Stepp, Wesley H., Kong, Keonho A., Chaskes, Mark, Quinsey, Carolyn S., Ebert, Charles S., Thorp, Brian D., Senior, Brent A., Kimple, Adam J.
Format:	Journal Article
Language:	English
Published:	Hoboken, USA John Wiley & Sons, Inc 01-02-2023 Wiley
Subjects:	Abscesses Allergy, Rhinology, and Immunology Antibiotics Coronaviruses COVID Epidural functional endoscopic sinus surgery Hematoma Hospitals Inflammation Magnetic resonance imaging Neurosurgery Ophthalmology Original Research Otolaryngology SARS‐CoV‐2 Severe acute respiratory syndrome coronavirus 2 Sinuses sinusitis Streptococcus infections Thrombosis Tomography Visual acuity COVID sinusitis SARS‐CoV‐2 functional endoscopic sinus surgery
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Summary:	Background The emergence of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has resulted in an unprecedented global pandemic. Most infected patients are either asymptomatic or have mild upper respiratory infection symptoms. However, life‐threatening sequelae have been observed. In this report, we reviewed nine cases of patients with severe complications from sinonasal disease in the setting of acute SARS‐CoV‐2 infection. Methods IRB approval was obtained prior to study initiation. A retrospective chart review was performed of patients admitted to a tertiary hospital with complex sinonasal symptoms that required otolaryngologic evaluation and management in the setting of concomitant SARS‐CoV‐2 infection. Results Nine patients, ranging from ages 3 to 71 years, with sinonasal disease and simultaneous SARS‐CoV‐2 infection were identified. Initial presentations ranged from asymptomatic infection to mild/moderate disease (nasal obstruction, cough) or more severe sequelae including epistaxis, proptosis, or neurologic changes. SARS‐CoV‐2 tests were positive from one to 12 days after symptom onset, with three patients receiving SARS‐CoV‐2‐directed treatment. Complex disease presentations included bilateral orbital abscesses, suppurative intracranial infection, cavernous sinus thrombosis with epidural abscess, systemic hematogenous spread with abscess development in four distinct anatomic locations, and hemorrhagic benign adenoidal tissue. Eight of nine patients (88.8%) required operative intervention. Patients with abscesses also required prolonged, culture‐directed antibiotic courses. Conclusion Though most SARS‐CoV‐2 infections are asymptomatic and/or self‐limited, there is significant morbidity and mortality in patients with severe disease sequela as outlined in our reported cases. This suggests early identification and treatment of sinonasal disease in this patient population is critical to minimizing poor outcomes. Further research on the pathophysiology of these atypical presentations is needed. Level of Evidence 4 (Case Series). The emergence of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has resulted in an unprecedented global pandemic. Most infected patients are either asymptomatic or have mild upper respiratory infection symptoms. However, life‐threatening sequelae have been observed. In this report, we reviewed nine cases of patients with severe complications from sinonasal disease in the setting of acute SARS‐CoV‐2 infection.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2378-8038 2378-8038
DOI:	10.1002/lio2.1006