Acute odynophagia: A new symptom of COVID‐19 during the SARS‐CoV‐2 Omicron variant wave in Sweden

• Published in: Journal of internal medicine Vol. 292; no. 1; pp. 154 - 161
• Main Authors: Piersiala, Krzysztof, Kakabas, Lara, Bruckova, Anna, Starkhammar, Magnus, Cardell, Lars Olaf
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-07-2022; John Wiley and Sons Inc
• Subjects: Adult; Antibiotics; Bacterial diseases; Brief Report; Brief Reports; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 vaccines; Edema; Emergency medical care; Emergency medical services; Epiglottitis; Ethics; Fever; Humans; Infections; Inflammation; Informed consent; Laryngitis; Laryngotracheitis; Larynx; Medicin och hälsovetenskap; Olfaction; Omicron; Pain; Patients; Pharyngitis; Respiratory tract; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Smell; Sweden - epidemiology; Viral diseases; Viruses; Sweden; COVID-19; laryngitis; SARS-CoV-2; Omicron; epiglottitis
• DOI: 10.1111/joim.13470
• EISSN: 1365-2796
• ISSN: 0954-6820; 1365-2796

Objective
The objective of this study is to present a novel clinical manifestation of infection with the Omicron variant of the SARS‐CoV‐2 virus affecting mainly young, vaccinated, and healthy adults. We describe a new group of COVID‐19 patients seeking emergency care with symptoms similar to the life‐threatening condition epiglottitis. Here, we present a case series and discuss management.
Methods
We performed a retrospective single‐center case study of patients diagnosed with COVID‐19 who were referred to the Ear, Nose, and Throat Emergency Department (ENT ED) between January 1 and January 23, 2022 with clinical symptoms such as acute odynophagia, severe sore throat, and fever. Ethical approval was obtained from the Swedish Ethical Review Authority (2020‐02579). Informed consent was obtained from all patients included in the study.
Results
Twenty patients meeting inclusion criteria were identified. Fifteen patients were fully vaccinated against COVID‐19. Four patients needed a short hospitalization for their symptoms. The most common diagnoses were COVID‐19‐associated acute viral laryngotracheitis and/or viral pharyngitis. Six patients presented with signs of secondary bacterial infection and were put on antibiotics.
Conclusion
Previous variants of SARS‐CoV‐2 infection affected predominantly the lower respiratory tract and were associated with loss of smell and taste in many patients. The Omicron variant seems to affect predominantly the upper airways and cause acute laryngitis without olfactory dysfunction. In some patients, the clinical manifestation is similar to the symptoms of epiglottitis. In such a case, a prompt examination of the larynx is the gold standard to exclude inflammatory edema in the upper airways. None of the patients described in this study developed epiglottitis. In this study, we discuss the management of acute odynophagia in COVID‐19 patients.