Recovery from COVID-19 related olfactory and gustatory dysfunction following omicron BA.1 subvariant infection: a six-month prospective study (preprint)

PurposeThe aim of the present study was to estimate the prevalence and the recovery rate of self-reported chemosensory dysfunction 6-month after SARS-CoV-2 infection acquired during the predominance of the Omicron BA.1 subvariant.MethodsProspective study based on the sino-nasal outcome tool 22 (SNOT-22), item "sense of smell or taste" and additional outcomes. Results. Of 338 patients with mild-to-moderate COVID-19 completing the baseline survey, 294 (87.0%) responded to the 6-month follow-up interview. Among them, 101 (34.4 %) and 4 (1.4 %) reported an altered sense of smell or taste at baseline and at 6 months, respectively. Among the 101 patients with COVID-19-associated smell or taste dysfunction during the acute phase of the disease, 97 (96.0%) reported complete resolution at 6 months. The duration of smell or taste impairment was significantly shorter in vaccinated patients (p=0.007).ConclusionsCompared with that observed in subjects infected during the first wave of the pandemic, the recovery rate from chemosensory dysfunctions reported in the present series of patients infected during the predominance of the Omicron BA.1 subvariant was more favourable with a shorter duration being positively influenced by vaccination.

Injection of Platelet Rich Plasma in the Olfactory Cleft for COVID-19 Patients with Persistent Olfactory Dysfunction: Description of the Technique (preprint)

Objective: To describe technique of platelet rich plasma injection into the olfactory cleft in patients with long-term COVID-19 olfactory dysfunction. Methods: The technique starts with the blood extraction and the isolation of PRP through a 10-min centrifugation (4,200 rpm). The supernatant was injected in nasal regions with a 27-G needle after a local anesthesia with Xylocain 10% spray. The injection was performed through a 0° rigid optic. Precisely, several points of 0.2–0.5 mL were performed in the nasal septum in regard of the head of the middle turbine, and in the head of the middle turbine in both sides. Clinical, psychophysical and pain outcomes were evaluated pre- to post-injection. Results: A 22-year-old female with 24-month post-COVID-19 anosmia was recruited for the injection of PRP. The olfactory cleft endoscopic scale score was 0 and the threshold, discrimination and identification scores were 1, 8 and 0, respectively. The Olfactory Disorder Questionnaire score was 51. The patient benefited from the injection of 2.2 mL of PRP in nasal regions, which was done without complication. The procedure pain level was 2/10, while the local anesthesia with xylocaine 10% was judged as the most annoyance step with a score of 3/10. At 2-month post-injection, the TDI scores reached 16, 16, and 16 (48), while the Olfactory Disorder Questionnaire was 73. The patient described its recovery as very rapid, lasting 3-4 days, and occurring 3-week post-injection. Conclusion: The injection of PRP into the olfactory cleft is a safe and easiness new approach that may improve the recovery of smell sense.

Postacute Laryngeal Injuries and Dysfunctions in COVID-19 Patients: A Scoping Review (preprint)

Objective: To investigate postacute laryngeal injuries and dysfunctions (PLID) in coronavirus disease 2019 (COVID-19) patients. Methods: Three independent investigators performed a systematic review of the current literature studying PLID in patients with a history of COVID-19. The review was performed according to PRISMA Statement. Epidemiological, clinical, hospitalization features, laryngeal diseases and voice outcomes were extracted from the included papers. Results: Eight papers met our inclusion criteria (393 patients) corresponding to 5 uncontrolled prospective and 3 retrospective studies. The most prevalent PLID were vocal fold dysmotility (65%), vocal fold edema (35%), laryngopharyngeal reflux (21%), and muscle tension dysphonia (21%). Posterior glottic stenosis (12%), granuloma (14%), and posterior glottic diastasis (12%) were the most common injuries. Most patients with PLID were obese and had a history of intensive care unit hospitalization, and orotracheal intubation. The delay between the discharge and the laryngology office consultation ranged from 51 to 122 days. The mean duration of intubation ranged from 10 to 34 days. Seventy-eight (49%) intubated patients were in prone position. The proportion of patients requiring surgical treatment ranged from 39% to 70% (mean=48%). There was an important heterogeneity between studies about inclusion, exclusion criteria and outcomes. Conclusion: COVID-19 appeared to be associated with PLID, especially in patients with a history of intubation. However, future controlled studies are needed to evaluate if intubated COVID-19 patients reported more frequently PLID than patients who were intubated for other conditions.

COVID-19-related Smell and Taste Impairment with Widespread Diffusion of SARS-CoV-2 Omicron Variant (preprint)

Background. The aim of this study was to estimate the prevalence of self-reported chemosensory dysfunction in a study cohort of subjects who developed a mild-to-moderate COVID-19 in the period from January 17, 2022 to February 4, 2022 (Omicron proxy period) and compared that with a historical series of patients tested positive for SARS-CoV-2 infection between March and April, 2020 (comparator period). Methods. Prospective study based on the sinonasal outcome tool 22 (SNOT-22), item sense of smell or taste and additional outcomes. Results. Patients characteristics and clinical presentations of COVID-19 were evaluated and compared in 779 patients, 338 of the study cohort and 441 of the historical series. The prevalence of self-reported chemosensory dysfunction during the proxy Omicron period (32.5%; 95% CI, 27.6-37.8) was significantly lower from that during the comparator period (66.9%; 95% CI, 62.3-71.3) (p

Correlations between IL-6 serum level and olfactory dysfunction severity in COVID-19 patients: a preliminary study. (preprint)

Background: Interleukin 6 (IL-6) is a proinflammatory cytokine that is secreted by cells infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and it is widely recognized as a negative prognostic factor. The purpose of this study was to analyze the correlations between the olfactory scores determined by psychophysical tests and the serum levels of IL-6 in patients affected by coronavirus disease 2019 (COVID-19)Methods: Patients underwent psychophysical olfactory assessment with Connecticut Chemosensory Clinical Research Center test and IL-6 plasma level determination within 10 days of the clinical onset of COVID-19. Results: Seventy-four COVID-19 patients were included in this study. COVID-19 staged as mild in 34 patients, moderate in 26 and severe in 14 cases. There were no significant differences in olfactory scores across the different COVID-19 severity groups In the patient series, the median plasma level of IL-6 was 7.7 pg/mL (IQR 3.7 – 18.8). The concentration of IL-6 was found to be significantly correlated with the severity of COVID-19 with a directly proportional relationship. The correlation between IL-6 plasma concentrations and olfactory scores was weak (rs=0.182) and not significant (p=0.12).Conclusions: In COVID-19 patients, psychophysical olfactory scores did not show significant correlations with the plasma levels of a well-recognized negative prognostic factor such as IL-6. This observation casts some shadows on the positive prognostic value of olfactory dysfunctions

Clinical and Radiological Evaluations of COVID-19 Patients with Anosmia: Preliminary Report. (preprint)

Objective: To investigate clinical and radiological features of olfactory clefts of patients with mild coronavirus disease 2019 (COVID-19). Methods: Sixteen COVID-19 patients were recruited. The epidemiological and clinical data were extracted. Nasal complaints were assessed through the sino-nasal outcome test 22 (SNOT-22). Patients underwent psychophysical olfactory testing, olfactory cleft examination and CT-scan. Results: Sixteen anosmic patients were included. The mean Sniffin Sticks score was 4.6+/-1.7. The majority of patients had no endoscopical abnormality, with a mean olfactory cleft endoscopy score of 0.6+/-0.9. The olfactory clefts were opacified in 3 patients on the CT-scan. The mean radiological olfactory cleft score was 0.7+/-0.8. There were no significant correlations between clinical, radiological and psychophysical olfactory testing. Conclusion: The olfactory cleft of anosmic COVID-19 patients is free regarding endoscopic examination and imaging. The anosmia etiology would be not related to edema of the olfactory cleft.

Objective Olfactory Evaluation of Self-reported Olfactory Dysfunction in a Case Series of 86 COVID-19 Patients (preprint)

Objective: To investigate olfactory dysfunction in patients with mild COVID-19 through patient-reported outcome questionnaires and objective psychophysical testing. Methods: Adult patients with COVID-19 and self-reported sudden-onset olfactory dysfunction were recruited through a public call for participation from the University of Mons. Demographic data, pathologic conditions, general and otolaryngological symptoms were collected, and general nasal complaints were evaluated with the sino-nasal outcome-22 (SNOT-22). Subjective olfactory and gustatory status was evaluated with the National Health and Nutrition Examination Survey (NHNES) and the short version of the Questionnaire of Olfactory Disorders-Negative Statements. Objective olfactory status was evaluated using an objective psychophysical test (Identification Sniffin Stick test). Results : 86 patients completed the study. The mean age was 42 + or - 12 years. The most common symptoms were fatigue (75%), headache (63%), nasal obstruction (58%), dysgeusia (51%), postnasal drip (49%), cough (49%) and myalgia (46%). On NHNES, total loss of taste and smell were reported by 51% and 74% of patients, respectively. 65% of patients reported a total loss of smell, while the remainder reported a partial loss. Objective olfactory testing found 41 anosmic (48%), 12 hyposmics (14%), and 33 normosmics (38%) patients. There was no correlation between the objective test results and subjective reports of nasal obstruction or postnasal drip, these complaints were absent in 69% of anosmic patients. Conclusion : A significant proportion of patients reporting olfactory dysfunction related to COVID-19 infection do not have olfactory dysfunction on objective testing. Furthermore, a majority of those with measured olfactory dysfunction did not have corresponding nasal obstruction.

Psychophysical Olfactory Findings of Mild-to-moderate COVID-19 Patients: Preliminary Report. (preprint)

Since the onset of the COVID-19 infection, many patients reported sudden loss of smell (SLS). However, due to the lack of psychophysical testings, it remains difficult to know if these patients really have hyposmia or anosmia. Our group investigated the prevalence of anosmia and hyposmia in 28 COVID-19 patients and the potential association with nasal complaints.

Sinus and Anterior Skull Base Surgery during the COVID-19 pandemic: Systematic review, Synthesis and YO-IFOS position. (preprint)

Purpose: The COVID-19 pandemic has caused significant confusion about healthcare providers and patients pandemic-specific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic. Methods: PubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID-19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. Results: 15 international publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited. Conclusions: Sinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing use of PPE is essential with sinus and anterior skull base surgery.

Systematic review of international guidelines for tracheostomy in COVID-19 patients. (preprint)

At this moment, the world leaves under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that are at particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures on demand at this moment is tracheostomy, due the increasing admission in ICU departments and the increased need of ventilatory support secondary to respiratory distress syndrome. This review of international guidelines for tracheostomy in COVID-19 infected patients, aiming to summarize in a systematic way the available recommendations from 18 guidelines from all over the world.