Evaluation of Chronic Rhinosinusitis Symptoms' Severity Following COVID-19 Infection: A Retrospective Analysis.

Objectives This study aims to compare the severity of chronic rhinosinusitis (CRS) symptoms pre- and post-COVID-19 infection and estimate the impact of the COVID-19 pandemic on the use of intranasal corticosteroids (ICS) among adult CRS patients. Methods This was an observational retrospective cohort study conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between July 2022 and October 2022. Adult CRS patients with sino-nasal outcomes test-22 (SNOT-22) scores documented prior to March 2020, marking the occurrence of Saudi Arabia's initial reported case of COVID-19, were requested to complete the SNOT-22 questionnaire following COVID-19 infection. A comparison was subsequently made between the two scores obtained. Results The study enrolled a total of 33 patients, with 16 assigned to the control group and 17 with a history of COVID-19 infection. The mean age of the patients was 43 years, and the majority (52%) were males. Statistical analysis did not reveal any statistically significant differences in the total SNOT-22 scores or domain-level scores between the two groups. Furthermore, the use of ICS during the COVID-19 pandemic did not show any significant associations, except for patients with asthma, where 80% of them used ICS during the pandemic (p=0.0073). Conclusion There was no statistically significant disparity observed in the SNOT-22 scores between patients who tested positive for COVID-19 and those who did not. The use of corticosteroids during the COVID-19 pandemic was found to be more prevalent in this study compared to previous studies conducted before the pandemic, particularly among patients with asthma. The use of ICS during the pandemic was not associated with the presence of polyps, functional endoscopic sinus surgery (FESS), allergic rhinitis, or eczema.

Otorhinolaryngology Symptom Assessment Using SNOT 22 Among SARS CoV-2 Patients in a Tertiary Care Centre.

The main aim of the study was to assess various ENT symptoms in COVID 19 patients, also to investigate the severity of ENT symptoms among COVID 19 patients and find their relation on basis of scores among five discrete domains of SNOT 22 (Sino nasal Outcome Test). A prospective observational study was conducted among 135 patients between 18 to 75 years of age, in the month of September 2020 with COVID-19 infection having mild, moderate disease who were admitted to our hospital. Subjects were divided into groups according to their presenting ENT symptoms based on age, gender and other comorbidities and differences between the groups were examined. The sinonasal symptoms were assessed using the SNOT 22 questionnaire. A strong statistical significance with loss of smell and taste sensation was noted in patients above the age of 40 years. It was also noted that the patients who presented with cough above the age of 40 years were significantly more. Evaluation of sinonasal symptoms using SNOT 22 questionnaire showed that Extranasal rhinologic symptoms, Psychological dysfunction, Sleep dysfunction had significantly higher association among patients who were more than 40 years. We observed that, Extranasal rhinologic symptoms were significantly higher among males than females. There is thus an emergent need to develop a uniform tool to assess the various ENT symptoms. In our study we assessed the patients with COVID 19 using a standard questionnaire to observe the symptomatology, psychological and sleep dysfunctions due to sinonasal issues, and to closely understand the relationship of various symptoms in a meticulous manner.

Face mask correlation with allergic rhinitis symptoms severity during COVID-19 pandemic: A cross-sectional study.

Background: Face mask is the first line to protect the respiratory mucosa from the coronavirus particles in aerocells and droplets and without this, the exposure of the mucosa to the virus and allergens trigger the immune and inflammatory system. These lead to Allergic Rhinitis (AR) symptoms or virus infection. Aim: This study discusses about the effects of face mask on the severity of AR symptoms using the Sino-Nasal Outcome Test (SNOT-22) in AR cases during the Corona Virus Disease 2019 (COVID-19) pandemic. Method: In this cross-sectional study, 54 cases previously diagnosed as moderate and severe AR based on Allergic Rhinitis and its Impact on Asthma and Visual Analog Scale score referred to the tertiary allergy clinic were involved, while 5 of them were excluded. AR symptoms before and during the pandemic were compared based on the SNOT-22 questionnaire. Demographics, AR severity, and comorbidities were registered. Results: The mean age was 31.4 ± 13.5 years with the male-female ratio of 1.4. The mean SNOT-22 score was 36.1 ± 20.3 before and 29.5 ± 16.8 during the pandemic. Although 36.7% (n: 18) of all participants had severe symptoms before the pandemic, 10.2% (n: 5) had severe AR symptoms during the pandemic. 53.0% (n: 26) of patients had moderate AR symptoms, and 36.7% (n: 18) had mild AR symptoms in the pandemic. There was no significant difference between each paired subgroup in AR symptom changes but the symptom improvement was significant in most of the subgroups when compared to the pre-pandemic period. Smoking had an adverse effect on AR symptoms (p: 0.034). Conclusion: Face mask affects the quality of life in AR patients and improves the severity of AR symptoms during COVID-19 pandemic. Smoking worsens this severity. Age, gender, pet ownership, underlying conditions, and previous COVID-19 infection were not associated with AR symptoms severity and alteration in the AR individuals' quality of life during the COVID-19 pandemic.

Association of anosmia and neutralizing antibody production in adolescents with SARS-CoV-2.

BACKGROUND: To monitor olfactory/gustatory dysfunction and its relationship to SARS-CoV-2 IgG antibody responses in an adolescent population. METHODS: Adolescents with changes in olfactory/gustatory functions were enrolled in a 15-month study. The patients were evaluated with 1) SNOT-22, 2) pediatric smell wheel, and 3) SARS-CoV-2 antibody testing. The relationship between these scores and length of anosmia, and the amount of SARS-CoV-2 IgG antibodies were assessed. A brain MRI was performed in cases of persistent special sensory symptoms. RESULTS: Eighteen patients were identified with smell and/or taste complaints. Most of the patients were female (67%) and median age was 15 years (range 11-17). Twelve patients had prior SARS-CoV-2 PCR testing, with only five patients with a positive result. The median SNOT-22 score was 16 (range 0-52) and the median smell wheel score was 6.5 (range 1-11). Patients with taste difficulty were more likely to have a score less than eight. 78% of the patients tested positive for antibodies and there was a strong negative correlation between smell wheel score and antibody level (Spearman, ρ = -0.798, p = 0.002). Five patients underwent MRI scan, and all resulted as normal olfactory bulb structures. 66% received nasal corticosteroids. 11 patients presented in follow up. CONCLUSIONS: Adolescents presenting to a pediatric ENT clinic during the SARS-CoV-2 pandemic were likely to have prolonged (>6 weeks) symptoms of SARS-CoV-2. The majority do not report positive PCR testing result but do report systemic symptoms including anosmia. This suggests that anosmia may be both a late and prolonged symptom of SARS-CoV-2.

Comparing the severity of chronic rhinosinusitis symptoms before versus during the COVID-19 pandemic.

Background: COVID-19 measures such as masking, social distancing, and staying indoors may mitigate chronic rhinosinusitis (CRS) symptoms. We evaluate whether these measures correlated with improved symptoms in patients with CRS. Methods: This retrospective study compared SNOT-22 survey data from the Northwestern CRS Registry at the time of enrollment and at years 1-5 of follow-up. The final sample consisted of 1826 SNOT-22 surveys for 598 patients. April 10, 2020 to December 31, 2021 was considered "during the pandemic" and prior to March 11, 2020 was considered "pre-pandemic." Wilcoxon test was used to compare SNOT22 at enrollment pre-pandemic versus during pandemic. Separate linear mixed models were performed to estimate SNOT22 at 1 to 5 years after enrollment pre-pandemic versus during pandemic. Results: Subjects enrolled during the pandemic had worse SNOT22 scores than those enrolled pre-pandemic (53 vs. 42, p = .0024). Total SNOT-22 scores were improved during the pandemic than before the pandemic at 1 year follow-up (18.17 vs. 12.22, p = .001). This effect persists when evaluating the nasal (7.33 vs. 5.13, p = .003), sleep (2.63 vs. 1.39, p = .008), function (1.40 vs. 0.72, p = .015), and emotion (0.77 vs. 0.17, p < .001) domains individually. There was no statistically significant difference in total SNOT-22 score at Years 2-5 of follow-up. Conclusions: Patients with CRS experience a greater reduction in symptom severity in their first year of treatment during the pandemic than before the pandemic, plausibly from measures such as masking and staying indoors. Level of Evidence: 4.

The COVOSMIA-19 trial: Preliminary application of the Singapore smell and taste test to objectively measure smell and taste function with COVID-19.

Sudden loss of smell and/or taste has been identified as an early symptom of SARS-CoV-2 2019 (COVID-19) infection, and presents an effective target for prompt self-isolation and reducing community spread. The current study sought to develop and test a novel, rapid, self-administered test to objectively measure smell and taste losses associated with COVID-19, and administered self-report questionnaires to characterise symptoms associated with COVID-19 in Singapore. Participants (N = 99) completed questionnaires to record recent changes in smell and taste ability. This was followed by the 'Singapore Smell and Taste Test' (SSTT), a personal, objective testing kit for daily self-assessment of smell and taste function at their place of residence. Seventy-two recruited participants were confirmed as COVID-19 positive at baseline, of which 58 completed the SSTT at home. Of these, 36.2% had objectively measured smell and/or taste loss. The SSTT measures of smell and taste function were positively associated with participants' self-reported smell and taste acuity, and rated smell intensity of 6 common household items. This study presents the first application of the SSTT as a rapid, cost-effective, objective tool to self-monitor smell and taste function in a residential setting, and ensures comparability across individuals through the use of standardised stimuli. The SSTT has potential for future application in populations with limited access to formal COVID-19 testing as a self-administered objective method to monitor sudden changes in smell and taste, and to prompt early self-isolation, in order to reduce community transmission of COVID-19.

The Frequency and Clinical Assessment of COVID-19 in Patients With Chronic Rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS), as an inflammatory airway disease, could be a risk factor for COVID-19 patients. This study aimed to investigate the frequency and severity of symptoms of COVID-19 in patients with CRS and to assess the association between the status of CRS symptoms and the quality of life (QoL) of the patients. METHODS: In this observational and cross-sectional study, 207 adult CRS patients participated. The patients, who presented the symptoms of COVID-19, were examined by taking the reverse transcription-polymerase chain reaction test. A questionnaire was completed by each patient, regarding their demographic and clinical data. In addition, the GA2LEN and Sino-Nasal Outcome Test (SNOT-22) standard questionnaires were used to identify the comorbid allergic condition and QoL of CRS patients. RESULTS: The frequency of patients with COVID-19 was 25 (12.1%) of which 22 were treated as outpatients, 2 of them admitted in wards and 1 at intensive care unit. The severity of hyposmia in the patients was 2 (8%) as mild, 5 (20%) moderate, and 11 (72%) as anosmia. The most common allergic and underlying comorbid diseases were allergic rhinitis (88%) and thyroid disorders (28%). Further, the average SNOT-22 score in 4 SNOT-22 domains (nasal, otologic, sleep, and emotional symptoms) was significantly decreased in CRS patients after a period of one year since the pandemic started (40.1 ± 18.0 vs. 46.3 ± 17.7; P < .0001). DISCUSSION: This study showed a low frequency of COVID-19 in patients with CRS and about the same rate of infection positivity in the general population; therefore, we concluded that CRS could not be considered as a risk factor for COVID-19. Interestingly, the lower average score of SNOT-22 after one year of the pandemic in the patients with CRS confirmed the necessity for performing the standard health protocols by the patients.

Temporal patterns of nasal symptoms in patients with mild severity SARS-CoV-2 infection.

BACKGROUND: No study to date has analyzed the progression of sinonasal symptoms over time in COVID-19 patients. The purpose of this study is to analyze the progression of sinonasal symptoms and risk factors for olfactory dysfunction in the mild severity COVID-19 patient. METHODS: An internet survey was used to assess sinonasal symptoms in patients with COVID-19. Changes in rhinologic domain and symptom-specific Sinonasal Outcome Test (SNOT-22) scores were compared at five time points: two weeks before diagnosis, at diagnosis, two weeks after diagnosis, four weeks after diagnosis, and six months after diagnosis. RESULTS: 521 responses were collected. Rhinologic domain SNOT-22 scores increased significantly (p < 0.001) to 8.94 at the time of diagnosis, remained elevated two weeks post-diagnosis (5.14, p = 0.004), and decreased significantly four weeks post-diagnosis (3.14, p = 0.004). Smell-specific SNOT-22 scores peaked at the time of diagnosis (2.05, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks post-diagnosis (0.64, p > 0.999). Taste-specific SNOT-22 scores also peaked at diagnosis (2.06, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks after diagnosis (0.71, p > 0.999). There were no significant differences in sense of smell or taste between 1-month and 6-month timepoints. CONCLUSION: Sinonasal symptoms, particularly loss of smell and taste, may be important presenting symptoms in the mild severity COVID-19 patient. Our findings support incorporating these symptoms into screening protocols. LEVEL OF EVIDENCE: 4.

Evaluation of effects of chronic nasal steroid use on rhinological symptoms of COVID-19 with SNOT-22 questionnaire.

BACKGROUND: The benefits of corticosteroids for the treatment of COVID-19 infection are documented in the literature. The goal of the study is to compare the severity of rhinological symptoms of COVID-19 between patients with nasal steroid use (NSU) and the control group (CG) using the sino-nasal outcome test (SNOT-22) questionnaire. METHODS: A face-to-face survey was conducted at a second referral state hospital between. Patients with a complete recovery from COVID-19 were included in NSU and CG groups. Two subscales of the SNOT-22 were filled by the patients. The frequency and duration of smell and taste loss and SNOT-22 scores were compared between the two groups. RESULTS: Forty-seven patients were included in the study. Thirty-one patients were in CG and 16 patients in the NSU group. Twenty-four (51.1%) patients were females and 23 (48.9%) were males. The mean age was 41.4 ± 8.6 years. Olfactory dysfunction was detected in 12 (75%) patients in the NSU group, and 31 (93.3%) patients in the control group (CG). Gustatory dysfunction was seen in 10 (62.5%) patients in the NSU group and 24 (77.4%) patients NSU group. (p = 0.071, 0.279, respectively). The duration of the olfactory (6.6 ± 2.5 days) and gustatory dysfunction (6.1 ± 2.6 days) and the mean SNOT-22 total score (11.9 ± 1.6) was significantly lower in the NSU group (p < 0.001, CI 11.1-5.1, CI 9.9-4.6, CI 9.3-5.9, respectively). CONCLUSIONS: Although nasal steroid use does not prevent olfactory and gustatory dysfunction in COVID-19 patients, it may reduce the severity and duration of these symptoms.