Emergency visits of otorhinolaryngology department during COVID-19 pandemic, Saudi Arabia, 2020

Aim: In this study, we aimed to assess the frequency of patient emergency visits to the Otorhinolaryngology (ORL) Department during coronavirus COVID-19 pandemic and compare it with that before coronavirus COVID-19. Material(s) and Method(s): A retrospective comparative study was performed at Al-Al-Hada Armed Forces Hospital, Taif (Saudi Arabia), and data regarding various diagnoses of ORL cases were collected from medical records of patients who visited/admitted to ORL-ED during the lockdown (Group 1) and those who visited/ admitted to ORL-ED before the pandemic (Group 2). Result(s): Group 2 had a significantly higher percentage of cases who had no ENT-related disorders, hypertrophy inferior turbinate (HIT), stridor, obstructive sleep apnea (OSA), epistaxis and who had no complications, had general ENT, foreign body ingestion-aspiration, trauma, otology and who had more than one disorder and Group 1 had a significantly higher percentage of those having nasal obstruction, tonsil hypertrophy grade 3, had emergency head and neck cancer, had deep neck space infections and who had complicated. Discussion(s): During coronavirus COVID-19 pandemic period, cold ENT visits were much less and foreign body ingestion remains the highest reason for ENT visits. Additionally, telemedicine has been shown to be effective in reducing ED visits during the pandemic period. Furthermore, older cases with chronic ENT problems who had regular follow-up ENT visits were less likely to visit ED during the pandemic.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Upper Airway Manifestations of SARS-CoV-2 Infection During New York City Omicron Wave: A Single-Institution Experience

Introduction: Studies have shown that COVID-19 viral glycoproteins bind to angiotensin-converting enzyme 2 (ACE2) receptors in the airway, causing downregulation of the ACE protein and leading to angioedema-like symptoms. Further, compared with previous variants, the Omicron variant of SARS-CoV-2 appears to replicate more readily in the upper airway than in the lungs. To our knowledge, this is the first case series to explore presentations involving the upper airway in patients with SARS-CoV-2 infection during the Omicron wave of the COVID-19 pandemic. Method(s): We reviewed a case series of adult patients who presented to a single New York City emergency department between December 2021 and January 2022 with acute upper airway symptoms that prompted otolaryngology consultation and who tested positive for SARS-CoV-2. Result(s): Between December 2021 and January 2022, there were at least 3 SARS-CoV-2-positive patients who presented to the New York-Presbyterian Hospital with upper airway conditions requiring evaluation by an otolaryngologist. Conditions included supraglottitis, tracheitis, and epiglottitis. Two patients had received the COVID vaccine;1 had not. One patient required intubation;2 were maintained on room air. One patient was admitted to the intensive care unit, 1 to the step-down unit, and 1 to the floor. Length of stay varied from 3 to 11 days, 1 for nonairway issues. All 3 had methicillinsusceptible/ methicillin-resistant Staphylococcus aureus nasal swabs;2 were positive. All had respiratory viral panels that were negative. One had a throat culture that was negative. All received antibiotics. Conclusion(s): To date, there have been no studies exploring the upper airway manifestations of SARS-CoV-2 infection in the Omicron wave. These data provide important clinical correlates that are highly relevant to otolaryngologists.

Acute infectious supraglottitis in adult population: epidemiology, management, outcomes and predictors of airway intervention.

PURPOSE: The purpose is to analyze the incidence of acute infectious supraglottitis in our center between 2010 and 2020, define the characteristics and trends of those patients and identify factors associated with the need of airway intervention. METHODS: A retrospective single-center observational study of a cohort of patients diagnosed with acute infectious supraglottitis between January 2010 and December 2020. Patients were stratified according to airway management. RESULTS: Eighty eight patients were included: 59 men (67%) and 29 women (33%). A significant upward trend of 9% in the annual incidence rate of supraglottitis was seen during 2010-2020, with an important increase in cases during 2019. Muffled voice (41%) and respiratory distress (38%) were the most common presenting symptoms; and the median duration of symptoms before hospital admission was 2 days [IQR 1; 3]. Airway intervention was performed in fifteen patients (17%). Nine patients (10%) were intubated and six required tracheotomy (7%). Comparing the patients who required airway intervention with those who received a conservative treatment, younger patients (p < 0.01) were more likely to need airway intervention. In logistic regression analysis, we found that epiglottic abscess (p = 0.015), hypersalivation (p = 0.027) and smoking (p = 0.036) were independent factors with a significant association with airway intervention. CONCLUSION: There was an important increase in cases and its severity in 2019, but due to COVID-19 pandemic, it was not possible to define if it was an isolate event or an upward trend. Epiglottic abscess, hypersalivation and smoking could be possible risk factors for airway intervention.

Pediatric COVID-19 presenting as supraglottitis with vocal cord hypomobility.

In the United States, an estimated 7.3% of confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) are among persons aged less than 18 years. Data regarding clinical manifestations in this age group are still evolving. An upper airway predilection has been reported in children. We describe the case of a 15-year-old female with supraglottitis and unilateral hypomobility of vocal cord with concern for critical airway, associated with COVID-19. She was managed by a multidisciplinary team including critical care, infectious diseases, and otolaryngology. This report adds to the sparse but evolving body of literature on the clinical presentation of COVID-19 disease in children.