Subject(s)
Coronavirus Infections/complications , Facial Paralysis/etiology , Guillain-Barre Syndrome/etiology , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Cerebral Angiography , Computed Tomography Angiography , Coronavirus Infections/diagnosis , Electrodiagnosis , Facial Nerve/diagnostic imaging , Facial Paralysis/diagnosis , Facial Paralysis/physiopathology , Facial Paralysis/therapy , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Lung/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Neural Conduction , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Tomography, X-Ray ComputedABSTRACT
COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.
Subject(s)
Bell Palsy , COVID-19 , Facial Paralysis , Guillain-Barre Syndrome/diagnosis , Prednisolone/administration & dosage , Pregnancy Complications, Infectious , Stroke/diagnosis , Valacyclovir/administration & dosage , Adult , Anti-Inflammatory Agents/administration & dosage , Antiviral Agents/administration & dosage , Bell Palsy/etiology , Bell Palsy/physiopathology , Bell Palsy/therapy , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , Diagnosis, Differential , Facial Paralysis/diagnosis , Facial Paralysis/physiopathology , Facial Paralysis/therapy , Facial Paralysis/virology , Female , Humans , Neurologic Examination/methods , Physical Therapy Modalities , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Treatment OutcomeABSTRACT
OBJECTIVES: To present the otologic findings of a patient with COVID-19 and complicated acute otitis media, evaluate for the presence of SARS-CoV-2 in middle ear fluid, and assess whether suctioning of middle ear fluid may be aerosol- generating. METHODS: The case of a man with SARS-CoV-2 infection and complicated acute otitis media with facial paralysis is presented to illustrate unique clinical decisions made in context of the COVID-19 pandemic. A cadaveric temporal bone was used to simulate droplet spread during suctioning of fluorescein-labelled middle ear fluid and visualized with a blue-light filter. RESULTS: A 23-year-old male who presented with complicated acute otitis media with facial paralysis was found to have an acute infection with SARS-CoV-2, with positive viral PCR of nasopharyngeal swab, and a negative PCR of the middle ear fluid. He was placed on isolation precautions and treated with myringotomy, topical and systemic antibiotics, and antivirals. Consistent with observations during endonasal suctioning, suctioning of middle ear fluid was not found to be aerosol or droplet generating. CONCLUSION: The case of a patient with active COVID-19 presenting with complicated acute otitis media in whom middle ear fluid was sampled to evaluate the etiology of the infection and the potential middle ear predilection of SARS-CoV-2 is described. This study has implications for the clinical management of patients with both known and unknown SARS-CoV-2 infection who present with ear disease. While middle ear suctioning may not be aerosol-generating, the risk of coughing or prolonged close contact requires heightened precautions during otologic procedures in patients with suspected or confirmed COVID-19.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Antiviral Agents/administration & dosage , COVID-19 Testing/methods , COVID-19 , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Middle Ear Ventilation , Otitis Media , SARS-CoV-2/isolation & purification , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Facial Paralysis/etiology , Facial Paralysis/therapy , Humans , Infection Control/methods , Male , Middle Ear Ventilation/methods , Middle Ear Ventilation/standards , Occupational Exposure/prevention & control , Otitis Media/complications , Otitis Media/etiology , Otitis Media/physiopathology , Otitis Media/therapy , Otitis Media with Effusion/diagnosis , Otitis Media with Effusion/microbiology , Treatment Outcome , Young AdultABSTRACT
Acute facial nerve disease leading to peripheral facial paralysis is commonly associated with viral infections. COVID-19 may be a potential cause of peripheral facial paralysis and neurological symptoms could be the first and only manifestation of the disease. We report a case of a term pregnancy diagnosed with COVID-19 after presenting with isolated peripheral facial palsy.