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1.
Cephalalgia ; 42(3): 218-228, 2022 03.
Article in English | MEDLINE | ID: covidwho-1430335

ABSTRACT

BACKGROUND: The genesis of headache in coronavirus disease 2019 (COVID-19) is currently unclear and the multitude of disease symptoms often further hinders locating the source of pain. Interestingly, many subjects with COVID-19 have symptoms of acute rhinosinusitis. The relation between nasal symptoms and headache in SARS-CoV-2 infection remains unknown. METHODS: This bi-center longitudinal study evaluated symptoms in consecutive COVID-19 patients in the participating practices. The first assessment was performed during the initial consultation after infection confirmation. That was followed up by a second consultation after a median 9 days. RESULTS: 130 patients were included in the study (80 women, 50 men; mean age 46.9 years). Headache was highly prevalent at the first visit (72%) and significantly associated with acute rhinosinusitis symptoms. The odds ratio for headache in subjects with rhinosinusitis was 3.5. Headache could be attributed to systemic viral infection in 96% and to acute rhinosinusitis in 51% of cases according to 3rd edition of the International Classification of Headache Disorders. Criterium C.3 (exacerbation of headache by pressure applied over paranasal sinuses) and C.4 (ipsilaterality of headache and sinusitis) had low sensitivity in headache attributed to acute rhinosinusitis. CONCLUSIONS: Nasal inflammation is associated with headache in COVID-19, although the pain mechanism lies probably in a systemic reaction to the virus. 3rd edition of the International Classification of Headache Disorders criteria for headache attributed to acute rhinosinusitis need adjusting to the current understanding of acute sinonasal infection.


Subject(s)
COVID-19 , Rhinitis , Sinusitis , COVID-19/complications , Female , Headache/diagnosis , Humans , Inflammation/complications , Longitudinal Studies , Male , Middle Aged , Rhinitis/complications , Rhinitis/diagnosis , SARS-CoV-2 , Sinusitis/complications , Sinusitis/diagnosis
2.
Am J Trop Med Hyg ; 105(2): 449-453, 2021 Jul 08.
Article in English | MEDLINE | ID: covidwho-1371040

ABSTRACT

COVID-19 first emerged in Wuhan, China, in December 2019. Since that time, the frequency of bacterial and fungal coinfections has been continuously increasing. Although invasive pulmonary aspergillosis is being increasingly recognized in association with COVID-19, there is limited information regarding COVID-19-associated mucormycosis. We describe a 50-year-old woman with uncontrolled diabetes who received systemic corticosteroids and remdesevir during her admission for COVID-19. A few days after discharge, the patient was readmitted because of facial swelling and numbness, and a diagnosis of COVID-19-associated rhinosinusitis mucormycosis caused by Rhizopus arrhizus (formerly called Rhizopus oryzae) was confirmed with sequencing of the internal transcribed spacer region of the ribosomal DNA. This report aimed to address the importance of short-term follow-up for COVID-19 patients who have received systemic corticosteroids, particularly those with predisposing conditions, because early detection and prompt, aggressive treatment are essential for the management of invasive fungal infections.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/complications , COVID-19/drug therapy , Rhinitis/etiology , Rhizopus oryzae/pathogenicity , SARS-CoV-2/drug effects , Sinusitis/etiology , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , DNA, Fungal/genetics , DNA, Ribosomal Spacer/genetics , Diabetes Mellitus , Fatal Outcome , Female , Humans , Invasive Fungal Infections/etiology , Middle Aged , Mucormycosis , Rhinitis/diagnosis , Rhinitis/microbiology , Sinusitis/diagnosis , Sinusitis/microbiology
3.
BMJ Case Rep ; 14(5)2021 May 26.
Article in English | MEDLINE | ID: covidwho-1247335

ABSTRACT

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Our case shows that delay in management and underdiagnosis of sinusitis with nasal polyposis can lead to devastating complications. A high index of suspicion, early recognition of the clinical findings and radiological evaluation with contrast-enhanced CT of paranasal sinuses, orbit and brain are essential to rule out fatal complications associated with CRSwNP. Timely endoscopic intervention and the use of antibiotics can lead to good outcomes, even in complicated cases.


Subject(s)
Abducens Nerve Diseases , Epidural Abscess , Nasal Polyps , Rhinitis , Sinusitis , Chronic Disease , Epidural Abscess/diagnosis , Epidural Abscess/diagnostic imaging , Humans , Nasal Polyps/diagnosis , Nasal Polyps/diagnostic imaging , Rhinitis/complications , Rhinitis/diagnosis , Sinusitis/complications , Sinusitis/diagnostic imaging
5.
Allergy ; 76(11): 3349-3358, 2021 11.
Article in English | MEDLINE | ID: covidwho-1216718

ABSTRACT

Chronic rhinosinusitis (CRS) is a complex upper airway inflammatory disease with a broad spectrum of clinical variants. As our understanding of the disease pathophysiology evolves, so too does our philosophy towards the approach and management of CRS. Endotyping is gaining favour over phenotype-based classifications, owing to its potential in prognosticating disease severity and delivering precision treatment. Endotyping is especially useful in challenging CRS with nasal polyposis cases, for whom novel treatment options such as biologicals are now available. The latest European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2020) reflects these changes with updated rhinosinusitis classifications and new integrated care pathways. With the coronavirus disease 2019 (COVID-19) pandemic, physicians and rhinologists have to balance the responsibility of managing their patients' upper airway while adequately protecting themselves from droplet and aerosol transmission. This review summarises the key updates from EPOS2020, endotype-based classification and biomarkers. The role of biologicals in CRS and the lessons we can draw from their use in severe asthma will be examined. Finally, the principles of CRS management during COVID-19 will also be discussed.


Subject(s)
COVID-19 , Nasal Polyps , Rhinitis , Sinusitis , Chronic Disease , Humans , Nasal Polyps/diagnosis , Nasal Polyps/therapy , Rhinitis/diagnosis , Rhinitis/therapy , SARS-CoV-2 , Sinusitis/diagnosis , Sinusitis/therapy
6.
J Allergy Clin Immunol ; 147(1): 29-36, 2021 01.
Article in English | MEDLINE | ID: covidwho-1007896

ABSTRACT

Uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) is the most bothersome phenotype of chronic rhinosinusitis; it is typically characterized by a type 2 inflammatory reaction and by comorbidities, including asthma, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, and allergies. Here, the European Forum for Research and Education in Allergy and Airway Diseases proposes structured definitions to enable communication between clinicians and provides a practical algorithm to define type 2 inflammation in CRSwNP in daily clinical practice. A rational approach for the treatment of uncontrolled severe CRSwNP is discussed; it consists of evaluating the perspective and risks of surgery and efficacy and adverse events of biologics on the basis of currently available data. Further, possible combinations of surgery and biologics are discussed, and a rationale is provided. Here, it is of importance to adequately counsel the patient about both approaches to enable a decision-making process with an informed patient. Criteria for the selection of a biologic drug are provided, as several biologics for uncontrolled severe CRSwNP will be available in many countries within a short time. Further, suggestions for monitoring of the drug effects that support recognition of responders to the therapy and, subsequently, the decision regarding continuation or discontinuation of the biologic are proposed.


Subject(s)
Nasal Polyps , Rhinitis , Sinusitis , Chronic Disease , Congresses as Topic , Humans , Nasal Polyps/classification , Nasal Polyps/diagnosis , Nasal Polyps/immunology , Nasal Polyps/therapy , Practice Guidelines as Topic , Rhinitis/classification , Rhinitis/diagnosis , Rhinitis/immunology , Rhinitis/therapy , Severity of Illness Index , Sinusitis/classification , Sinusitis/diagnosis , Sinusitis/immunology , Sinusitis/therapy
7.
Rhinology ; 58(5): 522-523, 2020 Oct 01.
Article in English | MEDLINE | ID: covidwho-902796

ABSTRACT

Social distancing with the aim of avoiding infections and pre-serve critical care capacities during the COVID-19 pandemic has been implemented in Germany according to World Health Organization (WHO) recommendations from early March onwards. Limitations of physical contacts to reduce exposure to SARS-CoV-2 infected individuals were handled strictly, particularly in medical centers dealing with airway diseases, like rhinology and pneumology clinics. Such measures and reluctance to visit out- and inpatient services resulted in a 82% decrease in consultations to the 12 German oto-rhino-laryngological (ORL) centres forming our database during the 50 days following March 09 in 2020 if compared to the same period in 2019. Our data on CRS care underline reports on undertreatment of non-COVID-19 individuals with several different diseases during the current pandemic. We should try to reduce the toll these patients have to pay as much as possible. We established telemedicine, e-Health and artificial intelligence-supported triage for selecting the right patients for onsite-consultations and to advise patients in several demands.


Subject(s)
Artificial Intelligence , Coronavirus Infections , Pandemics , Pneumonia, Viral , Rhinitis/diagnosis , Rhinitis/therapy , Sinusitis/diagnosis , Sinusitis/therapy , Betacoronavirus , COVID-19 , Chronic Disease , Germany/epidemiology , Humans , Otolaryngology/trends , SARS-CoV-2 , Telemedicine
9.
Am J Otolaryngol ; 41(5): 102604, 2020.
Article in English | MEDLINE | ID: covidwho-628588

ABSTRACT

OBJECTIVES: The role of topical anti-infectives in acute exacerbations of chronic rhinosinusitis is controversial. Povidone-iodine is an anti-bacterial and anti-viral that is affordable and available over-the-counter and may demonstrate advantages over mupirocin as a sinus irrigation therapy. The objective was to compare povidone-iodine or mupirocin versus saline sinus irrigations for sinusitis exacerbations in post-surgery subjects as well as to assess tolerability of povidone-iodine sinus irrigations. MATERIALS AND METHODS: This was a prospective single-blinded (clinician only) randomized controlled trial. Subjects were post-surgery with acute exacerbations of chronic rhinosinusitis and gram-positive bacteria on culture. They received povidone-iodine, mupirocin, or saline sinus irrigations, twice daily for 30 days. Outcomes were post-treatment culture negativity (primary) and Sinonasal Outcome Test-20 and Lund-Kennedy endoscopic score change (secondary). RESULTS: Of the 62 subjects analyzed, post-treatment culture negativity rate was higher in the MUP (14/20, 70%) group compared to the PI (9/21, 43%) and SAL (9/19, 47%) groups, although this was not significant (p = 0.29). Povidone-iodine sinus irrigations at the 1% concentration were very well-tolerated, similar to saline irrigations. There were no significant differences in Sinonasal Outcome Test-20 score (povidone-iodine -0.3 [-0.6, 0.05] vs. mupirocin -0.3 [-0.7, 0.05] vs. saline -0.4 [-0.8, 0.05]; p = 0.86) or Lund-Kennedy endoscopic score (povidone-iodine -3.5 [-7, -0.5] vs. mupirocin -2 [-4, 2] vs. saline -3 [-5, 0]; p = 0.45) change. No serious adverse effects were reported. CONCLUSIONS: In patients who have had prior sinus surgery with acute exacerbations of CRS and gram-positive bacteria on culture, mupirocin sinus irrigations achieved a better post-treatment culture "control" rate compared to saline and povidone-iodine. In addition, 1% povidone-iodine solution was well-tolerated as a sinus irrigation and may represent a feasible method for temporarily disinfecting the sinonasal cavity of bacteria and viruses such as COVID-19.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Mupirocin/therapeutic use , Postoperative Complications/drug therapy , Povidone-Iodine/therapeutic use , Rhinitis/drug therapy , Sinusitis/drug therapy , Adult , Anti-Infective Agents, Local , Chronic Disease , Female , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Prospective Studies , Rhinitis/diagnosis , Rhinitis/etiology , Saline Solution , Single-Blind Method , Sinusitis/diagnosis , Sinusitis/etiology , Therapeutic Irrigation
13.
Int Forum Allergy Rhinol ; 10(8): 944-950, 2020 08.
Article in English | MEDLINE | ID: covidwho-72528

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), is responsible for the largest pandemic since the 1918 influenza A virus subtype H1N1 influenza outbreak. The symptoms presently recognized by the World Health Organization are cough, fever, tiredness, and difficulty breathing. Patient-reported smell and taste loss has been associated with COVID-19 infection, yet no empirical olfactory testing on a cohort of COVID-19 patients has been performed. METHODS: The University of Pennsylvania Smell Identification Test (UPSIT), a well-validated 40-odorant test, was administered to 60 confirmed COVID-19 inpatients and 60 age- and sex-matched controls to assess the magnitude and frequency of their olfactory dysfunction. A mixed effects analysis of variance determined whether meaningful differences in test scores existed between the 2 groups and if the test scores were differentially influenced by sex. RESULTS: Fifty-nine (98%) of the 60 patients exhibited some smell dysfunction (mean [95% CI] UPSIT score: 20.98 [19.47, 22.48]; controls: 34.10 [33.31, 34.88]; p < 0.0001). Thirty-five of the 60 patients (58%) were either anosmic (15/60; 25%) or severely microsmic (20/60; 33%); 16 exhibited moderate microsmia (16/60; 27%), 8 mild microsmia (8/60; 13%), and 1 normosmia (1/60; 2%). Deficits were evident for all 40 UPSIT odorants. No meaningful relationships between the test scores and sex, disease severity, or comorbidities were found. CONCLUSION: Quantitative smell testing demonstrates that decreased smell function, but not always anosmia, is a major marker for SARS-CoV-2 infection and suggests the possibility that smell testing may help, in some cases, to identify COVID-19 patients in need of early treatment or quarantine.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Olfaction Disorders , Pandemics , Pneumonia, Viral , Rhinitis , Sino-Nasal Outcome Test , Sinusitis , Adult , COVID-19 , Chronic Disease , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Differential Threshold , Female , Humans , Male , Middle Aged , Odorants , Olfaction Disorders/diagnosis , Olfaction Disorders/etiology , Olfactory Perception , Pennsylvania/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Reproducibility of Results , Rhinitis/diagnosis , Rhinitis/epidemiology , Risk Factors , SARS-CoV-2 , Sinusitis/diagnosis , Sinusitis/epidemiology , Smell
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