Pulmonary diffusing capacity for carbon monoxide and nitric oxide after COVID-19: A prospective cohort study (the SECURe study).

Many patients exhibit persistently reduced pulmonary diffusing capacity after coronavirus disease 2019 (COVID-19). In this study, dual test gas diffusing capacity for carbon monoxide and nitric oxide (DL,CO,NO) metrics and their relationship to disease severity and physical performance were examined in patients who previously had COVID-19. An initial cohort of 148 patients diagnosed with COVID-19 of all severities between March 2020 and March 2021 had a DL,CO,NO measurement performed using the single-breath method at 5.7 months follow-up. All patients with at least one abnormal DL,CO,NO metric (n = 87) were revaluated at 12.5 months follow-up. The DL,CO,NO was used to provide the pulmonary diffusing capacity for nitric oxide (DL,NO), the pulmonary diffusing capacity for carbon monoxide (DL,CO,5s), the alveolar-capillary membrane diffusing capacity and the pulmonary capillary blood volume. At both 5.7 and 12.5 months, physical performance was assessed using a 30 s sit-to-stand test and the 6 min walk test. Approximately 60% of patients exhibited a severity-dependent decline in at least one DL,CO,NO metric at 5.7 months follow-up. At 12.5 months, both DL,NO and DL,CO,5s had returned towards normal but still remained abnormal in two-thirds of the patients. Concurrently, improvements in physical performance were observed, but with no apparent relationship to any DL,CO,NO metric. The severity-dependent decline in DL,NO and DL,CO observed at 5.7 months after COVID-19 appears to be reduced consistently at 12.5 months follow-up in the majority of patients, despite marked improvements in physical performance.

Head-to-Head Comparison of Nasopharyngeal, Oropharyngeal and Nasal Swabs for SARS-CoV-2 Molecular Testing.

Nasopharyngeal swabs (NPS) are considered the gold standard for SARS-CoV-2 testing but are technically challenging to perform and associated with discomfort. Alternative specimens for viral testing, such as oropharyngeal swabs (OPS) and nasal swabs, may be preferable, but strong evidence regarding their diagnostic sensitivity for SARS-CoV-2 testing is still missing. We conducted a head-to-head prospective study to compare the sensitivity of NPS, OPS and nasal swabs specimens for SARS-CoV-2 molecular testing. Adults with an initial positive SARS-CoV-2 test were invited to participate. All participants had OPS, NPS and nasal swab performed by an otorhinolaryngologist. We included 51 confirmed SARS-CoV-2-positive participants in the study. The sensitivity was highest for OPS at 94.1% (95% CI, 87 to 100%) compared to NPS at 92.5% (95% CI, 85 to 99%) (p = 1.00) and lowest for nasal swabs at 82.4% (95% CI, 72 to 93%) (p = 0.07). Combined OPS/NPS was detected in 100% of cases, while the combined OPS/nasal swab increased the sensitivity significantly to 96.1% (95% CI, 90 to 100%) compared to that of the nasal swab alone (p = 0.03). The mean Ct value for NPS was 24.98 compared to 26.63 for OPS (p = 0.084) and 30.60 for nasal swab (p = 0.002). OPS achieved a sensitivity comparable to NPS and should be considered an equivalent alternative for SARS-CoV-2 testing.

Relation of Pulmonary Diffusing Capacity Decline to HRCT and VQ SPECT/CT Findings at Early Follow-Up after COVID-19: A Prospective Cohort Study (The SECURe Study).

A large proportion of patients exhibit persistently reduced pulmonary diffusion capacity after COVID-19. It is unknown whether this is due to a post-COVID restrictive lung disease and/or pulmonary vascular disease. The aim of the current study was to investigate the association between initial COVID-19 severity and haemoglobin-corrected diffusion capacity to carbon monoxide (DLco) reduction at follow-up. Furthermore, to analyse if DLco reduction could be linked to pulmonary fibrosis (PF) and/or thromboembolic disease within the first months after the illness, a total of 67 patients diagnosed with COVID-19 from March to December 2020 were included across three severity groups: 12 not admitted to hospital (Group I), 40 admitted to hospital without intensive care unit (ICU) admission (Group II), and 15 admitted to hospital with ICU admission (Group III). At first follow-up, 5 months post SARS-CoV-2 positive testing/4 months after discharge, lung function testing, including DLco, high-resolution CT chest scan (HRCT) and ventilation-perfusion (VQ) single photon emission computed tomography (SPECT)/CT were conducted. DLco was reduced in 42% of the patients; the prevalence and extent depended on the clinical severity group and was typically observed as part of a restrictive pattern with reduced total lung capacity. Reduced DLco was associated with the extent of ground-glass opacification and signs of PF on HRCT, but not with mismatched perfusion defects on VQ SPECT/CT. The severity-dependent decline in DLco observed early after COVID-19 appears to be caused by restrictive and not pulmonary vascular disease.

Subjective and psychophysical olfactory and gustatory dysfunction among COVID-19 outpatients; short- and long-term results.

BACKGROUND: Olfactory and gustatory dysfunctions are early symptoms of SARS-CoV-2 infection. Between 20-80% of infected individuals report subjective altered sense of smell and/or taste during infection. Up to 2/3 of previously infected experience persistent olfactory and/or gustatory dysfunction after 6 months. The aim of this study was to examine subjective and psychophysical olfactory and gustatory function in non-hospitalized individuals with acute COVID-19 up to 6 months after infection. METHODS: Individuals aged 18-80-years with a positive SARS-CoV-2 PCR test no older than 10 days, were eligible. Only individuals able to visit the outpatient examination facilities were included. Gustatory function was tested with the Burgharts Taste Strips and olfactory function was examined with the Brief Smell Identifications test (Danish version). Subjective symptoms were examined through an online questionnaire at inclusion, day 30, 90 and 180 after inclusion. RESULTS: Fifty-eight SARS-CoV-2 positive and 56 negative controls were included. 58.6% (34/58) of SARS-CoV-2 positive individuals vs. 8.9% (5/56) of negative controls reported subjective olfactory dysfunction at inclusion. For gustatory dysfunction, 46.5% (27/58) of positive individuals reported impairment compared to 8.9% (5/56) of negative controls. In psychophysical tests, 75.9% (46/58) had olfactory dysfunction and 43.1% (25/58) had gustatory dysfunction among the SARS-CoV-2 positive individuals at inclusion. Compared to negative controls, SARS-CoV-2 infected had significantly reduced olfaction and gustation. Previously infected individuals continued to report lower subjective sense of smell 30 days after inclusion, whereafter the difference between the groups diminished. However, after 180 days, 20.7% (12/58) positive individuals still reported reduced sense of smell and taste. CONCLUSION: Olfactory and gustatory dysfunctions are prevalent symptoms of SARS-CoV-2 infection, but there is inconsistency between subjective reporting and psychophysical test assessment of especially olfaction. Most individuals regain normal function after 30 days, but approximately 20% report persistent olfactory and gustatory dysfunction 6 months after infection.

Olfactory and Gustatory Outcomes Including Health-Related Quality of Life 3-6 and 12 Months after Severe-to-Critical COVID-19: A SECURe Prospective Cohort Study.

Background: Long-term follow-up studies of COVID-19 olfactory and gustatory disorders (OGDs) are scarce. OGD, parosmia, and dysgeusia affect health-related quality of life (HRQoL) and the ability to detect potential hazards. Methods: In this study, 29 patients reporting OGD 1 month after severe-to-critical COVID-19 were tested at 3-6 months and retested at 12 months in case of hyposmia/anosmia. We used Sniffin Sticks Threshold, Discrimination, and Identification (TDI) test, Sniffin Sticks Identification Test (SIT16), Brief Smell Identification Test (BSIT), taste strips, and HRQoL. The patients were part of the prospective SECURe cohort. Results: Overall, 28% OD (TDI), 12% GD, 24% parosmia, and 24% dysgeusia (questionnaire) at 3-6 months (n = 29) and 28% OD (TDI), 38% parosmia, and 25% dysgeusia (questionnaire) at 12 months (n = 8) were observed. OGD decreased HRQoL: For 13%, it had a negative effect on daily life and, for 17%, it affected nutrition, 17% reported decreased mood, and 87-90% felt unable to navigate everyday life using their sense of smell and taste. A comparison of SIT16 and BSIT to TDI found sensitivity/specificity values of 75%/100% and 88%/86%. Conclusions: This is the first study to examine TDI, SIT16, BSIT, taste strips, and HRQoL up to 1 year after severe-to-critical COVID-19. The patients suffering from prolonged OGD, parosmia, and dysgeusia experienced severely decreasing HRQoL. We recommend including ear-nose-throat specialists in multidisciplinary post-COVID clinics.

[Chronic rhinosinusitisand type 2 disease].

Diseases of the upper and lower airways are commonly described as global airway disease, which shares basic inflammatory mechanisms, and airway comobidity is frequently found. The prevalence of chronic rhinosinusitis (CRS) is 5-12%, characterised as CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). Inflammation in CRSwNP is often type 2, whereas CRSsNP often involves non-type 2. New monoclonal antibodies towards type-2 inflammation have been launched internationally to treat refractory severe CRSwNP, with effect on polyps, congestions and smell, as well as quality of life. This review gives a summary of the current treatment modalities.

Autologous fibrin sealant co-delivered with antibiotics is a robust method for topical antibiotic treatment after sinus surgery.

BACKGROUND: Most patients with cystic fibrosis have the risk of pathogenic bacteria being exchanged between their sinuses and lungs. AIMS: A method for topical application of antibiotics where the antibiotics persist for a long period of time is needed. MATERIAL AND METHODS: Ten patients with cystic fibrosis and bacterial sinusitis were included. Autologous platelet rich fibrin was mixed with an antibiotic solution and sprayed onto the mucosa at the end of an endoscopic sinus surgery; Colistin, a Ciprofloxacin-Colistin combination or Tobramycin was used. The antibiotic concentration was measured in the sinonasal mucus four, seven and 13 days after surgery. RESULTS: Nine patients had Pseudomonas aeruginosa in their nose/sinuses at the time of surgery; in eight of these P. aeruginosa was not detected by culture at the final visit. In the majority of the ten included patients the antibiotics were continuously released for more than 7 days. No severe side effects were seen. CONCLUSIONS: Autologous platelet rich fibrin co-delivered with antibiotics is a feasible method for topical antibiotic treatment in supplementary to sinus surgery. SIGNIFICANCE: We expect that this treatment is successful for eradication of sinonasal bacterial infections in immunosuppressed patients suffering from recalcitrant sinus infections. The efficacy should be evaluated in randomized controlled trials.

Chronic rhinosinusitis in COPD: A prevalent but unrecognized comorbidity impacting health related quality of life.

INTRODUCTION: Unified airway disease where upper respiratory tract inflammation including chronic rhinosinusitis (CRS) affects lower airway disease is known from asthma, bronchiectasis, cystic fibrosis and primary ciliary dyskinesia but little is known about CRS and health related quality of life in COPD. We investigate firstly, the prevalence of CRS in COPD. Secondly the impact of CRS on HRQoL. Thirdly, risk factors for CRS in COPD. METHODS: cross-sectional study of CRS in 222 COPD patients from 2017 to 2019 according to EPOS2012/2020 and GOLD2019 criteria. Patients completed the COPD assessment test (CAT), Medical Research Council dyspnea scale and Sinonasal outcome test 22 (SNOT22) and questions on CRS symptoms. They then had a physical examination including flexible nasal endoscopy, CT-sinus scan and HRCT-thorax. RESULTS: 22.5% of COPD patients had CRS and 82% of these were undiagnosed prior to the study. HRQoL (CAT, SNOT22 and the SNOT22-nasal symptom subscore) was significantly worse in COPD patients with CRS compared with those without CRS and healthy controls. Multiple logistic regression analysis suggests that the most likely candidate for having CRS was a male COPD patient who actively smoked, took inhaled steroids, had a high CAT and SNOT22_nasal symptom subscore. DISCUSSION: the largest clinical study of CRS in COPD and the only study diagnosing CRS according to EPOS and GOLD. This study supports unified airway disease in COPD. The SNOT22_nasal symptoms subscore is recommended as a standard questionnaire for COPD patients and patients at risk should be referred to an otorhinolaryngologist.

[Chronic rhinosinusitis].

The aim of this review is to evaluate current guidelines for diagnosis, treatment and follow-up of patients with chronic rhinosinusitis. We discuss: 1) diagnostic criteria, 2) the use of supplementary tools like visual analogue scale, Sino-Nasal Outcome Test and Sniffin' Sticks, 3) the use of tests like allergy, serum IgE and biopsy and 4) comorbidity in relation to the unified airways concept. Furthermore, we evaluate: 1) initial treatment with topical steroids and nasal irrigation, 2) additional treatment options including surgery, systemic steroids and antibiotics and 3) treatment risks. Follow-up of patients is important for evaluating treatment effect and possible need of further treatment.

Large discrepancies in otomycosis treatment in private ear, nose, and throat clinics in Denmark.

INTRODUCTION: Otomycosis is a fungal infection of the external ear canal that can involve the middle ear in case of tympanic membrane perforation and also extend to the auricle. Fungi cause 7-15% of external otitis. Diagnosing otomycosis is often based entirely on non-specific clinical signs and symptoms. A multitude of antifungal drugs are available. Some are ototoxic in animals, a few are proven safe, but the ototoxicity of many drugs remains unknown. The aim of this study was to describe how otomycosis was diagnosed and treated by private ear, nose, and throat (ENT) consultants in Denmark and to investigate if the patient's immune status and the presence of a tympanic membrane perforation affected the chosen treatment modality. METHOD: A questionnaire on the treatment of otomycosis was sent to 147 private ENT consultants. RESULTS: In total, 103 (70%) responded. 95% performed intensive aural cleaning using an otomicroscope. The initial diagnosis was based on symptoms as only 20% required to see fungal hypha. 42% sent material for culture and sensitivity (C + S) before starting treatment and 92% sent for C + S if treatment failed. 89% used a variety of topical antifungal drugs as the first line of medical treatment. Antiseptics were used in 5%. The presence of a tympanic membrane perforation did not alter the treatment modality. Only 13% treated immunocompromised patients differently. CONCLUSION: The initial diagnosis was based on non-specific symptoms and there were large discrepancies in the chosen antifungal treatment. Topical antifungal drugs were preferred. Additional research is needed. FUNDING: Department of Otorhinolaryngolgy and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark. The Danish Association of Research-interested Otorhinolaryngology Consultants: Kim Werther, Peter Tingsgaard, Mads Stougaard, Steen Telmer, Henrik Møller, Liviu Guldfred. TRIAL REGISTRATION: No trial registration was necessary as the questionnaire was anonymous and contained no patient data.

[Differential diagnostic considerations about a tumour on the tongue of a 43-year-old man].

Schwannomas are benign tumours originating from the Schwann cells that ensheath peripheral nerves. 25-40% of schwannomas are located in the head and neck area, only 1% of these are found in the oral cavity. Schwannomas are slow-growing benign tumours with little or no occurrence of malignant transformation. A case report of a 43-year-old man presenting with a 2 ´ 1.5 cm protruding tumour on the anterior part of the tongue is reported. The patient complained of difficulty eating and a tendency to bite on the tumour. Biopsy showed a benign schwannoma. Total excision in local anaesthesia was performed.