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in category otolaryngology

83 results found. For more information, click each entry to expand.

1: Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak
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Posted 27 Mar 2020

Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak
7,459 downloads medRxiv otolaryngology

Seyed Hamidreza Bagheri, Alimohamad Asghari, Mohammad Farhadi, Ahmad Reza Shamshiri, Ali Kabir, Seyed Kamran Kamrava, Maryam Jalessi, Alireza Mohebbi, Rafieh Alizadeh, Ali Asghar Honarmand, Babak Ghalehbaghi, Alireza Salimi

BackgroundRecent surge of olfactory dysfunction in patients who were referred to ENT clinics and concurrent COVID-19epidemic in Iran motivated us to evaluate anosmic/hyposmic patients to find any relation between these two events. MethodsThis is a cross-sectional study with an online checklist on voluntary cases in all provinces of Iran between the 12th and 17th March, 2020. Cases was defined as self-reported anosmia/hyposmia in responders fewer than 4 weeks later (from start the of COVID-19 epidemic in Iran). Variables consist of clinical presentations, related past medical history, family history of recent respiratory tract infection and hospitalization. ResultsIn this study 10069 participants aged 32.5{+/-}8.6 (7-78) years, 71.13% female and 81.68% non-smoker completed online checklist. They reported 10.55% a history of a trip out of home town and 1.1% hospitalization due to respiratory problems recently. From family members 12.17% had a history of severe respiratory disease in recent days and 48.23% had anosmia/hyposmia. Correlation between the number of olfactory disorder and reported COVID-19 patients in all 31 provinces till 16th March 2020 was highly significant (Spearman correlation coefficient=0.87, p-Value<0.001). The onset of anosmia was sudden in 76.24% and till the time of filling the questionnaire in 60.90% of patients decreased sense of smell was constant. Also 83.38 of this patients had decreased taste sensation in association with anosmia. ConclusionsIt seems that we have a surge in outbreak of olfactory dysfunction happened in Iran during the COVID-19 epidemic. The exact mechanism of anosmia/hyposmia in COVID-19 patients needs further investigations.

2: Utility of Olfactory test as screening tool for COVID-19: A pilot study
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Posted 05 Sep 2020

Utility of Olfactory test as screening tool for COVID-19: A pilot study
3,902 downloads medRxiv otolaryngology

Pragyanshu Khare, Atul Munish Chander, Kanhaiya Agrawal, Satyam Singh Jayant, Soham Mukherjee, Kamalendra Yadav, Rahul Gupta, Shakun Chaudhary, Sumit Srivastava, Sanuj Muralidharan, Rijin Mohan, Shikha Chaudhary, Rimesh Pal, Sandeep Bansal, Kanthi Kiran Kondepudi, Govardhan Dutt Puri, MAHENDRA BISHNOI, Sanjay Kumar Bhadada

Loss of smell function (Anosmia) is reported to be associated with novel coronavirus disease 2019 (COVID-19) infection. The present study was designed to evaluate the effectiveness of an indigenously developed prototype smell test to identify/diagnose asymptomatic COVID-19 positive individuals. A panel of five different odorants belonging to Indian household with unique and mutually exclusive odor were used to develop prototype kit to test the hypothesis. The developed prototype kit was tested at 2 centers (N=49 and 34) with slight modifications. Simultaneously, the kit was also tested on 55 (N=35 and 20) healthy controls. Our results indicate that otherwise asymptomatic COVID-19 positive individuals were having quantifiable deficit in smell sensation. Interestingly, the variable sensitivity of different odorants was observed in different patients. None of the healthy controls reported difficulty in sensing any of the odorant, whereas, some of healthy controls did misidentify the odorants. Overall, the present study provides a preliminary data that loss in smell sensation for various odorants can be exploited as a quick and affordable screening test to identify infected cases among at risk individuals.

3: Close-range exposure to a COVID-19 carrier: transmission trends in the respiratory tract and estimation of infectious dose
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Posted 29 Jul 2020

Close-range exposure to a COVID-19 carrier: transmission trends in the respiratory tract and estimation of infectious dose
2,354 downloads medRxiv otolaryngology

Saikat Basu

How human respiratory physiology and inhaled airflow therein proceed to impact transmission of SARS-CoV-2, leading to the initial infection, is an open question. An answer can help determine the susceptibility of an individual on exposure to a COVID-2019 carrier and can also quantify the still-unknown infectious dose for the disease. Combining computational fluid mechanics-based tracking of respiratory transport in anatomic domains with sputum assessment data from hospitalized COVID-19 patients and earlier measurements of ejecta size distribution during regular speech - this study shows that the regional deposition of virus-laden inhaled droplets at the initial nasopharyngeal infection sites, located in the upper airway, peaks over the droplet size range of 2.5 - 19 microns; and reveals that the number of virions that can potentially establish the infection is, at most, of O(100).

4: Sudden hyposmia as a prevalent symptom of COVID-19 infection.
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Posted 07 Apr 2020

Sudden hyposmia as a prevalent symptom of COVID-19 infection.
2,090 downloads medRxiv otolaryngology

Rosario Marchese-Ragona, Giancarlo Ottaviano, Nicolai Piero, Andrea Vianello, Carecchio Miryam

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has recently caused a pandemic that has involved Italy as the second worldwide nation in terms of infected patients and deaths. The clinical manifestation of Covid-19 ranges from asymptomatic carrier status to severe pneumonia. Asymptomatic individuals in Covid-19 are those who are carriers of the virus but do not show clinical symptoms and are able to transmit the disease in the same degree as symptomatic carriers. In order to contain contagions is of supreme importance to identify asymptomatic patients because this subpopulation is one of the main factors contributing to the spread of this disease. We report on six Italian patients with COVID-19 who presented sudden hyposmia as the only or most prominent disease manifestation, without upper or lower respiratory tract involvement or other major features of the disease. A supra-threshold olfaction test confirmed the hyposmia in all patients. The onset of hyposmia during a Covid-19 outbreak should be considered as a warning sign of an infection that requires a diagnostic test for Covid-19

5: Real-time Hearing Threshold Determination of Auditory Brainstem Responses by Cross-correlation Analysis
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Posted 13 Aug 2019

Real-time Hearing Threshold Determination of Auditory Brainstem Responses by Cross-correlation Analysis
1,921 downloads medRxiv otolaryngology

Haoyu Wang, Bei Li, Yan Lu, Kun Han, Haibin Sheng, Jialei Zhou, Yumeng Qi, Xueling Wang, Zhiwu Huang, Lei Song, Yunfeng Hua

Auditory brainstem response (ABR) serves as an objective indication of auditory perception at given sound level and is nowadays widely used in hearing function assessment. Despite efforts for automation over decades, hearing threshold determination by machine algorithm remains unreliable and thereby still rely on visual identification by trained personnel. Here, we described a procedure for automatic threshold determination that can be used in both animal and human ABR tests. The method terminates level averaging of ABR recordings upon detection of time-locked waveform through cross-correlation analysis. The threshold level was then indicated by a dramatic increase in the sweep numbers required to produce "qualified" level averaging. A good match was obtained between the algorithm outcome and the human readouts. Moreover, the method varies the level averaging based on the cross-correlation, thereby adapting to the signal-to-noise ratio of single sweep recordings. These features empower a robust and fully automated ABR test.

6: Applications of qualitative grounded theory methodology to investigate hearing loss: Protocol for a qualitative systematic review
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Posted 13 Aug 2019

Applications of qualitative grounded theory methodology to investigate hearing loss: Protocol for a qualitative systematic review
1,735 downloads medRxiv otolaryngology

Yasmin H K Ali, Nicola Wright, David Charnock, Helen Henshaw, Melanie A. Ferguson, Derek J Hoare

ABTRACTO_ST_ABSIntroductionC_ST_ABSHearing loss is a chronic condition affecting 11 million individuals in the UK. People with hearing loss regularly experience difficulties interacting in everyday conversations. These difficulties in communication can result in a person with hearing loss withdrawing from social situations and becoming isolated. While hearing health loss research has largely deployed quantitative methods to investigate various aspects of the condition, qualitative research is becoming more widespread. Grounded theory is a specific qualitative methodology that has been used to establish novel theories on the experiences of living with hearing loss. Method and analysisThe aim of this systematic review is to establish how grounded theory has been applied to investigate the psychosocial aspects of hearing loss. Methods are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) 2015 checklist. Studies included in this review will have applied grounded theory methodology. For a study to be included, it can apply grounded theory as an overarching methodology, or have grounded theory methodology embedded amongst other methodologies. These studies can be in the form of retrospective or prospective studies, before and after comparison studies, RCTs, non-RCTs, cohort studies, prospective observational studies, case-control studies, cross-sectional studies, longitudinal studies, and mixed method studies. Purely quantitative studies, studies that have not applied grounded theory methodology, articles reporting expert opinions, case reports, practice guidelines, case series, conference abstracts, and book chapters will be excluded. Studies included will have adult participants ([&ge;]18 years) who are either people with an acquired hearing loss, their family and friends (communication partners), or audiologists. The quality of application of grounded theory in each study will be assessed using the Guideline for Reporting and Evaluating Grounded Theory Research Studies (GUREGT). Ethics and disseminationAs only secondary data will be used in this systematic review, ethical approval is not required. No other ethical issues are foreseen. The International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO) holds the registration record of this systematic review. Findings will be disseminated via peer reviewed publications and at relevant academic conferences. Findings may also be published in relevant professional and third sector newsletters and magazines as appropriate. Data will inform future research and guideline development. Prospero registration numberPROSPERO CRD42019134197 Strengths and limitations of this studyO_LIThis systematic review is the first to provide a comprehensive critique of the use of grounded theory to investigate hearing loss. C_LIO_LIThe search strategy was formed in collaboration with an information specialist at the University of Nottingham. C_LIO_LIThe PRISMA-P guidelines have directed the considerations and layout of this protocol. C_LIO_LIBecause experiences and articulations of hearing loss are influenced by age, only adult ([&ge;]18 years) participants (people with hearing loss, communication partners, audiologists) will be considered. C_LIO_LIThe search will not include grey literature. C_LIO_LIThe studies included will only have samples of individuals with hearing loss, rather than full deafness. C_LI

7: Impulse dispersion of aerosols during singing and speaking
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Posted 22 Jul 2020

Impulse dispersion of aerosols during singing and speaking
1,643 downloads medRxiv otolaryngology

Matthias Echternach, Sophia Gantner, Gregor Peters, Caroline Westphalen, Tobias Benthaus, Bernhard Jakubass, Liudmila Kuranova, Michael Doellinger, Stefan Kniesburges

Group singing events have been linked to several outbreaks of infection during the CoVID-19 pandemic, leading to singing activities being banned in many areas across the globe. This link between singing and infection rates supports the possibility that aerosols are partly responsible for person-to-person infection. In contrast to droplets, the smaller aerosol particles do not fall to the ground within a short distance after being expelled by e.g. a singer. Aerosol particles hover and spread via convection in the environmental air. According to the super-spreading theory, choir singing and loud talking (theater and presentations) during rehearsals or performances may constitute a high risk of infectious virus transmission to large numbers of people. Thus, it is essential to define the safety distances between singers in super-spreading situations. The aim of this study is to investigate the impulse dispersion of aerosols during singing and speaking in comparison to breathing and coughing. Ten professional singers (5 males and 5 females) of the Bavarian Radio Chorus performed 9 tasks including singing a phrase of Beethovens 9th symphony, to the original German text. The inhaled air volume was marked with small aerosol particles produced via a commercial e-cigarette. The expelled aerosol cloud was recorded with three high definition TV cameras from different perspectives. Afterwards, the dimensions and dynamics of the aerosol cloud was measured by segmenting the video footage at every time point. While the median expansion was below 1m, the aerosol cloud was expelled up to 1.4m in the singing direction for individual subjects. Consonants produced larger distances of aerosol expulsion than vowels. The dispersion in the lateral and vertical dimension was less pronounced than the forward direction. After completion of each task, the cloud continued to distribute in the air increasing its dimensions. Consequently, we propose increasing the current recommendations of many governmental councils for choirs or singing at religious services from 1.5m to the front and 1m to the side to a distance between choir singers of 2m to the front and 1.5m to the sides.

8: Systematic review of international guidelines for tracheostomy in COVID-19 patients.
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Posted 29 Apr 2020

Systematic review of international guidelines for tracheostomy in COVID-19 patients.
1,619 downloads medRxiv otolaryngology

Carlos M Chiesa-Estomba, Jerome R Lechien, Christian Calvo-Henriquez, Nicolas Fakhry, Petros D Karkos, Shazia Peer, Jon A Sistiaga-Suarez, Jose A Gonzalez-Garcia, Giovanni Cammaroto, Miguel Mayo, Pablo Parente-Arias, Sven Saussez, Tareck Ayad

At this moment, the world leaves under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that are at particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures on demand at this moment is tracheostomy, due the increasing admission in ICU departments and the increased need of ventilatory support secondary to respiratory distress syndrome. This review of international guidelines for tracheostomy in COVID-19 infected patients, aiming to summarize in a systematic way the available recommendations from 18 guidelines from all over the world.

9: SCENTinel 1.0: development of a rapid test to screen for smell loss
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Posted 11 Dec 2020

SCENTinel 1.0: development of a rapid test to screen for smell loss
1,512 downloads medRxiv otolaryngology

Valentina Parma, Mackenzie E Hannum, Maureen O'Leary, Robert Pellegrino, Nancy Rawson, Danielle R Reed, Pamela H Dalton

Background: Commercially available smell tests are primarily used in research or in-depth clinical evaluations, but are too costly and lengthy for population surveillance in health emergencies like COVID-19. We developed the SCENTinel 1.0 test which rapidly evaluates three olfactory functions (detection, intensity, and identification). We tested whether self-administering the SCENTinel 1.0 test discriminates between individuals with smell loss or average smell ability (normosmics), and provides comparable performance as the validated and standardized NIH Toolbox Odor Identification Test in normosmics. Methods: Using Bayesian linear models and prognostic classification algorithms, we compared the SCENTinel 1.0 performance of a group of self-reported anosmics (N=111, 47+/-13yo, F=71%,) and normosmics (N=154, 47+/-14yo, F=74%), as well as individuals reporting other smell disorders (e.g., hyposmia, parosmia; N=42, 55+/-10yo, F=67%). Results: Ninety-four percent of normosmics met our SCENTinel 1.0 accuracy criteria, while only 10% of anosmics and 64% of individuals with other smell disorders did. Overall performance on SCENTinel 1.0 predicted belonging to the normosmic group better than identification or detection alone (vs. anosmic: AUC=0.95, Sensitivity=0.72, Specificity=0.94). Odor intensity provided the best single-feature predictor to classify normosmics. Among normosmics, 92% met the accuracy criteria at both SCENTinel 1.0 and the NIH Toolbox Odor Identification Test. Conclusions: SCENTinel 1.0 is a practical test able to discriminate individuals with smell loss and is likely to be useful in many clinical situations, including COVID-19 symptom screening.

10: Objective olfactory testing in patients presenting with sudden onset olfactory dysfunction as the first manifestation of confirmed COVID-19 infection
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Posted 18 Apr 2020

Objective olfactory testing in patients presenting with sudden onset olfactory dysfunction as the first manifestation of confirmed COVID-19 infection
1,438 downloads medRxiv otolaryngology

jerome lechien, pierre cabaraux, carlos chiesa-estomba, mohammad khalife, jan plzak, stephane hans, delphine martiny, christian Henriquez, Claire hopkins, sven saussez

Abstract Background: The aims of this study are to investigate the COVID-19 status of patients with initial sudden olfactory anosmia (ISOA) using nasopharyngeal swabs for RT-PCR analysis and to explore their olfactory dysfunctions with psychophysical olfactory evaluation. Methodology: This prospective study included 78 ISOA patients who fulfilled a patient-reported outcome questionnaire and underwent a nasopharyngeal swabs. Among these, 46 patients performed psychophysical olfactory evaluation using sniffing tests. Based on the duration of the ISOA, two groups of patients were compared: patients with anosmia duration [&le;]12 days (group 1) and those with duration >12 days (group 2). Results: Among group 1, 42 patients (87.5%) had a positive viral load regarding RT-PCR while 6 patients (12.5%) were negative. In group 2, 7 patients (23%) had a positive viral load and 23 patients (77%) were negative. Among the 46 patients having performed a psychophysical olfactory evaluation, we observed anosmia in 52% (N=24), hyposmia in 24% (N=11) and normosmia in 24% (N=11) of patients. The viral load significantly decreased throughout the 14-days following the onset of the olfactory disorder. Conclusions: Our results support that a high proportion of ISOA patients are Covid+. Our study supports the need to add anosmia to the list of symptoms used in screening tools for possible COVID-19 infection.

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Posted 02 Sep 2020

1,386 downloads medRxiv otolaryngology

Rosalinda Pieruzzini, Carlos Ayala, Jose Navas, Wilneg Carolina Rodriguez, Nathalia Parra, Emily Luque, Aida Sanchez, Scarleth Gonzalez, Alexandra Hagobian, Angeline Grullon, Karen Diaz, Mariano Morales, Melanie De Jesus, Sonia Pena, Luis Rodriguez, Lenin Pena, Ana Asaro, Magda Magris

There is a relationship between smell and taste disturbances and coronavirus infection. These symptoms have been considered the best predictor of coronavirus infection, for this reason, it was decided to evaluate the predictive value of the smell and taste test and its association with the results of SARS-CoV-2 PCR-RT and rapid diagnostic tests. in the diagnosis of pathology. Methodology: 248 patients divided into 3 groups: asymptomatic, symptomatic without chemosensory disorders, and chemosensory disorders alone. All of them underwent SARS-CoV-2 PCR-RT, a rapid diagnostic test and a test of Venezuelan smell and basic taste at the beginning. Weekly follow-up with smell and taste test and SARS-CoV-2 PCR-RT until recovery. Results: 20.56% of patients had smell and taste disorders to a variable degree and were positive by SARS-CoV-PCR-RT. 2.15.3% of patients with chemosensory disorders were negative for COVID-19. The positive predictive value of the smell and taste test was 57.3; Sensitivity 41.13% and specificity 69.35%. There were no statistically significant differences by age, sex and chemosensory disorders. The predominant chemosensory disorder was the combination of mild hyposmia and hypogeusia and appeared in the company of other symptoms. Recovery occurred in an average of 8.5 days, asynchronously with the SARS-CoV-2 RT-PCR negativization, which occurred up to more than 15 days after the senses recovered. Maximum time of negativization of the RT-PCR of 34 days. Conclusion: chemosensory disorders are a symptom and / or sign of coronavirus disease but cannot be considered as predictors of said disease in this population studied. The gold standard remains the SARS-CoV-2 PCR-RT test. Rapid diagnostic tests should be used for follow-up. Recommendations: it is necessary to expand the sample, include routine psychophysical smell and taste tests to screen cases and take race and virus mutations into consideration to explain behavior in certain populations. Key words: Smell, taste, coronavirus, test, diagnosis.

12: Prevalence of Chemosensory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis Reveals Significant Ethnic Differences
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Posted 17 Jun 2020

Prevalence of Chemosensory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis Reveals Significant Ethnic Differences
1,280 downloads medRxiv otolaryngology

Christopher S von Bartheld, Molly M Hagen, Rafal Butowt

A significant fraction of people who test positive for COVID-19 have chemosensory deficits. However, the reported prevalence of these deficits in smell and/or taste varies widely, and the reason for the differences between studies is unclear. We determined the pooled prevalence of such chemosensory deficits in a systematic review. We searched the COVID-19 portfolio of the National Institutes of Health for all studies that reported the prevalence of smell and/or taste deficits in patients diagnosed with COVID-19. Forty-two studies reporting on 23,353 patients qualified and were subjected to a systematic review and meta-analysis. Estimated random prevalence of olfactory dysfunction was 38.5%, of taste dysfunction was 30.4% and of overall chemosensory dysfunction was 50.2%. We examined the effects of age, disease severity, and ethnicity on chemosensory dysfunction. The effect of age did not reach significance, but anosmia/hypogeusia decreased with disease severity, and ethnicity was highly significant: Caucasians had a 3-6 times higher prevalence of chemosensory deficits than East Asians. The finding of ethnic differences points to genetic, ethnicity-specific differences of the virus-binding entry proteins in the olfactory epithelium and taste buds as the most likely explanation, with major implications for infectivity, diagnosis and management of the COVID-19 pandemic.

13: Towards a differential diagnosis of cochlear synaptopathy and outer-hair-cell deficits in mixed sensorineural hearing loss pathologies
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Posted 18 Oct 2019

Towards a differential diagnosis of cochlear synaptopathy and outer-hair-cell deficits in mixed sensorineural hearing loss pathologies
890 downloads medRxiv otolaryngology

Viacheslav Vasilkov, Sarah Verhulst

Damage to the auditory periphery is more widespread than predicted by the gold-standard clinical audiogram. Noise exposure, ototoxicity and aging can destroy cochlear inner-hair-cell afferent synapses and result in a degraded subcortical representation of sound while leaving hearing thresholds unaffected. Damaged afferent synapses, i.e. cochlear synaptopathy, can be quantified using histology, but a differential diagnosis in living humans is difficult: histology cannot be applied and existing auditory evoked potential (AEP) metrics for synaptopathy become insensitive when other sensorineural hearing impairments co-exist (e.g., outer-hair-cell damage associated with elevated hearing thresholds). To develop a non-invasive diagnostic method which quantifies synaptopathy in humans and animals with normal or elevated hearing thresholds, we employ a computational model approach in combination with human AEP and psychoacoustics. We propose the use of a sensorineural hearing loss (SNHL) map which comprises two relative AEP-based metrics to quantify the respective degrees of synaptopathy and OHC damage and evaluate to which degree our predictions of AEP alterations can explain individual data-points in recorded SNHL maps from listeners with normal or elevated audiometric thresholds. We conclude that SNHL maps can offer a more precise diagnostic tool than existing AEP methods for individual assessment of the synaptopathy and OHC-damage aspect of sensorineural hearing loss. Significance StatementHearing loss ranks fourth in global causes for disability and risk factors include noise exposure, ototoxicity and aging. The most vulnerable parts of the cochlea are the inner-hair-cell afferent synapses and their damage (cochlear synaptopathy) results in a degraded subcortical representation of sound. While synaptopathy can be estimated reliably using histology, it cannot be quantified this way in living humans. Secondly, when other aspects of sensorineural hearing deficits (e.g., outer-hair-cell damage) co-exist, standard auditory evoked potential (AEP) metrics for synaptopathy are impacted by both and become insensitive for differential diagnosis. To quantify synaptopathy in humans and animals with normal or elevated hearing thresholds, we adopt a theoretical and interdisciplinary approach to develop a non-invasive AEP-based method. Sensitive diagnostic metrics for synaptopathy are crucial to assess its prevalence in humans, study its impact on sound perception and yield effective hearing restoration strategies.

14: Psychophysical Olfactory Findings of Mild-to-moderate COVID-19 Patients: Preliminary Report.
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Posted 06 May 2020

Psychophysical Olfactory Findings of Mild-to-moderate COVID-19 Patients: Preliminary Report.
860 downloads medRxiv otolaryngology

Jerome R Lechien, sven saussez, Pierre Cabaraux, Stephane Hans, Mohamad Khalife, Delphine Martiny, Carlos Chiesa

Since the onset of the COVID-19 infection, many patients reported sudden loss of smell (SLS). However, due to the lack of psychophysical testings, it remains difficult to know if these patients really have hyposmia or anosmia. Our group investigated the prevalence of anosmia and hyposmia in 28 COVID-19 patients and the potential association with nasal complaints.

15: Objective Olfactory Evaluation of Self-reported Olfactory Dysfunction in a Case Series of 86 COVID-19 Patients
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Posted 08 May 2020

Objective Olfactory Evaluation of Self-reported Olfactory Dysfunction in a Case Series of 86 COVID-19 Patients
847 downloads medRxiv otolaryngology

Pierre Cabaraux, Jerome R Lechien, sven saussez, Carlos M Chiesa-Estomba, Mohamad Khalife, Stephane Hans, Delphine Martiny, Fabrice Journe, Christian Calvo Henriquez, Leigh Sowerby

Objective: To investigate olfactory dysfunction in patients with mild COVID-19 through patient-reported outcome questionnaires and objective psychophysical testing. Methods: Adult patients with COVID-19 and self-reported sudden-onset olfactory dysfunction were recruited through a public call for participation from the University of Mons. Demographic data, pathologic conditions, general and otolaryngological symptoms were collected, and general nasal complaints were evaluated with the sino-nasal outcome-22 (SNOT-22). Subjective olfactory and gustatory status was evaluated with the National Health and Nutrition Examination Survey (NHNES) and the short version of the Questionnaire of Olfactory Disorders-Negative Statements. Objective olfactory status was evaluated using an objective psychophysical test (Identification Sniffin Stick test). Results : 86 patients completed the study. The mean age was 42 + or - 12 years. The most common symptoms were fatigue (75%), headache (63%), nasal obstruction (58%), dysgeusia (51%), postnasal drip (49%), cough (49%) and myalgia (46%). On NHNES, total loss of taste and smell were reported by 51% and 74% of patients, respectively. 65% of patients reported a total loss of smell, while the remainder reported a partial loss. Objective olfactory testing found 41 anosmic (48%), 12 hyposmics (14%), and 33 normosmics (38%) patients. There was no correlation between the objective test results and subjective reports of nasal obstruction or postnasal drip, these complaints were absent in 69% of anosmic patients. Conclusion : A significant proportion of patients reporting olfactory dysfunction related to COVID-19 infection do not have olfactory dysfunction on objective testing. Furthermore, a majority of those with measured olfactory dysfunction did not have corresponding nasal obstruction.

16: Self-reported taste and smell disorders in patients with COVID-19: distinct features in China
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Posted 15 Jun 2020

Self-reported taste and smell disorders in patients with COVID-19: distinct features in China
834 downloads medRxiv otolaryngology

Jia Song, Yi-Ke Deng, Hai Wang, Zhi-Chao Wang, Bo Liao, Jin Ma, Chao He, Li Pan, Yang Liu, Isam Alobid, De-Yun Wang, Ming Zeng, Joaquim Mullol, Zheng Liu

Objectives: We aimed to explore the frequencies of nasal symptoms in patients with COVID-19, including loss of smell and taste, as well as their presentation as the first symptom of the disease and their association with the severity of COVID-19. Methods: In this retrospective study, 1,206 laboratory-confirmed COVID-19 patients were included and followed-up by telephone call one month after discharged from Tongji Hospital, Wuhan. Demographic data, laboratory values, comorbidities, symptoms, and numerical rating scale scores (0-10) of nasal symptoms were extracted from the hospital medical records, and confirmed or reevaluated by the telephone follow-up. Results: From COVID-19 patients (N = 1,172) completing follow-up, 199 (17%) subjects had severe COVID-19 and 342 (29.2%) reported nasal symptoms. The most common nasal symptom was loss of taste (20.6%, median score = 6), while 11.4% had loss of smell (median score = 5). The incidence of nasal symptom including loss of smell and loss of taste as the first onset symptom was <1% in COVID-19 patients. Loss of smell or taste scores showed no correlation with the scores of other nasal symptoms. Loss of taste scores, but not loss of smell scores, were significantly increased in severe vs. non-severe COVID-19 patients. Interleukin (IL)-6 and lactose dehydrogenase (LDH) serum levels positively correlated with loss of taste scores. About 80% of COVID-19 patients recovered from smell and taste dysfunction in 2 weeks. Conclusion: In the Wuhan COVID-19 cohort, only 1 out of 10 hospital admitted patients had loss of smell while 1 out 5 reported loss of taste which was associated to severity of COVID-19. Most patients recovered smell and taste dysfunctions in 2 weeks.

17: Molecular Mechanism of Parosmia
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Posted 08 Feb 2021

Molecular Mechanism of Parosmia
771 downloads medRxiv otolaryngology

Jane K Parker, Christine E. Kelly, Simon B Gane

The molecular stimuli that trigger parosmia have been identified. Parosmia is a debilitating disease in which familiar smells become distorted and unpleasant. Often a result of post infectious smell loss, incidences are increasing as the number of COVID-19 cases escalates worldwide. Little is understood of its pathophysiology, but the prevailing hypothesis for the underlying mechanism is a mis-wiring of olfactory sensory neurons. We identified 15 different molecular triggers in coffee using GC-Olfactometry as a relatively rapid screening tool for assessment of both quantitative olfactory loss and parosmia. This provides evidence for peripheral causation, but places constraints on the mis-wiring theory.

18: Clinical and Radiological Evaluations of COVID-19 Patients with Anosmia: Preliminary Report.
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Posted 26 May 2020

Clinical and Radiological Evaluations of COVID-19 Patients with Anosmia: Preliminary Report.
748 downloads medRxiv otolaryngology

Jerome R Lechien, Justin Michel, Thomas Radulesco, Carlos M Chiesa-Estomba, Luigi A Vaira, Giacomo De Riu, Leigh J Sowerby, Claire Hopkins, Sven Saussez

Objective: To investigate clinical and radiological features of olfactory clefts of patients with mild coronavirus disease 2019 (COVID-19). Methods: Sixteen COVID-19 patients were recruited. The epidemiological and clinical data were extracted. Nasal complaints were assessed through the sino-nasal outcome test 22 (SNOT-22). Patients underwent psychophysical olfactory testing, olfactory cleft examination and CT-scan. Results: Sixteen anosmic patients were included. The mean Sniffin Sticks score was 4.6+/-1.7. The majority of patients had no endoscopical abnormality, with a mean olfactory cleft endoscopy score of 0.6+/-0.9. The olfactory clefts were opacified in 3 patients on the CT-scan. The mean radiological olfactory cleft score was 0.7+/-0.8. There were no significant correlations between clinical, radiological and psychophysical olfactory testing. Conclusion: The olfactory cleft of anosmic COVID-19 patients is free regarding endoscopic examination and imaging. The anosmia etiology would be not related to edema of the olfactory cleft.

19: Susceptibility to Residual Inhibition is Associated with Hearing Loss and Tinnitus Chronicity
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Posted 06 Aug 2020

Susceptibility to Residual Inhibition is Associated with Hearing Loss and Tinnitus Chronicity
724 downloads medRxiv otolaryngology

Suyi Hu, Lukas Anschuetz, Deborah A. Hall, Marco Caversaccio, Wilhelm Wimmer

Residual inhibition, i.e. the temporary suppression of tinnitus loudness after acoustic stimulation, is a frequently observed phenomenon that may have prognostic value for clinical applications. However, it is unclear in which subjects residual inhibition is more likely and how stable the suppression can be induced repeatedly. The primary aim of this work was to evaluate the effect of hearing loss and tinnitus chronicity on residual inhibition susceptibility. The secondary aim was to investigate the short-term repeatability of residual inhibition. Residual inhibition was assessed in 74 tinnitus subjects with 60-second narrow-band noise stimuli in 10 consecutive trials. The subjects were assigned to groups according to their depth of suppression (substantial residual inhibition vs. comparator group). In addition, a categorization in normal hearing and hearing loss groups, related to the degree of hearing loss at the frequency corresponding to the tinnitus pitch, was made. Logistic regression was used to identify factors associated with susceptibility to residual inhibition. Repeatability of residual inhibition was assessed using mixed-effects ordinal regression including post-stimulus time and repetitions as factors. Tinnitus chronicity was not associated with residual inhibition for subjects with hearing loss, while a statistically significant negative association between tinnitus chronicity and residual inhibition susceptibility was observed in normal hearing subjects (odds ratio: 0.63; CI: 0.41 to 0.83; p = 0.0076). Moreover, repeated states of suppression can be stably induced. Our results suggest that long chronicity and residual inhibition susceptibility could be indicators for hidden lesions along the auditory pathway in subjects with normal hearing thresholds at their tinnitus frequency.

20: COVIDTrach; a prospective cohort study of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK
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Posted 27 Oct 2020

COVIDTrach; a prospective cohort study of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK
697 downloads medRxiv otolaryngology

COVIDTrach, Nick JI Hamilton

BackgroundCOVIDTrach is a UK multi-centre prospective cohort study project evaluating the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation. It also examines the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure. MethodAn invitation to participate was sent to all UK NHS departments involved in tracheostomy in mechanically ventilated patients with COVID-19. Data was entered prospectively and clinical outcomes updated over time via an online database (REDCap). Clinical variables were compared with clinical outcomes using multivariable regression analysis, with logistic regression used to develop a prediction model for mortality. Participants recorded whether any of the operators tested positive for SARS-CoV-2 within two weeks of the procedure. FindingsThe cohort comprised 1605 tracheostomy cases from 126 UK hospitals. The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration requirement on the day of tracheostomy, PEEP setting, pyrexia, number of days of ventilation before tracheostomy, C-reactive protein and the use of anticoagulation and inotropic support independently predicticted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within two weeks following the procedure. InterpretationTracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical indicators that are predictive of mortality. Optimal timing of the procedure remains to be determined. FundingThe COVIDTrach project is supported by the Wellcome Trust UCL COVID-19 Rapid Response Award and the National Institute for Health Research.

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