CC BY 4.0 · Int Arch Otorhinolaryngol
DOI: 10.1055/s-0043-1777805
Systematic Reviews

Persistent ENT Manifestations in Individuals who Recovered from COVID-19: A Systematic Review

1   Department of Ear, Nose, and Throat, SGT Medical College, Hospital, and Research Institute, Gurgaon, Haryana, India
,
Rohit Kumar Jakhar
1   Department of Ear, Nose, and Throat, SGT Medical College, Hospital, and Research Institute, Gurgaon, Haryana, India
,
Vikas Kakkar
1   Department of Ear, Nose, and Throat, SGT Medical College, Hospital, and Research Institute, Gurgaon, Haryana, India
,
1   Department of Ear, Nose, and Throat, SGT Medical College, Hospital, and Research Institute, Gurgaon, Haryana, India
› Author Affiliations
Funding The authors declare that they have received no financial support from agencies in the public, private or non-profit sectors for the conduction of the present research.

Abstract

Introduction Long coronavirus disease (COVID) refers to the persistence of symptoms long after the recovery from the acute phase of the illness, and it is due to the interplay of various inflammatory mechanisms. This has led to emergence of new deficits, including otorhinolaryngological symptoms, in patients wo have recovered from COVID. The plethora of otorhinolaryngological symptoms associated with long COVID are tinnitus, sensorineural hearing loss (SNHL), vertigo, nasal congestion, sinonasal discomfort, hyposmia/anosmia, dysgeusia, sore throat, dry cough, dyspnea, dysphagia, and hoarseness of voice.

Objective To evaluate the possible ENT symptoms in patients wo have recovered from COVID and to combine those findings with our experience.

Data Synthesis We conducted a search on the PubMed, ENT Cochrane, Web of Science, and Google Scholar databases, and a total of 44 studies were selected for the present review.

Conclusion Otorhinolaryngological complications such as tinnitus, SNHL, vertigo, nasal congestion, sinonasal discomfort, hyposmia/anosmia, dysgeusia, sore throat, dry cough, dyspnea, dysphagia, and hoarseness of voice have been widely reported among in long-COVID patients.



Publication History

Received: 18 May 2023

Accepted: 12 November 2023

Article published online:
15 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • References

  • 1 El-Anwar MW, Elzayat S, Fouad YA. ENT manifestation in COVID-19 patients. Auris Nasus Larynx 2020; 47 (04) 559-564
  • 2 Guan WJ, Ni ZY, Hu Y. et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
  • 3 Heller L, Mota CR, Greco DB. COVID-19 faecal-oral transmission: Are we asking the right questions?. Sci Total Environ 2020; 729: 138919
  • 4 Gengler I, Wang JC, Speth MM, Sedaghat AR. Sinonasal pathophysiology of SARS-CoV-2 and COVID-19: A systematic review of the current evidence. Laryngoscope Investig Otolaryngol 2020; 5 (03) 354-359
  • 5 Hoffmann M, Kleine-Weber H, Schroeder S. et al. SARS-CoV-2 Cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181 (02) 271-280.e8
  • 6 Hussman JP. Cellular and molecular pathways of COVID-19 and potential points of therapeutic intervention. Front Pharmacol 2020; 11: 1169
  • 7 Tuang GJ, Abdul Wahab AF, Husain S. Otolaryngology manifestations of COVID-19: a contemporary viewpoint. Postgrad Med J 2022; 98 (e2): e97-e98
  • 8 Bianco MR, Modica DM, Drago GD. et al. Alteration of smell and taste in asymptomatic and symptomatic COVID-19 patients in sicily, italy. Ear Nose Throat J 2021; 100 (2_suppl, suppl) 182S-185S
  • 9 National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19 NICE guideline. ; c 2020 https://www.nice.org.uk/guidance/ng188
  • 10 https://www.who.int/podcasts/series/science-in-5/episode–47−post-covid-19-condition
  • 11 Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023; 21 (03) 133-146
  • 12 Kilic O, Kalcioglu MT, Cag Y. et al. Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss. Int J Infect Dis 2020; 97: 208-211
  • 13 Degen C, Lenarz T, Willenborg K. Acute Profound Sensorineural Hearing Loss After COVID-19 Pneumonia. Mayo Clin Proc 2020; 95 (08) 1801-1803
  • 14 Abdel Rhman S, Abdel Wahid A. COVID -19 and sudden sensorineural hearing loss, a case report. Otolaryngol Case Rep 2020; 16: 100198
  • 15 Lang B, Hintze J, Conlon B. Coronavirus disease 2019 and sudden sensorineural hearing loss. J Laryngol Otol 2020; 134: 1-3
  • 16 Koumpa FS, Forde CT, Manjaly JG. Sudden irreversible hearing loss post COVID-19. BMJ Case Rep 2020; 13 (11) e238419
  • 17 Lamounier P, Franco Gonçalves V, Ramos HVL. et al. A 67-Year-Old Woman with Sudden Hearing Loss Associated with SARS-CoV-2 Infection. Am J Case Rep 2020; 21: e927519
  • 18 Karimi-Galougahi M, Naeini AS, Raad N, Mikaniki N, Ghorbani J. Vertigo and hearing loss during the COVID-19 pandemic - is there an association?. Acta Otorhinolaryngol Ital 2020; 40 (06) 463-465
  • 19 Chern A, Famuyide AO, Moonis G, Lalwani AK. Bilateral Sudden Sensorineural Hearing Loss and Intralabyrinthine Hemorrhage in a Patient With COVID-19. Otol Neurotol 2021; 42 (01) e10-e14
  • 20 Aasfara J, Hajjij A, Bensouda H, Ouhabi H, Benariba F. A unique association of bifacial weakness, paresthesia and vestibulocochlear neuritis as post-COVID-19 manifestation in pregnant women: a case report. Pan Afr Med J 2021; 38: 30
  • 21 Beckers E, Chouvel P, Cassetto V, Mustin V. Sudden sensorineural hearing loss in COVID-19: A case report and literature review. Clin Case Rep 2021; 9 (04) 2300-2304
  • 22 Edwards M, Muzaffar J, Naik P, Coulson C. Catastrophic bilateral sudden sensorineural hearing loss following COVID-19. BMJ Case Rep 2021; 14 (06) e243157
  • 23 Ozer F, Alkan O. Simultaneous Sudden Hearing Loss and Peripheral Facial Paralysis in a Patient with COVID-19. Ear Nose Throat 2021
  • 24 Ricciardiello F, Pisani D, Viola P. et al. Sudden Sensorineural Hearing Loss in Mild COVID-19: Case Series and Analysis of the Literature. Audiology Res 2021; 11 (03) 313-326
  • 25 Gerstacker K, Speck I, Riemann S, Aschendorff A, Knopf A, Arndt S. Deafness after COVID-19?. HNO 2021; 69 (Suppl. 02) 92-95
  • 26 Jeong M, Ocwieja KE, Han D. et al. Direct SARS-CoV-2 infection of the human inner ear may underlie COVID-19-associated audiovestibular dysfunction. Commun Med (Lond) 2021; 1 (01) 44
  • 27 Pokharel S, Tamang S, Pokharel S, Mahaseth RK. Sudden sensorineural hearing loss in a post-COVID-19 patient. Clin Case Rep 2021; 9 (10) e04956
  • 28 Asfour L, Kay-Rivest E, Roland Jr JT. Cochlear implantation for single-sided deafness after COVID-19 hospitalization. Cochlear Implants Int 2021; 22 (06) 353-357
  • 29 Raymaekers V, D'hulst S, Herijgers D. et al. Susac syndrome complicating a SARS-CoV-2 infection. J Neurovirol 2021; 27 (06) 954-959
  • 30 Viola P, Ralli M, Pisani D. et al. Tinnitus and equilibrium disorders in COVID-19 patients: preliminary results. Eur Arch Otorhinolaryngol 2021; 278 (10) 3725-3730
  • 31 Bhatta S, Sharma S, Sharma D. et al. Study of hearing status in COVID-19 patients: a multicentered review. Indian J Otolaryngol Head Neck Surg 2021; 1-7
  • 32 Gallus R, Melis A, Rizzo D. et al. Audiovestibular symptoms and sequelae in COVID-19 patients. J Vestib Res 2021; 31 (05) 381-387
  • 33 Kökoğlu K, Tektaş N, Baktir-Okcesiz FEM, Şahin Mİ. Mild and moderate COVID-19 disease does not affect hearing function permanently: a cross-sectional study ınvolving young and middle-aged healthcare givers. Eur Arch Otorhinolaryngol 2021; 278 (09) 3299-3305
  • 34 Thrane JF, Britze A, Fjaeldstad AW. Incidence and duration of self-reported hearing loss and tinnitus in a cohort of COVID-19 patients with sudden chemosensory loss: a STROBE observational study. Eur Ann Otorhinolaryngol Head Neck Dis 2021:S1879-7296(21)00224-6
  • 35 Gedik Ö, Hüsam H, Başöz M, Tas N, Aksoy F. The effect of coronavirus disease 2019 on the hearing system. J Laryngol Otol 2021; 135 (09) 810-814
  • 36 Graham EL, Clark JR, Orban ZS. et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers”. Ann Clin Transl Neurol 2021; 8 (05) 1073-1085
  • 37 Boscolo-Rizzo P, Guida F, Polesel J. et al. Sequelae in adults at 12 months after mild-to-moderate coronavirus disease 2019 (COVID-19). Int Forum Allergy Rhinol 2021; 11 (12) 1685-1688
  • 38 Havervall S, Rosell A, Phillipson M. et al. Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers. JAMA 2021; 325 (19) 2015-2016
  • 39 Augustin M, Schommers P, Stecher M. et al. Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur 2021; 6: 100122
  • 40 Vaira LA, Gessa C, Deiana G. et al. The Effects of Persistent Olfactory and Gustatory Dysfunctions on Quality of Life in Long-COVID-19 Patients. Life (Basel) 2022; 12 (02) 141
  • 41 Carvalho-Schneider C, Laurent E, Lemaignen A. et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect 2021; 27 (02) 258-263
  • 42 Ercoli T, Masala C, Pinna I. et al. Qualitative smell/taste disorders as sequelae of acute COVID-19. Neurol Sci 2021; 42 (12) 4921-4926
  • 43 Lackermair K, Wilhelm K, William F. et al. The prevalence of persistent symptoms after COVID-19 disease. Dtsch Arztebl Int 2022; 119 (10) 175-176
  • 44 Bianco MR, Ralli M, Minni A, Greco A, de Vincentiis M, Allegra E. Evaluation of olfactory dysfunction persistence after COVID-19: a prospective study. Eur Rev Med Pharmacol Sci 2022; 26 (03) 1042-1048
  • 45 Halpin SJ, McIvor C, Whyatt G. et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol 2021; 93 (02) 1013-1022
  • 46 El Kik A, Eid H, Aoun Bacha Z. Post-COVID-19 paradoxical vocal cord movement and dysfunctional dysphonia: A clinical case. Respir Med Case Rep 2022; 39: 101710
  • 47 Dassie-Leite AP, Gueths TP, Ribeiro VV, Pereira EC, Martins PDN, Daniel CR. Vocal Signs and Symptoms Related to COVID-19 and Risk Factors for their Persistence. J Voice 2021; :S0892-1997 (21) 00253-8
  • 48 Neevel AJ, Smith JD, Morrison RJ, Hogikyan ND, Kupfer RA, Stein AP. Postacute COVID-19 Laryngeal Injury and Dysfunction. OTO Open 2021; 5 (03) X211041040
  • 49 Kang YR, Oh JY, Lee JH, Small PM, Chung KF, Song WJ. Long-COVID severe refractory cough: discussion of a case with 6-week longitudinal cough characterization. Asia Pac Allergy 2022; 12 (02) e19
  • 50 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323 (13) 1239-1242
  • 51 Geddes L. Why strange and debilitating coronavirus symptoms can last for months. New Sci 2020 https://www.newscientist.com/article/mg24632881-400-why-strange-and-debilitatingcoronavirus-symptoms-can-last-for-months/
  • 52 Nabavi N. Long covid: How to define it and how to manage it. BMJ 2020; 370: m3489
  • 53 Garg P, Arora U, Kumar A, Wig N. The “post-COVID” syndrome: how deep is the damage?. J Med Virol 2020
  • 54 Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ 2020; 370: m3026
  • 55 Colafrancesco S, Alessandri C, Conti F, Priori R. COVID-19 gone bad: A new character in the spectrum of the hyperferritinemic syndrome?. Autoimmun Rev 2020; 19 (07) 102573
  • 56 Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol 2020; 20 (06) 363-374
  • 57 Raveendran AV, Jayadevan R, Sashidharan S. Long COVID: An overview. Diabetes Metab Syndr 2021; 15 (03) 869-875
  • 58 Fancello V, Hatzopoulos S, Corazzi V. et al. SARS-CoV-2 (COVID-19) and audio-vestibular disorders. Int J Immunopathol Pharmacol 2021;35:20587384211027373
  • 59 De Luca P, Di Stadio A, Colacurcio V. et al. Long COVID, audiovestibular symptoms and persistent chemosensory dysfunction: a systematic review of the current evidence. Acta Otorhinolaryngol Ital 2022; 42 (2, Suppl. 1) S87-S93
  • 60 Fancello V, Fancello G, Hatzopoulos S. et al. Sensorineural Hearing Loss Post-COVID-19 Infection: An Update. Audiology Res 2022; 12 (03) 307-315
  • 61 Safwan M, Vijayan KN, Najeeb, Jithu TG. Post-Coronavirus Disease 2019 De Quervain's Thyroiditis – A Case Report and Literature Review. Innovare Journal of Medical Sciences 2021; 9 (02) 4-6
  • 62 Muller I, Cannavaro D, Dazzi D. et al. SARS-CoV-2-related atypical thyroiditis. Lancet Diabetes Endocrinol 2020; 8 (09) 739-741
  • 63 Lee M-H, Perl DP, Nair G. et al. Microvascular Injury in the Brains of Patients with Covid-19. N Engl J Med 2021; 384 (05) 481-483
  • 64 Angileri F, Legare S, Marino Gammazza A, Conway de Macario E, Jl Macario A, Cappello F. Molecular mimicry may explain multi-organ damage in COVID-19. Autoimmun Rev 2020; 19 (08) 102591
  • 65 Kaliyappan K, Chen YC, Krishnan Muthaiah VP. Vestibular Cochlear Manifestations in COVID-19 Cases. Front Neurol 2022; 13: 850337
  • 66 Gruol DL. IL-6 regulation of synaptic function in the CNS. Neuropharmacology 2015; 96 (Pt A): 42-54
  • 67 De Luca P, Scarpa A, Ralli M. et al. Auditory disturbances and SARS-CoV-2 infection: brain inflammation or cochlear affection? Systematic review and discussion of potential pathogenesis. Front Neurol 2021; 12: 707207
  • 68 Johansen PB, Gran JT. Ototoxicity due to hydroxychloroquine: report of two cases. Clin Exp Rheumatol 1998; 16 (04) 472-474
  • 69 Cianfrone G, Pentangelo D, Cianfrone F. et al. Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide. Eur Rev Med Pharmacol Sci 2011; 15 (06) 601-636
  • 70 Elfiky AA. Ribavirin, Remdesivir, Sofosbuvir, Galidesivir, and Tenofovir against SARS-CoV-2 RNA dependent RNA polymerase (RdRp): A molecular docking study. Life Sci 2020; 253: 117592
  • 71 Ciorba A, Corazzi V, Skarżyński PH. et al. Don't forget ototoxicity during the SARS-CoV-2 (Covid-19) pandemic!. Int J Immunopathol Pharmacol 2020;34:2058738420941754