Measuring the Possibility of Middle Ear Discharge for COVID-19 Test Material

Otitis media with effusion in adults during the SARS-CoV-2 epidemic

OBJECTIVES

The purpose of this study was to investigate the fluctuations in the prevalence of individuals diagnosed with otitis media with effusion (OME) during the SARS-CoV-2 pandemic, while also evaluating the persistence of SARS-CoV-2 in middle ear effusion (MEE) and assessing the effectiveness of tympanocentesis as a treatment modality for OME in this specific period.

METHODS

The total number of outpatients and patients diagnosed with OME in our department was recorded for January 2022 and January 2023. Thirty patients (aged 15-86 years) were categorized into two groups: group A (n = 12), who developed OME during their SARS-CoV-2 infection and group B (n = 18), who experienced OME after the resolution of SARS-CoV-2 infection. All patients underwent otoendoscopic tympanocentesis (without a ventilation tube), where MEE and nasopharyngeal secretions were simultaneously collected for SARS-CoV-2 detection by polymerase chain reaction. The time interval from SARS-CoV-2 infection to tympanocentesis, results of SARS-CoV-2 detection, preoperative and postoperative average hearing threshold, and Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores were documented.

RESULTS

The proportion of outpatients with OME in January 2023 was higher than that in January 2022. There were five patients who had positive test results for SARS-CoV-2 on MEE after tympanocentesis. These 5 patients underwent tympanocentesis at a mean of 28 ± 7.28 days following confirmation of SARS-CoV-2 infection. The ETDQ-7 scores of group A exhibited a reduction from 21.85 ± 4.8 to 10.00 ± 4.07 following tympanocentesis, while the ETDQ-7 scores of group B also demonstrated a decrease from 21.22 ± 4.65 to 10.11 ± 3.68 after undergoing tympanocentesis. The tympanocentesis was effective in both groups.

CONCLUSIONS

The study confirmed that the proportion of outpatients with OME in the Clinics of Otolaryngology during the SARS-CoV-2 epidemic increased significantly. SARS-CoV-2 RNA was detectable in MEE of COVID-19-related OME patients. Tympanocentesis was therapeutic for OME during SARS-CoV-2 infection, which facilitated viral clearance in MEE.

Presence of SARS-CoV-2 in middle ear fluid and characterization of otitis media with effusion in patients with COVID-19

OBJECTIVES

This study sought to determine whether SARS-CoV-2 is present in the middle ear fluid (MEF) of patients with COVID-19 who have otitis media with effusion (OME).

METHODS

A case-control study was designed to detect SARS-CoV-2 and six other common respiratory viruses (influenza A virus, influenza B virus, respiratory syncytial virus, adenovirus, human rhinovirus [HRV], and mycoplasma pneumonia) by polymerase chain reaction (PCR) in the MEF of patients with OME. Follow-up tests, including pure-tone audiometry and tympanometry, were conducted.

RESULTS

In the COVID-19 group, 18 of 27 MEF specimens were PCR-positive for SARS-CoV-2, with cycle thresholds ranging from 24.9-42.2. And one patient tested positive for the HRV. In the control group, all 15 MEF specimens were PCR-negative for SARS-CoV-2, but two patients tested positive for the HRV. After treatment for OME, 11 patients (40.7%) reported complete resolution, 14 (51.9%) reported improvement, and two (7.4%) reported no change. The average improvement in hearing was 14.5 ± 8.1 dB, and the average air-bone gap decrease was 13.5 ± 9.0 dB.

CONCLUSION

This study confirmed the presence of SARS-CoV-2 in the MEF of patients who were previously COVID-19-positive suggesting a possible association between COVID-19 and OME. OME should be considered a possible symptom of COVID-19.

COVID-19-related secretory otitis media in the omicron era: a case series

OBJECTIVES

Increased numbers of patients with secretory otitis media appeared in outpatient clinics after the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Omicron pandemic; however, the relationship between SARS-CoV-2 Omicron variant infection and secretory otitis media is uncertain.

METHODS

We performed tympanocentesis and used reverse transcription-polymerase chain reaction (RT-PCR) testing to examine middle ear effusion (MEE) and nasopharyngeal secretions from 30 patients with secretory otitis media associated with SARS-CoV-2 infection. RT-PCR was performed using the open reading frame 1ab and nucleocapsid protein gene kit from Shanghai Berger Medical Technology Co., Ltd., as the sole assay method, in accordance with the manufacturer's instructions.

RESULTS

MEEs from 5 of the 30 patients tested positive for SARS-CoV-2, including one patient with positive results for both the nasopharyngeal secretion and MEE. We report and discuss the medical records of six patients, including these five MEE-positive patients and a MEE-negative patient.

CONCLUSION

SARS-CoV-2 RNA can be detected in MEE caused by coronavirus disease 2019-related secretory otitis media even when a patient's nasopharyngeal secretion tests PCR-negative for SARS-CoV-2. The virus can remain in the MEE for a long time after SARS-CoV-2 infection.