ORIGINAL RESEARCH
The Prognostic Impact of Otorhinolaryngology Symptoms on COVID-19 Patients
Kulak Burun Boğaz Semptomlarının COVID-19 Hastalarında Prognoza Etkisi
Received Date : 08 Jul 2020
Accepted Date : 08 Sep 2020
Available Online : 30 Oct 2020
E. Deniz GÖZENa, Sinem KARAa, Rafet YILDIRIMa, Eyyup KARAb, Umur AKINERc, İlker İnanç BALKANd, H. Murat YENERa
aDepartment of Otorhinolaryngology-Head and Neck Surgery, İstanbul-Cerrahpaşa University Faculty of Cerrahpaşa Medicine,
İstanbul, TURKEY
bDepartment of Audiology, İstanbul-Cerrahpaşa University Faculty of Health Sciences, İstanbul, TURKEY
cDepartment of ENT, Acıbadem Sefakoy Hospital, İstanbul, TURKEY
dDepartment of Infectious Disease, İstanbul-Cerrahpaşa University Faculty of Medicine, İstanbul, TURKEY
Doi: 10.24179/kbbbbc.2020-77914 - Makale Dili: EN
KBB ve BBC Dergisi. 2020;28(3):208-15
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: Although corona virus disseminates by aerosol or
droplet and colonizes in nasal cavity and nasopharynx, symptoms related to upper
respiratory tract are uncommon in coronavirus-disease-2019 (COVID-19). In this
report we aimed to classify the patients applying to COVID-19 outpatient clinics
according to ear-nose-throat (ENT) specific and COVID-19 specific symptoms
and to compare these patients’ prognosis. Material and Methods: Sixty-five patients
with COVID-19 were included to the study. The patients were classified
according to their presenting symptoms. The symptom categories were COVID-
19 specific (Group 1) and Covid-19+ENT specific (Group 2) symptoms. As specific
symptoms of COVID-19; fever, cough, headache, myalgia and dyspnea were
assumed. Mild ENT symptoms were also included to this group. As otolaryngology-
specific symptoms; dysfunction in smell, nasal congestion, runny nose,
sneezing, postnasal drip, sore throat, dysphagia, dysphonia, hearing loss, tinnitus,
dizziness/vertigo and aural fullness were considered. C-reactive protein, leukocyte,
lymphocyte, platelet levels in peripheral blood, and oxygen saturation levels
were also recorded. The symptom scores were analyzed by visual analog scale
scoring system. Results: The most common presenting symptom of the patients
in Group 1 was fever followed by constitutional symptoms and cough, whereas
the most common presenting symptom in Group 2 was constitutional followed by
myalgia and fever. Olfactory dysfunction was prevalent in the patients in Group
2 with a significant difference. Average nasal symptom scores of the patients in
Group 2 were; none: 3, mild: 0, moderate: 25, severe: 12 and the difference was
statistically significant. Oral cavity/oropharynx symptoms were again more prevalent
in Group 2. The average ear symptom scores of the patients among groups
did not differ significantly. Fourteen of the patients in Group 1 had better prognosis
and 15 had worse outcome. In Group 2 better prognosis was seen in 25 patients
and worse prognosis was detected in 11 patients. Conclusion: The
evaluation of the parameters concluded that although the patients with ENT predominant
symptoms were doing better than the patients with more systemic symptoms,
the difference was not statistically significant.
Keywords: COVID-19; symptom scores; ENT symptoms; prognosis
ÖZET
Amaç: Koronavirüs, aerosol veya damlacıkla yayılıp burun boşluğu ve nazofarenkste
kolonize olsa da koronavirüs hastalığı-2019 [coronavirus disease-
2019 (COVID-19)]’da üst solunum yoluyla ilgili semptomlar nadirdir. Bu
çalışmada, COVID-19 polikliniklerine başvuran hastaları kulak-burun-boğaz
(KBB) spesifik ve COVID-19 spesifik semptomlara göre sınıflandırmayı ve bu
hastaların prognozlarını karşılaştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya,
65 COVID-19 hastası dâhil edildi. Hastalar, başvuru semptomlarına göre
sınıflandırıldı. Semptom kategorileri COVID-19'a özgü (Grup 1) ve COVID-
19+KBB'ye özgü (Grup 2) olarak ayrıldı. COVID-19'un spesifik semptomları
ateş, öksürük, baş ağrısı, kas ağrısı ve nefes darlığı olarak kabul edildi. Hafif KBB
semptomları da bu gruba dâhil edildi. KBB’ye özgü semptomlar ise koku bozukluğu,
burun tıkanıklığı, burun akıntısı, hapşırma, postnazal akıntı, boğaz ağrısı,
yutma güçlüğü, ses kısıklığı, işitme kaybı, kulak çınlaması, baş dönmesi ve
kulakta dolgunluk olarak kabul edildi. Periferik kanda bakılan C-reaktif protein,
lökosit, lenfosit, trombosit düzeyleri ve oksijen saturasyon düzeyleri de kaydedildi.
Semptom skorları vizüel analog skala ile analiz edildi. Bulgular: Grup
1'deki hastaların en sık başvuru semptomu ateş, ardından nonspesifik semptomlar
ve öksürük iken, Grup 2'deki en sık başvuru semptomu ise nonspesifik
semptomlar ve ardından miyalji ve ateş idi. Olfaktör disfonksiyonun Grup
2'deki hastalarda anlamlı olarak daha fazla izlendiği gösterildi. Grup 2'deki
hastaların ortalama burun semptom skorları; yok: 3, hafif: 0, orta: 25, şiddetli:
12 olarak görüldü ve fark istatistiksel olarak anlamlı bulundu. Oral kavite/orofarinks
semptomları da Grup 2'de aynı şekilde daha yaygın saptandı. Gruplar
arasında hastaların ortalama kulak semptom skorları anlamlı farklılık göstermedi.
Grup 1'deki hastaların 14'ünde daha iyi prognoz ve 15'inde daha kötü
sonuç vardı. Grup 2'de 25 hastada daha iyi prognoz, 11 hastada daha kötü prognoz
saptandı. Sonuç: Elde edilen parametreler değerlendirildiğinde ulaşılan sonuca
göre, KBB baskın semptomları olan hastalar daha sistemik semptomları olan
hastalardan daha iyi klinik gidişat gösterse de fark istatistiksel olarak anlamlı bulunmadı.
Anahtar Kelimeler: COVID-19; semptom skoru; KBB semptomları; prognoz
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