Olfactory and gustatory dysfunction, evaluation and the impact on quality of life among COVID-19 patients: a multi-centre study.

Background: Olfactory and gustatory dysfunctions are frequently reported symptoms among COVID-19 patients. However, several reports suggested that there might be significant variation in the prevalence and clinical picture of chemosensory dysfunction in COVID-19 patients among different population. Objective: To study the prevalence of chemosensory dysfunction, recovery time and its impact on quality of life (QoL) among COVID-19 patients in Saudi population. Methods: This multi-centre observational study was conducted at three COVID-19 centres in Saudi Arabia. Epidemiological and clinical data were extracted at baseline and within the 2-month post-infection. Olfactory and gustatory dysfunctions were assessed via valid taste and smell questionnaire, electronically collected via online survey. Short version of questionnaire of Olfactory disorders-negative statements (sQOD-NS) was used to assess the impact on QoL. Result: Total 1734 patients [926 males and 808 females, the mean age of patients was 37.7±11.6 years] with laboratory confirmed COVID-19 were recruited for this study. Chemosensory dysfunction was reported in 56.5% cases. olfactory and gustatory dysfunctions were significantly high in females (66.2%) and age group younger than or equal to 40 years (62.2%). Among patients with olfactory dysfunction and gustatory dysfunction, recovery rate was 757 (77.2%) and 702 (71.6%). Furthermore, the recovery time was within 8 days of onset of symptoms in 53.6% and 61.3% of olfactory dysfunction and gustatory dysfunction cases, respectively. Overall mean QoL score indicated Olfactory and gustatory dysfunction has significant impact on QoL [11.3±6.2 (P value<0.001)]. female as compared to males (12.8±7). Females had significant impact on QoL (11.4±6.6) as compared to males [12.8±7 (P value<0.001)]. Conclusion: Chemosensory dysfunction among Saudi population was comparable to the European data and significantly higher than Asian supporting the fact that these symptoms vary as per ethnicity. Olfactory and gustatory dysfunction significantly impaired QoL and could present as an early symptom of COVID-19. Recovery rate of these symptoms can serve as a good prognostic data for patient's counselling. Further long-term follow-up studies would lead to better understanding of prognosis and clinical outcomes.

The Influence of the COVID-19 Pandemic on the Hearing Impaired.

Background In this study, we aimed to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic-induced social restrictions, including face masks, on patients with hearing problems. Methodology This cross-sectional survey study was conducted in an ENT tertiary care center. After signing the consent form, we invited study subjects with hearing disabilities who were using unilateral or bilateral hearing aids to participate in filling out the study survey. The study questionnaire was completed by 80 subjects. The questionnaire included various questions about the respondent's demographics, hearing aids, and communication with a face mask during COVID-19 restrictions. All statistical analyses were performed using SPSS version 19 (IBM Corp., Armonk, NY, USA). Results Overall, 40% of the study sample agreed that understanding people wearing face masks is harder because their speech is muffled, whereas 10% disagreed, and 50% were neutral. While 41.3% agreed that understanding is harder because they cannot see their mouth moving, 23.8% disagreed, and 35% were neutral. More than half of the study sample (55%) agreed that they are worried about how they will communicate with others if wearing face masks becomes more common. However, 50% of the participants thought that they can still hear people when they speak to them from a safe distance. Of note, 71.3% of subjects disagreed about tinnitus being worse since the lockdown. Conclusions The widespread use of face masks had a significant impact on the daily communication and interactions of people with hearing impairments. More research is needed to find creative ways to help these patients improve their daily communication and social interactions.

Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia: A multicenter study.

OBJECTIVES: To assess the otorhinolaryngological (ORL) symptoms, including their prevalence, severity, and early presentations among coronavirus disease-19 (COVID-19) patients in the Saudi population. METHODS: This was a multicentric, cross-sectional study carried out on severe acute respiratory syndrome coronavirus-2 positive patients at 3 COVID-19 centres; Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, ALKhobar, Qatif Central Hospital, AlQatif, and Ohud Hospital, Al Madinah Al Munawarah, Saudi Arabia. The validated survey consisted of sociodemographic data, general symptoms of COVID-19, and ORL manifestations. RESULTS: A total of 1734 COVID-19 positive patients were included in the study (mean age: 37.7±11.6 years). Most of the cases were mild (51.8%), followed by moderate (45.6%), and severe (2.6%) cases. Approximately 33.7% were asymptomatic. Severity of symptoms was significantly associated with male gender (p=0.017), higher age-group (p=0.04), and smoking (p<0.001). The most common initial ORL presentations were sore throat (20.9%), anosmia (15.5%), hyposmia (10%), and loss of taste (11.4%). Overall, 79.5% showed ORL symptoms as the initial presenting symptoms for COVID-19, with anosmia and sore throat being the most common symptoms. CONCLUSION: This study confirmed the prevalence of ORL symptoms among COVID-19 patients in Saudi Arabia. Moreover, these symptoms could also be considered for early detection of COVID-19 as they might appear prior to other symptoms.

Seasonal influenza vaccination coverage and its association with COVID-19 in Saudi Arabia.

Coronavirus Disease 2019 (COVID-19) pandemic is still on-going worldwide. The available information regarding the seasonal influenza vaccine (SIV) coverage during the COVID-19 pandemic and its impact on SARS-CoV-2 spread are limited. Moreover, it is argued that SIV may or may not lessen the COVID-19 severity. No previous studies have been revealed SIV coverage among COVID-19 patients and its association with COVID-19 spread and severity, especially in Saudi Arabia. Hence, this study aimed to estimate the influenza vaccine uptake in confirmed COVID-19 patients and investigate its impact on COVID-19 spread and severity. Accordingly, 1734 COVID-19 confirmed patients were included from three government hospitals in Saudi Arabia (SA). The data were collected electronically through a newly formed, self-administrated questionnaire. Among those patients, 335 were covered with SIV (19.31%), and the coverage rate of females and males was 23.4% and 15.8%, respectively. Severe COVID-19 cases were less in vaccinated patients than in non-vaccinated (2.69% vs. 3.5%, respectively). Additionally, the results showed a significant decrease in getting infected by SARS-CoV-2 after receiving SIV (P = 0.022). Even with the tremendous efforts to promote SIV uptake among the general population and high-risk groups, the SIV coverage in SA is not optimal yet. Nevertheless, there is a significant decrease in the probability of getting infected with SARS-CoV-2 after receiving SIV. Such findings with the continuous progression of the COVID-19 pandemic call for a novel approach regarding vaccination policies to increase SIV and COVID-19 vaccine uptake.

Consistency of Using an Auditory Prosthesis Device Post a Sequentially Implanted Cochlear Implant: Data-Logging Evidence.

Objectives The aim of this study was to explore: 1) the average use of each device in sequentially implanted cochlear implants; 2) whether the inter-implant duration between implants produced any significant difference in the average use of the second implant; and 3) whether wearing hearing aids before the implantation of the second cochlear implant affects its average use. Materials and methods The study included 20 participants with bilateral Nucleus 24 implants (Cochlear Corporation, Lone Tree, CO). Data regarding various variables were extracted and then analyzed with IBM SPSS Statistics for Mac, version 23 (IBM Corp., Armonk, NY). Results The pediatric group included 14 subjects (average age 7.5 years) while the adult group comprised six subjects (average age 37.5 years). The average use of the second device was 0.9 hours per day more than the first in the pediatric group while it was 1.22 hours per day more in the adult group. We also divided the subjects on the basis of duration between the first and second devices and calculated the average use of each device by them. There was no significant difference (p>0.05). The average use by subjects who did and did not use hearing aids before implantation was also insignificant (p>0.05). Conclusions No significant difference between the average use of the first and second implants, between the inter-implant duration of the first and second implants, the average use of the second implant, and between using hearing aids before the implantation of the second device and the average use was observed.

Investigating Facial Nerve Stimulation After Cochlear Implantation in Adult and Pediatric Recipients.

OBJECTIVES/HYPOTHESIS: Facial nerve stimulation (FNS) can occur after cochlear implantation for a small number of recipients. This study aimed to investigate if a correlation exists between the variables involved in FNS. STUDY DESIGN: Retrospective cohort review. METHODS: There were 32 out of 1,100 cochlear implant recipients who experienced FNS in our clinic between 2010 and 2019. The following variables were recorded from a retrospective chart review: grade of FNS, onset of FNS, the number of channels stimulating FNS, and radiological findings of abnormalities in the inner ear. Statistical analyses were performed to identify a correlation between any of the variables involved. The techniques used to reduce FNS were analyzed. RESULTS: Eleven adult ears had progressive hearing loss, three had idiopathic sudden sensorineural hearing loss (SNHL), and one congenital SNHL. All pediatric ears were diagnosed with congenital SNHL, except for one ear with idiopathic sudden SNHL. The grade of FNS ranged from mild stimulation or slight motion in the eye, mouth, nasolabial, or forehead regions (n = 8) to total severe stimulation of the facial musculature and/or severe pain (n = 3). The onset of FNS occurred immediately after activation for nine ears, and up to 16 months later for the other subjects. A significant correlation was observed between the number of channels stimulating FNS, the grade of FNS, and the radiological findings of the inner ear. FNS was completely resolved for 30 ears and partially resolved for two ears. CONCLUSIONS: FNS can occur any time after cochlear implantation and can affect both adult and pediatric. However, it can be effectively resolved using specific fitting techniques. LEVEL OF EVIDENCE: 2c Laryngoscope, 131:374-379, 2021.

FORM24 electrode array and perioperative cerebrospinal fluid leakage in cochlear implant recipients with cochleovestibular malformations.

BACKGROUND: Cochlear implant (CI) recipients with a cochleovestibular malformation (CVM) are at a higher risk of experiencing an intra-operative cerebrospinal fluid (CSF) gusher and, therefore are at greater risk of developing postoperative meningitis than are CI recipients with normal cochlear anatomy. To control CSF gushers, the FORM electrode array was developed. OBJECTIVES: To assess the ability of the FORM24 electrode array in managing intraoperative CSF gushers and preventing postoperative CSF leakage in a population of CI recipients. DESIGN: Retrospective. SETTING: Tertiary health care center. PATIENTS AND METHODS: All CIs in which a FORM24 was used between January 2014 and March 2018 were reviewed for demographic and safety results. MAIN OUTCOME MEASURES: Safety results were assessed as the intraoperative or postoperative presence of an episode of CSF leakage or meningitis. SAMPLE SIZE: 177 CI recipients. RESULTS: Thirty-six (20.3%) had a CVM and 141 had normal anatomy (79.7%). Of the 36 participants with a CVM, 20 (55.6%) experienced an intraoperative CSF gusher, all of which were resolved. No cases of postoperative leakage or meningitis were recorded after a mean follow-up time of 36 months. CONCLUSION: The FORM24 array is able to help surgeons stop intraoperative CSF gushers and prevent postoperative CSF leakage and meningitis in CI recipients with a CVM. LIMITATIONS: Further studies are needed. CONFLICT OF INTEREST: None.

New Classification of Cochlear Hypoplasia Type Malformation: Relevance in Cochlear Implantation.

OBJECTIVES: This paper attempts to create a new classification type of cochlear hypoplasia (CH)-type malformation taking into consideration of vestibular section and internal auditory canal (IAC). MATERIALS AND METHODS: Preoperative computed-tomography (CT) scans of cochlear implant (CI) candidates (N=31) from various clinics across the world with CH type malformation were taken for analysis. CT dataset were loaded into 3D-slicer freeware for three-dimensional (3D) segmentation of the inner-ear by capturing complete inner-ear structures from the entire dataset. Cochlear size in terms of diameter of available cochlear basal turn and length of cochlear lumen was measured from the dataset. In addition, structural connection between IAC and cochlear portions was scrutinized, which is highly relevant to the proposed CH classification in this study. RESULTS: CH group-I has the normal presence of IAC leading to cochlear and vestibular portions, whereas CH group-II is like CH group-I but with some degree of disruption in vestibular portion. In CH group-III, a disconnection between IAC and the cochlear portion irrespective of other features. Within all these three CH groups, the basal turn diameter varied between 3.1 mm and 9.6 mm, and the corresponding cochlear lumen length varied between 3 mm and 21 mm for the CI electrode array placement. CONCLUSION: A new classification of CH mainly based on the IAC connecting the cochlear and vestibular portions is presented in this study. CI electrode array length could be selected based on the length of the cochlear lumen, which can be observed from the 3D image.

Feasibility and Efficacy of Vibrant Soundbridge Short Process Coupler in Patients With Aural Atresia.

OBJECTIVES: Different options are available for hearing restoration in patients with aural atresia. Middle ear implantation with the Vibrant Soundbridge (VSB) has been used successfully in many patients with aural atresia with conductive or mixed hearing loss. The aim of the current study was to assess the safety and the efficiency of VSBs coupled to the short process of the incus in patients with aural atresia with conductive or mixed hearing loss. METHODS: The study was a retrospective chart review conducted at a tertiary university hospital. Audiological and surgical data from six ears with aural atresia implanted with VSBs coupled to the short process of the incus were analyzed. The audiological results were compared with previously reported results obtained after the utilization of different coupling techniques. RESULTS: All six atretic ears were successfully implanted using the short process coupler, and there were no major complications. Postoperative bone conduction thresholds did not differ substantially from preoperative thresholds. The respective mean preoperative pure-tone average 4, speech reception threshold, and word recognition score values were 56.7 dB, 61.7 dB, and 44%. Postoperative pure-tone average 4 thresholds (25 ±â€Š3.5 dB) and speech reception thresholds (20.8 ±â€Š8 dB) were significantly improved. The maximum postoperative word recognition score achieved was 100%. The audiological outcomes obtained were similar to previously reported outcomes after classic stapes placement. CONCLUSION: Coupling of the floating mass transducer to the short process of the incus in patients with aural atresia resulted in significant audiological improvements that were comparable to previously reported improvements after placement via other methods.

Influence of family environment on the outcomes of cochlear implantation in pediatric recipients.

OBJECTIVES: To determine whether family environment and demographic factors such as family income and education produce any significant difference in postoperative performance of cochlear implant (CI) patients. METHODS: In this study, 49 participants who received cochlear implant devices at King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia before the age 5 years were included. Data were collected between July 2019 and August 2019. Postoperative performance was assessed by speech intelligibility rating (SIR) and categories of auditory performance (CAP) scales. Family environment was assessed with family environment scale (FES) survey. Data of demography, average income, and maternal and paternal education were obtained through review of patient's medical files. The data obtained were analyzed using Statistical Package for Social Sciences for Mac, version 23 (IBM Corp, Armonk, NY, USA). RESULTS: A significant difference between the organization categories of FES (p less than 0.05) was observed in terms of postoperative CAP scores, while a significant effect of the expressiveness category on both postoperative CAP and SIR scores (p less than 0.05) was observed. The scores on both CAP and SIR scales were significantly affected by maternal education, and the scores on SIR scale were positively correlated with paternal education. CONCLUSION: This study suggests that post-procedural performance of auditory perception and speech intelligibility in CI patients is significantly related to the family environment as well as the education levels of the parents.

Complications of post-cochlear implantation in 1027 adults and children.

BACKGROUND: The number of cochlear implant (CI) recipients is increasing so there needs to be greater awareness of possible CI complications. OBJECTIVES: Describe complications of CI. DESIGN: Retrospective, descriptional. SETTINGS: Tertiary health care center. PATIENTS AND METHODS: Data was collected by retrospective chart review on complications for recipients implanted for the period from January 2006 to June 2017. MAIN OUTCOME MEASURES: Major and minor post cochlear implantation complications. SAMPLE SIZE: 1027 cochlear implant recipients. RESULTS: Post-operative complications were reported in 105 patients (10.2%). Minor complications were most often encountered (9.5%). Swelling (wound seroma or hematoma) was the most common complication. The major complication rate was only 7/105, 0.7%. Meningitis did not occur and cholesteatoma occurred in only one patient. CONCLUSION: CI is a safe surgical procedure at our center. We believe that this is probably due to the preoperative protocol, the surgical technique used, and the postoperative care conducted for all our patients. Despite this, it is important that both physicians and patients have knowledge of the possible consequences and risks posed by CI, especially in view of the fact that these patients require lifetime follow-up. LIMITATIONS: Further studies are needed, and should include more ENT centers across all regions of Saudi Arabia. CONFLICT OF INTEREST: None.