Assessment of SARS-CoV-2 in the Cerumen of COVID-19-Positive Patients.

OBJECTIVE: To evaluate the presence of SARS-CoV-2 virus in the cerumen of patients with COVID-19. METHODS: A prospective study was conducted in a tertiary care pandemic hospital. Sixty COVID-19 patients with cerumen in their external auditory canals were included in the study. Swabs were taken from the external auditory canal of the patients by an experienced otolaryngologist with the test swab. Sampling was done by rotating the sample swab 360° 10 times in each external auditory canal for a total of 20 times. After collection, swabs were placed into 2 mL of the sterile viral transport medium (various manufacturers), then transported and tested as soon as possible after collection. RESULTS: SARS-CoV-2 was not detected in the cerumen polymerase chain reaction (PCR) samples of any of the 60 patients with positive nasopharyngeal/oropharyngeal swabs. CONCLUSION: Cerumen cleaning is one of the most common procedures performed by otolaryngologists, and care should be taken during the procedure or due to the possibility of infection from the resulting contaminants. The cerumen contains the secretions of the glands in the external auditory canal and may contain certain pathogens that are actively found in the body. The presence of hepatitis B virus in the cerumen was examined and isolated in the cerumen. In our study, the presence of SARS-CoV-2 virus in the cerumen was evaluated in SARS-CoV-2 PCR-positive patients. SARS-CoV-2 virus was not detected in the cerumen samples of any of the patients.

SARS-CoV-2 Presence in the Saliva, Tears, and Cerumen of COVID-19 Patients.

OBJECTIVES/HYPOTHESIS: The emergence of a new coronavirus strain (SARS-CoV-2) in December 2019 from China led to a global pandemic. The lack of herd immunity against this virus and the possibility of viral spread from asymptomatic individuals is still a major challenge for the prevention of viral transmission. The aim of this study was to evaluate the presence of the virus in different bodily secretions as a potential source of viral spread among patients infected with SARS-CoV-2. STUDY DESIGN: Cross Sectional Study. METHODS: The study included 38 COVID-19 patients with a positive real-time polymerase chain reaction (RT-PCR) test result for SARS-CoV-2, obtained from the combined nasopharyngeal-oropharyngeal swab samples. Saliva, tear, and cerumen samples were taken from the patients within 72 hours of the first RT-PCR test. SARS-CoV-2 N1 and N2 gene regions were studied with single-step RT-PCR in all samples. RESULTS: Among the studied samples, the highest positivity rate was in saliva (76.3%) followed by tears (55.3%) and cerumen (39.5%). Viral load in saliva was also significantly higher compared to tears and cerumen (P < .001), while there was no significant difference between tears and cerumen. Higher viral load in combined nasopharyngeal-oropharyngeal swab samples was associated with higher viral load in tears, but not in saliva or cerumen. Half of the saliva, tear, and cerumen samples obtained from asymptomatic patients contained SARS-CoV-2 genome. CONCLUSIONS: The virus was detected in the saliva, tears, and cerumen samples of both symptomatic and asymptomatic patients. The potential role of these bodily fluids on viral spread needs to be studied. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1677-E1682, 2021.

Does cerumen have a risk for transmission of HIV?

Human immunodeficiency virus (HIV) is mainly transmitted via sexual activity, mother-to-child transmission, and contact with body fluids, such as saliva and semen. Cerumen, however, has not been investigated for its capability to transmit HIV. The purpose of this study was to evaluate the potential of cerumen for transmission of HIV infection. This study was conducted among 42 treatment-naive HIV-infected patients with positive HIV RNA and 27 HIV-infected patients with negative HIV RNA receiving antiviral treatment. Simultaneous blood samples were studied as positive controls. Sixty-nine prospectively collected cerumen specimens were analyzed for the presence of HIV RNA by real-time polymerase chain reaction (PCR). None of the 69 cerumen specimens were positive for HIV RNA. These results conclude that cerumen in HIV-positive patients with or without antiretroviral therapy (ART) carry only an insignificant risk of transmission. However, standard infection control precautions should be applied carefully in all examinations and surgical operations of the ears.

Detection of hepatitis B virus in the cerumen of patients with chronic hepatitis B infection.

OBJECTIVE: To investigate hepatitis B virus DNA in the cerumen of hepatitis B virus infected patients. METHODS: This study comprised 30 confirmed cases of chronic hepatitis B. Patients' serum samples were examined for hepatitis B surface antigen and antibodies using enzyme immunoassay systems. The presence of hepatitis B virus DNA in cerumen was investigated using a polymerase chain reaction test. RESULTS: All of the samples were positive for hepatitis B surface antigen and negative for hepatitis B surface antibodies. Hepatitis virus DNA was detected in two cerumen samples (6.6 per cent of patients). CONCLUSION: Cerumen can be a potential source of transmission of hepatitis B virus.

Cerumen as a potential risk for transmission of Hepatitis B virus.

Hepatitis B virus (HBV) transmission via blood and other body fluids from infected individuals to healthy people has been largely demonstrated. However, in the current literature, there is little information available on the potential role of cerumen in HBV transmission. Cerumen and blood were collected from 70 patients infected with HBV and 70 volunteer healthy people were selected as the control group, and the samples were evaluated by ELISA and Real-time PCR. All the patients proved positive for HBsAg and anti HBc total. Sixty-one of the 70 cerumen samples of cases (82.1%) and 5 (7%) of controls were positive for HBV DNA with ranges from 1.53 × 102 to 2.9 × 108 and 1.3 × 102-2.6 × 105/ml, respectively. In three patients, the level of HBV DNA in cerumen was higher than that in the serums. The patients who were positive for HBeAg showed a higher rate of HBVDNA in the serum and cerumen.The results of this study showed the level of HBV DNA as a probably indicator of high risk transmission factor, which was present in the cerumen of chronic hepatitis B patients in west of Iran.

Analysis of hepatitis B virus in the cerumen and otorrhea of chronic HBV-infected patients: is there a hepatitis B virus infectivity?

HYPOTHESIS: The object of this study was to find out whether cerumen and otorrhea have any infectivity in the transmission of hepatitis B virus (HBV). BACKGROUND: The HBV infection is a worldwide health problem. It can be transmitted by infected blood or other body fluids through percutaneous or permucosal exposure. Recently, there have been some reports where cerumen can be a potential source of HBV transmission. METHODS: This study was performed on 30 chronic hepatitis B patients who tested positive in hepatitis B surface antigen (HBs Ag). Thirty cerumen and 5 otorrhea samples were analyzed. The cerumen and the serum were examined for (HBs Ag) and hepatitis B e antigen (HBe Ag) by using enzyme immunoassay systems. As for HBV DNA detection, quantitative polymerase chain reaction was performed on the serum, cerumen, and otorrhea. RESULTS: : Hepatitis B virus DNA was detected in the 20 samples of cerumen (66.7%) and all 5 otorrhea (100%) from 30 patients. The mean values of HBV DNA in cerumen and otorrhea were significantly lower than serum. Hepatitis B virus DNA and HBs Ag were detected with significantly higher rates in the cerumen of patients who are serum HBe Ag positive than negative. However, positive HBe Ag, which implies that it is associated with the increased risk of disease progression and infectivity, was not detected in any of cerumen samples. CONCLUSION: The cerumen and otorrhea of chronic hepatitis B patients have a low risk of infectivity.

Detection of HCV-RNA in cerumen of chronically HCV-infected patients.

OBJECTIVES/HYPOTHESIS: Viral hepatitis C is a worldwide public health problem. Hepatitis C virus is mainly transmitted by parenteral or percutaneous route. Nonparenteral transmission, such as through sexual activity, household contact, and vertical or perinatal exposure to body fluids or secretions, can occur, which has been studied before. Cerumen, however, has not been investigated for its ability to transmit hepatitis C virus. The aim of this study is to evaluate the importance of cerumen in transmission of hepatitis C virus infection. STUDY DESIGN: This study was performed on 35 patients with confirmed chronic hepatitis C virus infection. METHODS: Thirty-five cerumen specimens collected from the patients with hepatitis C virus RNA in their sera were prospectively analyzed for the presence of hepatitis C virus RNA by polymerase chain reaction. RESULTS: None of the 35 cerumen specimens were positive for hepatitis C virus RNA. CONCLUSION: This study showed that cerumen has no risk for transmission of hepatitis C virus infection, even in patients with high hepatitis C virus RNA serum levels; however, standard infection control precautions should be applied carefully in all examinations and surgical operations of the ears.

Does cerumen have a risk for transmission of hepatitis B?

OBJECTIVES/HYPOTHESIS: Chronic hepatitis B virus infection is a significant worldwide health problem. It affects 350 to 400 million people. The patients with chronic hepatitis B virus infection have a significant risk for the development of cirrhosis or hepatocellular carcinoma. Full awareness of the mechanisms of transmission can allows susceptible individuals to refrain from this infection. Cerumen has never been studied as a route for hepatitis B transmission. The aim of the study was evaluate the importance of cerumen in transmission of hepatitis B virus infection. STUDY DESIGN: This study was performed on forty patients with confirmed hepatitis B virus infection. METHODS: Forty cerumen specimens collected from the patients with hepatitis B virus DNA in their sera were prospectively analyzed for the presence of hepatitis B virus DNA by real-time polymerase chain reaction. RESULTS: Eleven of 40 cerumen specimens (27.5%) were positive for hepatitis B virus DNA, with counts ranging from 4.2 x 10 to 4.7 x 10 copies per sample. There was positive correlation between hepatitis B virus DNA concentrations of serum and cerumen. Half of hepatitis B e antigen (HBeAg)-positive patients had detectable hepatitis B virus DNA levels (5.7 x 10 to 4.7 x 10 copies) in cerumen specimens, whereas 12.5% of cerumen specimens from anti-HBe-positive patients had hepatitis B virus DNA levels (4.2 x 10 to 7.0 x 10 copies). CONCLUSION: Cerumen can be a potential source of transmission. Therefore, this route should be investigated in further studies for horizontal, nosocomial, and occupational transmission of hepatitis B.