COVID-19 findings revealed via otolaryngological examination: Findings of a Japan Otorhinolaryngologist Association questionnaire

Abstract

Objective: In Japan, many otolaryngologists provide primary care for patients with coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the characteristics of otorhinolaryngological findings in order to improve COVID-19 diagnostic systems in a primary care setting.

Methods: A total of 351 patients (mean age, 36.0 ± 15.4 years) diagnosed with COVID-19 by otolaryngologists who belong to the Japan Otorhinolaryngologists Association were included in the study. A web-based questionnaire was used to collect information regarding the timing of positive identification of COVID-19, the route of infection, symptoms, and findings in the tonsils, nasal cavity, pharynx, ear, and neck. A modified Centor score was calculated for cases in which age, symptoms, and tonsil and neck findings were described.

Results: Symptoms included fever (56%), olfactory disturbance (46%), and a sore throat (56%). Of the individuals considered, 63% had ordinary rhinoscopic findings, 21% experienced watery rhinorrhea, and 12% had observable mucosal redness. Further, 87% had ordinary tonsillar findings, 13% displayed tonsillar redness, with enlargement and white mucus observe in 2% and 1% of participants, respectively. A total of 193 patients had a calculated Centor score of 3 points in 2%, and scores of the remaining participants were ≤2 points.

Conclusion: Of all patients considered, 40% had nasal findings and 4% had purulent nasal discharge. In contrast, only 13% of the patients had tonsillar findings, and no patients had Centor scores ≥4 points. Symptom differentiation from that of bacterial infections is difficult. In areas where COVID-19 is prevalent, the disease should be considered in patients presenting with fever, olfactory disturbances, and sore throat with minimal or no clinical findings in the nasal cavity and pharynx.

Keywords: COVID-19; Centor score; Olfactory disturbances; Otolaryngological findings.

Fig. 1

Facility where patients were diagnosed with coronavirus disease. For 125 (36%) patients, COVID-19 was diagnosed at their own ENT hospitals, 137 (39%) at fever outpatient clinics, 45 (13%) at PCR centers, 33 (9%) at public health centers, and 11 (3%) at unknown locations.

Fig. 2

Route of infection identified at the time of initial diagnosis. Routes of infection identified at the time of the first visit were as follows: 24 (7%) cases from workplace exposure, 20 (6%) cases from eating with an infected individual, 15 (4%) cases from nightlife exposure, 9 (2%) cases from school, and 6 (2%) cases from travel. A total of 233 (66%) cases were of unknown origin, or the infection route was not reported at the time of the patient's initial examination.

Fig. 3

Symptoms of coronavirus disease present at the initial visit.

Fig. 4

Nasal findings associated with coronavirus disease present at the initial visit.

Fig. 5

Tonsillar findings associated with coronavirus disease present at the initial visit.

Fig. 6

Centor score determined for coronavirus disease-positive patients with a description of associated tonsillar and neck findings present at the initial visit (n = 193). The Centor score calculated was 3 (2%), 2 (34%), 1 (57%), and 0 (7%) for 3, 66, 110, and 14 cases, respectively.