Ethical Consideration
Because this research includes human subjects, ethical approval was taken from the Ministry of Health and the local ethical commitee. All patient were informed about the study and informed consent was obtained.
RESULTS:
A total of 42 hospitalized patients who were confirmed positive for COVID-19 and had a temporal computed tomography (CT) scans, paranasal CT axial scans or cranial CT scans were included to this study.
The mean age was 45,61 (standard deviation ± 19.60; min–max 20–83 years). Of the 42 patients, 26 (61.9%) were male and 16 (38.1%) were female. Patients were divided into two groups according to their chest CT findings. Group 1 had specific chest CT findings and included 26 patients, group 2 had no findings in chest CT and included 16 patients. There were no difference in the female/male proportion between groups (p: 0.636). There was no difference between the groups for comorbid diseases (Table 1) and onset symptoms of disease (Table 2). No obvious mastoid air cells and middle ear cavity involvement was observed in any of the patients. Temporal imaging findings were compared according to our grading system and there were no difference between the groups (p=0,50) (Table 3).
DISCUSSION:
SARS-CoV-2 virus found in high concentrations in nose and nasopharynx. Nasopharynx has close relation with mastoid cells and middle ear. Airway mucosa is involved in COVID-19. Middle ear, eustachian tube and mastoid cells are covered by airway mucosa which is involved in COVID-19. Because of these findings ear might be contaminated but there is no evidence.1,12,13
It is known that coronaviruses has role in acute otitis media and upper respiratory tract infections. Effusion often seen in acute otitis media and upper respiratory tract infections. This effusion can be seen in radiological examination of the middle ear and mastiod cells. There is a unknown about SARS-CoV-2’s middle ear involvement. Virus might cause otitis media like other coronaviruses and this can be seen in radiological imaging.6.13,14
Evaluating hearing loss pathogenesis of COVID-19 has getting attention and needs more studies and evidence. Middle ear and mastoid cavity may be an important route of infection. Virus may effect middle ear, inner ear or mastoid cells and cause hearing loss which may be detected by temporal bone imaging. But there is no study about temporal bone imaging of COVID-19.
Untill now there is no specific treatment for COVID-19, so hand hygiene, social distancing, quarantine and wearing face masks are the main points of the preventing the spread of the disease. 15,16,17
COVID-19 pneumonia has typical radiological signs in chest CT like unilateral or bilateral ground-glass opacities and consolidation with or without vascular enlargement, interlobular septal thickening, and air bronchogram sign.18
In our study we found no specific involment in temporal bone. No typical CT findings and interestingly no effusion in mastoid cells or middle ear. All patients had normal healthy temporal CT. There were no difference between two groups according to grading with or without typical signs of COVID-19 in chest CT.
Our study is the first study which investigate the temporal CT in COVID-19. The signs of acute otitis and/or effusion and typical CT findings in temporal bone were investigated.
Limitations of our study were retrospective design, small number of the study groups and lack of hearing test of the patients. Because the COVID-19 is very contagious we could not design a prospective study, which performs temporal bone tomography and hearing test together to all of the patients.
We examined the tympanic membranes of the all patients but we did not perform hearing test and tympanometric test to patients. After evaluating the mastoid cells, middle ear and inner ear temporal bone findings we found that the virus has no effect on temporal bone with or without chest CT findings. It can be suggested that hearing loss in COVID-19 is not because of the effusion in ear, acute otitis or any involment that can be diagnosed via temporal CT with these findings. Further studies with larger populations, detailed hearing tests, cochlear and inner ear evaluation will be useful to evaluate the etiology of hearing loss in COVID-19.
CONCLUSİON:
There was no middle ear or mastoid involment also no effusion seen in COVID-19. According to our findings SARS-CoV-2 doesn’t cause any temporal bone radiological changes.
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