ABSTRACT:

Objective: To investigate temporal bone findings in COVID-19

Design: Retrospective study

Settings: Using database of our tertiary pandemic hospital, patients with COVID-19 infection with a positive PCR test and temporal bone tomography imaging were evaluated.

Participants: 42 PCR positive COVID-19 patients with temporal bone imaging.

Main outcome measures: Grading system was created to evaluate effusion in middle ear and mastoid air cells. Also any specific sign in temporal bone imaging.

Results: 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.

No obvious temporal bone involvement was observed in any of the patients. Temporal bone imaging findings were compared according to a grading system and there were no difference between the groups (p=0,50).

Conclusion: The SARS-CoV-2 does not effect the temporal bone. There was no sign of effusion in mastoid air cells or middle ear or any specific sign in temporal bone in our study group.

Keywords: COVID-19, temporal bone, SARS-CoV-2, mastoid, middle ear

INTRODUCTION:

SARS-CoV-2; a novel coronavirus; was identified as the cause of anof acute respiratory disease in Wuhan, China. The number of cases had increased and outbreak spread across the worldwide. World Health Organisation (WHO) was named this new disease as COVID-19 (corona virus disease 2019). COVID-19was declaredpandemic byWHO in March 2020.

There is a lot of unknown about the disease even symptoms are not certain. Fever, cough and shortness of the breath is observed frequently as a result of pneumonia. Disease generally settle in lungs but, the nose and nasopharynx have been shown to be reservoirs for high concentrations of theSARS-CoV-2 virus. ^1,2

Middle ear and mastoid air cell system is covered by respiratory mucosa. Airway mucosa is involved in COVID-19 but it is not known if the respiratory mucosa lining eustachian tube, middle ear and mastoid air system is involved but might be contaminated. ^3,4

Rhinovirus, respiratory syncytial virus and coronovirus as respiratory viruses have been implicated as potential agents of acute otitis media. Acute otitis media is an inflammatory process of the middle ear associated with an effusion. Middle ear and mastoid air cell inflammation result effusion and effusion can be detected by computed tomography. ^5,6,7

Viral infections can cause congenital or acquired, unilateral or bilateral hearing loss. They can directly damage inner ear structures, can stimulate inflammatory responses and cause inner ear damage or can result secondary bacterial or fungal infection; leading to hearingloss. Generally viruses cause sensorineural hearing loss but conductive and mixed hearing losses can be seen. In a study it was shown that hair cells of the cochlea can be injured in COVID-19. But the mechanism is unclear. ^8,9,10,11

There is no information about effect of SARS-CoV-2 virus on ear. Does the virus effect mastoid cells and middle ear like other coronaviruses? Does it cause otitis media or effusion? Is there any radiological finding in mastoid or middle ear or cochlea?

In our study we investigated the temporal imaging of the COVID-19 positive patients.

MATERIAL AND METHODS:

This was a retrospective observational study. The study group comprised of 42 patients. The patients with COVID-19 infection with a positive PCR test and temporal computed tomography (CT) were evaluated. 42 subjects were included through total 789 patients due to the selection of those who has temporal bone imaging. Patients had temporal computed tomography (CT) scans, paranasal CT axial scans or cranial CT scans. All patients had active COVID-19 infection, imaging including temporal bone during hospitalization, normal tympanic membrane and symptoms which lead to imaging like headache or fullness around eyes.

The patients with a history of chronic otitis media, ear surgery, active other infection besides COVID-19, hearing loss, smoker or vertigo are excluded from the study. Grading system was used to evaluate effusion in imagines. These score is applied as for left or right mastoid cells and left or right middle ear separately 0= no inflammation, 1= partial inflammation and 2= %100 inflammation. Maximum total score was8.

The patients divided into two groups due to findings in chest (CT) findings. Group 1 (27 patients) had typical radiological signs for COVID-19 and group 2 (15 patients) had negative no signs of COVID-19. Groups was compared for grading scores.