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Lee, S.H.;  Seo, M.Y. SARS-CoV-2 Infection and Rhinologic Manifestation. Encyclopedia. Available online: https://encyclopedia.pub/entry/26030 (accessed on 22 July 2024).
Lee SH,  Seo MY. SARS-CoV-2 Infection and Rhinologic Manifestation. Encyclopedia. Available at: https://encyclopedia.pub/entry/26030. Accessed July 22, 2024.
Lee, Seung Hoon, Min Young Seo. "SARS-CoV-2 Infection and Rhinologic Manifestation" Encyclopedia, https://encyclopedia.pub/entry/26030 (accessed July 22, 2024).
Lee, S.H., & Seo, M.Y. (2022, August 10). SARS-CoV-2 Infection and Rhinologic Manifestation. In Encyclopedia. https://encyclopedia.pub/entry/26030
Lee, Seung Hoon and Min Young Seo. "SARS-CoV-2 Infection and Rhinologic Manifestation." Encyclopedia. Web. 10 August, 2022.
SARS-CoV-2 Infection and Rhinologic Manifestation
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This entry is adapted from the peer-reviewed paper 10.3390/jpm12081234

Many researchers have reported that the nasal cavity is an important initial route for SARS-CoV-2 infection and that the spike protein of this virus binds to angiotensin-converting enzyme 2 (ACE2) on epithelial cell surfaces. Therefore, COVID-19 is thought to significantly affect nasal symptoms and various rhinological diseases. 

SARS-CoV-2 COVID-19 olfaction chronic rhinosinusitis allergic rhinitis rhinology

1. Olfactory Dysfunction

Olfactory dysfunction is regarded as a cardinal symptom of COVID-19. Since the early stages of the pandemic, various centers such as the WHO, CDC, and AAO-HNS have used this symptom as part of the initial screening for COVID-19 [1][2]. Therefore, numerous studies have been conducted on olfactory dysfunction in patients with COVID-19. A recently published article reported that in patients with long-lasting/relapsing olfactory dysfunction after a COVID-19 infection, SARS-CoV-2 RNA was detected in cytological samples from olfactory mucosa but not in nasopharyngeal samples [3]. Therefore, researchers determined that SARS-CoV-2 is persistent in the olfactory epithelium of COVID-19 patients with olfactory dysfunction, and that the olfactory dysfunction is linked to inflammation caused by persistent SARS-CoV-2 infection [3]. In addition, direct damage to the olfactory epithelium, followed by retrograde neuro-invasion of SARS-CoV-2 through the olfactory route, might also affect the olfactory function in COVID-19 patients [3].
The initial prevalence of olfactory dysfunction in hospitalized COVID-19 patients in Wuhan, China, was approximately 13.8% [4]. A study reporting this prevalence shows considerable variability according to researchers and diagnostic tools. A recently published meta-analysis of 27,492 patients reported that the overall prevalence of olfactory dysfunction in COVID-19 patients was 47.85% (95% CI: 41.20–54.50) [3]. The researchers also reported that the prevalence showed variability according to geographical differences: 54.40% in Europe, 51.11% in North America, 31.39% in Asia, and 10.71% in Australia [3]. However, these results include both subjective and objective olfactory disorders, which were assessed using questionnaires and psychophysical tests. When the results were separated according to screening tool (subjective questionnaires and objective psychophysical tests), the prevalence rates were 44.53% and 72.10%, respectively [3]. In another study, the authors conducted an evaluation of 2581 COVID-19 patients and reported that the prevalence of subjective olfactory dysfunction was 85.9% in mild, 4.5% in moderate, and 6.9% in severe COVID-19 patients. However, objective olfactory dysfunction was observed in 54.7% of mild and 36.6% of patients with moderate-to-severe COVID-19 [5]. Therefore, it has also been found that olfactory dysfunction is more prevalent in mild forms of COVID-19. When considering the inconsistency between subjective and objective olfactory dysfunction, olfactory function in COVID-19 patients should not be assessed solely based on the patient’s statements and questionnaires.
The improvement rate of olfactory dysfunction in patients with COVID-19 is relatively higher than that of other symptoms. Regarding subjective olfactory function improvement, about 84.2% of patients stated that their olfactory function was ‘very good’ or ‘good’ 4 weeks after their symptom onset [6]. In addition, only approximately 10% to 25% of patients reported no improvement in their olfactory function. Approximately 48.7% of patients reported complete resolution of olfaction at 4 weeks after symptom onset [7][8][9][10]. Two months after symptom onset, only 24.1% of patients reported no improvement in their olfactory function [5]. Regarding objective olfactory function improvement, only 15.3% and 4.7% of patients did not show improvement at 2 and 6 months, respectively [5]. The authors also published an article about olfactory recovery in COVID-19 infection; 92.1% of patients stated that their olfaction was normalized 2 months after symptom onset. However, only 52.6% of patients were confirmed to have a normosmic status according to a psychophysical test such as the Cross-Cultural Smell Identification Test (CC-SIT) [11]. Considering these results, it is also found that subjective olfactory function assessment using self-reporting questionnaires overestimates the degree of recovery. Therefore, an objective psychophysical test should be conducted.
To date, there has been no definitive treatment for COVID-19-associated olfactory dysfunction. Therefore, many physicians perform various therapeutic modalities, including olfactory training with and without systemic or topical corticosteroid supplementation. Olfactory training is the most validated therapeutic modality for olfactory dysfunction, developed by Hummel et al. [12] using the four odorants according to Henning’s odor prism: eucalyptus (resinous), clove (spicy), lemon (fruity), and rose (flowery). Repetitive exposure to odorants changes the olfactory epithelium, olfactory bulb, and even higher levels of olfactory perception such as neuroplasticity [12]. Functional connectivity, such as olfactory, somatosensory, and integrative networks, increases after olfactory training [13]. Olfactory training is a widely used therapeutic modality especially in patients with post-infectious olfactory dysfunction. Post-infectious olfactory dysfunction occasionally occurs because of upper airway viral infection, in which olfactory impairment persists even after the improvement in other respiratory symptoms [11]. Previously, the authors reported that COVID-19-associated olfactory dysfunction was regarded as a quantitative disorder (hyposmia or anosmia) with a sensorineural cause. These clinical characteristics are similar to those of post-infectious olfactory dysfunction. Therefore, the authors regarded that olfactory training might be significantly effective in treating COVID-19-associated olfactory dysfunction, as do most physicians also looking at it from the same point of view [14].

2. Rhinosinusitis

As mentioned above, the spike protein of SARS-CoV-2 binds to ACE2 on epithelial cell surfaces for primary invasion. Therefore, alterations in ACE2 expression may affect COVID-19 infection. According to a recently published article, ACE2 expression in the sinonasal mucosa is lower in eosinophilic chronic rhinosinusitis (CRS) patients with type-2 inflammation than in patients with non-eosinophilic CRS or control subjects [15]. In addition, ACE2 regulation is positively correlated with proinflammatory cytokines such as tumor necrosis factor (TNF) and interleukin (IL)-1β in CRS patients, and negatively correlated with eotaxin-3, which chemokines related with eosinophil [15]. Another study reported that the expression of ACE2 in the sinonasal mucosa is influenced by the CRS endotypes in patients with nasal polyps. In nasal epithelial cells, type 1 inflammation increases ACE2 expression, while type 2 inflammation decreases it [16]. Therefore, CRS type might be related to SARS-CoV-2 transmission, and an understanding of these findings might contribute to the prevention and control of COVID-19 infection [15][16].
According to the European position paper on rhinosinusitis and nasal polyps 2020 (EPOS 2020), coronavirus is the most common virus isolated from acute rhinosinusitis and acute exacerbating chronic rhinosinusitis [17]. SARS-CoV-2 is a member of the Coronaviridae family, so it causes similar clinical symptoms to other members of the Coronaviridae family. A recently published clinical study reported that clinical diagnosis of acute rhinosinusitis according to EPOS 2020 could be confirmed in approximately 45% of COVID-19 patients. Furthermore, headache is significantly associated with acute rhinosinusitis symptoms in COVID-19 patients, and nasal symptoms were more prevalent in the COVID-19 patients with headache than headache-free COVID-19 patients [18].
To date, there have been many reports on the association between acute invasive fungal rhinosinusitis and COVID-19 infection [19][20][21][22]. Abdelsamie et al. presented a cross-sectional cohort study of 22 adult COVID-19 patients with concomitantly confirmed acute invasive fungal rhinosinusitis. They reported that all patients had diabetes mellitus, and 77.3% of patients were treated with systemic steroid supplementation. Among these 22 patients, 20 patients were treated with intravenous liposomal amphotericin B therapy, and surgical management was performed in 18 patients. According to the pathological results, mucormycosis was confirmed in 19 patients (86.4%) and aspergillus in only 3 patients (13.6%). The treatment outcome included total improvement in 10 patients (45.5%), intracranial extension in 10 patents (45.5%), and 6 patients died from the disease (the mortality rate was 27.3%) [19]. Dilek et al. systematically reviewed COVID-19-associated mucormycosis in 100 patients. They reported that the highest prevalence is in India (n = 68), and 76% were men. The most frequently involved sites were the rhino-orbital complex (n = 50), sinonasal (n = 17), and rhino-orbito cerebral (n = 15) sites. The overall survival rate was approximately 66.7% [20]. According to these articles, the most common risk factors have been corticosteroid use and diabetes mellitus [19][20]. Immune suppression observed in COVID-19 patients was attributed to a decrease in CD4+ and CD8+ T cells [23]. Therefore, COVID-19 patients are more vulnerable to fungal infections. In cases of acute invasive fungal rhinosinusitis, the treatment of choice is management of underlying disease and aggressive surgical debridement. Elmokadem et al. recently published an article about post-operative imaging outcomes in COVID-19 associated acute invasive fungal rhinosinusitis. They reported that 72% of patients showed rapid progression, newly developed intracranial extension, residual/recurrent osteonecrosis, or post-operative facial defects. In addition, 20% of patients showed residual infection, and conservative management with antifungal therapy was performed [24].

3. Allergic Rhinitis

According to two studies, using a COVID-19 protective facial mask during pollen season may reduce the symptoms of allergic rhinitis [25][26]. Dubini et al. reported that ragweed-allergy -related nasal symptoms (sneezing, rhinorrhea, nasal obstruction, and nasal itching) significantly improved in the 2020 ragweed season compared with 2019 [25]. However, ocular symptoms (watering eyes, swollen eyes, eye itching, and tired or sore eyes) were not significantly different between the 2020 and 2019 ragweed seasons [25]. In addition, Liccardi et al. reported that spring seasonal-allergy-related (Parietaria, grasses, and Olea europaea) nasal symptoms (sneezing, rhinorrhea, nasal obstruction, and nasal pruritus) significantly improved in April 2020 compared with April 2019 [25]. However, ocular symptoms (ocular pruritus and tearing) were modest or not significantly different between April 2020 and April 2019 [25].
In patients with COVID-19, lymphopenia affects the T-cell response; severe inflammatory responses, including cytokine storm in severe patients; Th1-Th2 responses; and significant antibody levels increases. Therefore, the response to immunotherapy may be significantly different in COVID-19 patients. According to the Allergic Rhinitis and Its Impact on Asthma-European Academy of Allergy and Clinical Immunology (ARIA-EAACI) statement, in non-infected individuals or patients who have recovered from COVID-19, interrupting subcutaneous immunotherapy (SCIT) is not advised, but expanding injection intervals in the continuation phase may be beneficial. In addition, the interruption of sublingual immunotherapy (SLIT) is not advised and can be performed at home. In COVID-19 patients, interruption of SCIT and SLIT is recommended [27].

References

  1. Xydakis, M.S.; Dehgani-Mobaraki, P.; Holbrook, E.H.; Geisthoff, U.W.; Bauer, C.; Hautefort, C.; Herman, P.; Manley, G.T.; Lyon, D.M.; Hopkins, C. Smell and taste dysfunction in patients with COVID-19. Lancet Infect. Dis. 2020, 20, 1015–1016.
  2. Kowalski, L.P.; Sanabria, A.; Ridge, J.A.; Ng, W.T.; de Bree, R.; Rinaldo, A.; Takes, R.P.; Makitie, A.A.; Carvalho, A.L.; Bradford, C.R.; et al. COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head Neck 2020, 42, 1259–1267.
  3. Saniasiaya, J.; Islam, M.A.; Abdullah, B. Prevalence of Olfactory Dysfunction in Coronavirus Disease 2019 (COVID-19): A Meta-analysis of 27,492 Patients. Laryngoscope 2021, 131, 865–878.
  4. Mao, L.; Jin, H.; Wang, M.; Hu, Y.; Chen, S.; He, Q.; Chang, J.; Hong, C.; Zhou, Y.; Wang, D.; et al. Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020, 77, 683–690.
  5. Lechien, J.R.; Chiesa-Estomba, C.M.; Beckers, E.; Mustin, V.; Ducarme, M.; Journe, F.; Marchant, A.; Jouffe, L.; Barillari, M.R.; Cammaroto, G.; et al. Prevalence and 6-month recovery of olfactory dysfunction: A multicentre study of 1363 COVID-19 patients. J. Intern. Med. 2021, 290, 451–461.
  6. Reiter, E.R.; Coelho, D.H.; Kons, Z.A.; Costanzo, R.M. Subjective smell and taste changes during the COVID-19 pandemic: Short term recovery. Am. J. Otolaryngol. 2020, 41, 102639.
  7. Lv, H.; Zhang, W.; Zhu, Z.; Xiong, Q.; Xiang, R.; Wang, Y.; Shi, W.; Deng, Z.; Xu, Y. Prevalence and recovery time of olfactory and gustatory dysfunction in hospitalized patients with COVID-19 in Wuhan, China. Int. J. Infect. Dis. 2020, 100, 507–512.
  8. Boscolo-Rizzo, P.; Borsetto, D.; Fabbris, C.; Spinato, G.; Frezza, D.; Menegaldo, A.; Mularoni, F.; Gaudioso, P.; Cazzador, D.; Marciani, S.; et al. Evolution of Altered Sense of Smell or Taste in Patients with Mildly Symptomatic COVID-19. JAMA Otolaryngol. Head Neck Surg. 2020, 146, 729–732.
  9. Amer, M.A.; Elsherif, H.S.; Abdel-Hamid, A.S.; Elzayat, S. Early recovery patterns of olfactory disorders in COVID-19 patients; a clinical cohort study. Am. J. Otolaryngol. 2020, 41, 102725.
  10. Altundag, A.; Saatci, O.; Sanli, D.E.T.; Duz, O.A.; Sanli, A.N.; Olmuscelik, O.; Temirbekov, D.; Kandemirli, S.G.; Karaaltin, A.B. The temporal course of COVID-19 anosmia and relation to other clinical symptoms. Eur. Arch. Oto-Rhino-Laryngol. 2020, 278, 1891–1897.
  11. Seo, M.Y.; Choi, W.S.; Lee, S.H. Clinical Features of Olfactory Dysfunction in COVID-19 Patients. J. Korean Med. Sci. 2021, 36, e161.
  12. Hummel, T.; Rissom, K.; Reden, J.; Hahner, A.; Weidenbecher, M.; Huttenbrink, K.B. Effects of olfactory training in patients with olfactory loss. Laryngoscope 2009, 119, 496–499.
  13. Kollndorfer, K.; Fischmeister, F.P.S.; Kowalczyk, K.; Hoche, E.; Mueller, C.A.; Trattnig, S.; Schöpf, V. Olfactory training induces changes in regional functional connectivity in patients with long-term smell loss. NeuroImage Clin. 2015, 9, 401–410.
  14. Seo, M.Y.; Seok, H.; Hwang, S.J.; Choi, H.K.; Jeon, J.H.; Sohn, J.W.; Park, D.W.; Lee, S.H.; Choi, W.S. Trend of Olfactory and Gustatory Dysfunction in COVID-19 Patients in a Quarantine Facility. J. Korean Med. Sci. 2020, 35, e375.
  15. Kawasumi, T.; Takeno, S.; Nishimura, M.; Ishino, T.; Ueda, T.; Hamamoto, T.; Takemoto, K.; Horibe, Y. Differential expression of angiotensin-converting enzyme-2 in human paranasal sinus mucosa in patients with chronic rhinosinusitis. J. Laryngol. Otol. 2021, 135, 773–778.
  16. Wang, M.; Wang, C.; Zhang, L. Inflammatory endotypes of CRSwNP and responses to COVID-19. Curr. Opin. Allergy Clin. Immunol. 2021, 21, 8–15.
  17. Fokkens, W.J.; Lund, V.J.; Hopkins, C.; Hellings, P.W.; Kern, R.; Reitsma, S.; Toppila-Salmi, S.; Bernal-Sprekelsen, M.; Mullol, J.; Alobid, I.; et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 2020, 58, 1–464.
  18. Straburzynski, M.; Nowaczewska, M.; Budrewicz, S.; Waliszewska-Prosol, M. COVID-19-related headache and sinonasal inflammation: A longitudinal study analysing the role of acute rhinosinusitis and ICHD-3 classification difficulties in SARS-CoV-2 infection. Cephalalgia 2022, 42, 218–228.
  19. Abdelsamie, A.M.; Abdelazim, H.M.; Elnems, M.G.; Abdelhakam, R.B.; Abdelalim, A.A. COVID-19-Related Acute Invasive Fungal Sinusitis: Clinical Features and Outcomes. Int. Arch. Otorhinolaryngol. 2022, 26, e152–e157.
  20. Dilek, A.; Ozaras, R.; Ozkaya, S.; Sunbul, M.; Sen, E.I.; Leblebicioglu, H. COVID-19-associated mucormycosis: Case report and systematic review. Travel Med. Infect. Dis. 2021, 44, 102148.
  21. Karimi-Galougahi, M.; Arastou, S.; Haseli, S. Fulminant mucormycosis complicating coronavirus disease 2019 (COVID-19). Int. Forum Allergy Rhinol. 2021, 11, 1029–1030.
  22. Waizel-Haiat, S.; Guerrero-Paz, J.A.; Sanchez-Hurtado, L.; Calleja-Alarcon, S.; Romero-Gutierrez, L. A Case of Fatal Rhino-Orbital Mucormycosis Associated with New Onset Diabetic Ketoacidosis and COVID-19. Cureus 2021, 13, e13163.
  23. El-Kholy, N.A.; El-Fattah, A.M.A.; Khafagy, Y.W. Invasive Fungal Sinusitis in Post COVID-19 Patients: A New Clinical Entity. Laryngoscope 2021, 131, 2652–2658.
  24. Elmokadem, A.H.; Bayoumi, D.; Mansour, M.; Ghonim, M.; Saad, E.A.; Khedr, D. COVID-19-associated acute invasive fungal sinusitis: Clinical and imaging findings. J. Neuroimaging 2022, 32, 676–689.
  25. Dubini, M.; Robotti, C.; Benazzo, M.; Rivolta, F. Impact of quarantine and face masks on ragweed-induced oculorhinits during the COVID-19 pandemic in Northern Italy. Int. Forum Allergy Rhinol. 2022, 12, 220–222.
  26. Liccardi, G.; Bilo, M.B.; Milanese, M.; Martini, M.; Calzetta, L.; Califano, F.; Carucci, L.; Ciccarelli, A.; Cutajar, M.; D’Auria, P.; et al. Face masks during COVID-19 pandemic lockdown and self-reported seasonal allergic rhinitis symptoms. Rhinology 2021, 59, 481–484.
  27. Klimek, L.; Jutel, M.; Akdis, C.; Bousquet, J.; Akdis, M.; Bachert, C.; Agache, I.; Ansotegui, I.; Bedbrook, A.; Bosnic-Anticevich, S.; et al. Handling of allergen immunotherapy in the COVID-19 pandemic: An ARIA-EAACI statement. Allergy 2020, 75, 1546–1554.
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Update Date: 11 Aug 2022
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