Otolaryngology manifestations of COVID-19 in pediatric patients

Abstract

Background The coronavirus disease 2019 pandemic has affected millions of people since its outbreak in December 2019. Limited data exist on otolaryngology manifestations of COVID-19 in pediatrics. This study aims to discuss the clinical features of COVID-19 in pediatrics, with an emphasis on otolaryngology manifestations. Methods The study included 660 COVID-19 laboratory-confirmed positive pediatric patients (aged 3–15 years) diagnosed at King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia. Data were retrospectively retrieved from January to July 2020 from electronic medical records and included patients' epidemiological and clinical features. Patients were then followed-up via phone calls to document any symptoms encountered after the first visit. Patients were categorized into three main groups according to age (3-6 years, 7-10 years, 11-15 years). Results Nearly half of the patients (43.6%) had asymptomatic infections. Fever and cough were the most commonly reported manifestations accounting for 39.2% and 19.8%, respectively. The most frequently reported otolaryngology symptoms were sore throat (17.3%) and rhinorrhea (14.4%). Moreover, 10.4% and 13.1% of children aged 7-15 years old experienced smell and taste disturbances, respectively. Older children (11-15 years) were more likely to report taste disturbances when compared to the younger children (17.2% vs 9.8%, p-value 0.02). Children aged between 3 to 6 years had significantly higher rates of admission (13.7%) and mortality (0.9%) when compared to the older groups (p-value 0.00). Conclusion COVID-19 in pediatrics has a milder disease course and a better prognosis than adults. Multiple otolaryngology symptoms were reported in pediatric patients with COVID-19, which can help identify the suspected cases before the test result.

A systematic review and meta-analysis of otorhinolaryngological manifestations of coronavirus disease 2019 in paediatric patients

“…A higher prevalence is noted in older children. 9 This may be attributed to an age-related biological difference, or may be secondary to the inability of the children to identify or communicate these symptoms effectively. Regarding the pooled incidence, these symptoms affected less than a tenth of infected children.…”

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

“…Indeed, the laboratory findings showed that among hospitalized patients, lymphocytopenia and leukopenia, in addition to elevated levels of ferritin, D-dimer, and C-reactive proteins, were encountered (Almoosa et al, 2020;Alnajjar et al, 2021;Mosalli et al, 2021;Shahin et al, 2021). The mortality rate was very low in the infected children of this country, with this latter not exceeding four deaths among all reports (Almoosa et al, 2020;Alnajjar et al, 2021;Alshengeti et al, 2021;Asseri et al, 2021;Hijazi et al, 2021;Kari et al, 2021b;Mosalli et al, 2021;AlGhamdi et al, 2022). Interestingly, in one study, it was found that 21% of hospitalized children infected with SARS-CoV-2 developed acute kidney injury.…”

“…In the Kingdom of Saudi Arabia, studies have shown a dominant benign prognosis of COVID-19 disease in children. A substantial portion were asymptomatic ( Ahmad et al, 2021 ; Almuzaini et al, 2021 ; Hijazi et al, 2021 ) with this rate ranging from 27.9% ( Mosalli et al, 2021 ) to 54.6% ( Alharbi et al, 2021 ). Among symptomatic ones, the most common reported symptoms were fever, cough, runny nose, and shortness of breath ( Harbi et al, 2020 ; Ahmad et al, 2021 ; Alharbi et al, 2021 ; Alshengeti et al, 2021 ; Mosalli et al, 2021 ; Shahin et al, 2021 ; AlGhamdi et al, 2022 ).…”

“…In some patients, the infection was first asymptomatic and presented later as a complicated course in the form of MIC-S ( Almoosa et al, 2020 ; Al Qahtani et al, 2021 Shahin et al, 2021 ; Table 2 ). Among symptomatic ones, the rate of hospitalization ranged from 4.4% ( Hijazi et al, 2021 ) to 9.6% ( Alharbi et al, 2021 ). Similar to what was observed in Iran, it was found that pre-existing comorbidities, notably cardiac diseases, malignancies, and neurological and metabolic disorders, in addition to higher frequency of lower respiratory and gastrointestinal symptoms, are significantly associated with hospitalization in infected children ( Alharbi et al, 2021 ); an observation that was also described in other studies ( DeBiasi et al, 2020 ; Hendler et al, 2021 ; Woodruff et al, 2022 ).…”

“…Moeller et al, conducted a multicenter study across 174 centers in Europe, found that children with chronic respiratory conditions might be at a higher risk of experiencing a severe form of COVID-19 ( Moeller et al, 2020 ). In hospitalized COVID-19 children, the majority were admitted to the general ward and did not require intensive care ( Alshengeti et al, 2021 ; Asseri et al, 2021 ; Almuzaini et al, 2021 ; Alnajjar et al, 2021 ; Hijazi et al, 2021 ; Kari et al, 2021b ; AlGhamdi et al, 2022 ). On the other hand, those that needed intensive care had more frequent shortness of breath, higher absolute neutrophil counts and ferritin levels, and lower oxygen saturation, and albumin levels compared to those admitted to the general ward in the hospital ( Asseri et al, 2021 ).…”