Case Studies
Patient 1. A 38-year-old man with “the worst cold of his life for the past 2 weeks” presented with chronic nonproductive cough and mild dyspnea on exertion. Additionally, he complained of hearing loss and a sense of pressure in his ears. The physical exam revealed bilateral coarse crackle and wheezing on lung auscultation, and tympanic membrane bulging and purulent effusion on otoscopy. Bilateral consolidations with bronchiolectasis in peripheral locations were identified in organizing pneumonia pattern on spiral non-contrast computed tomography (CT) of both lungs. Polymerase chain reaction (PCR) assay on sample from oropharyngeal swab was positive for COVID-19. He received outpatient treatment and all the symptoms resolved except for anosmia.
Patient 2. A 35-year-old woman presented with sudden-onset anosmia for the past 7 days. The head and neck exam revealed no sign of nasal congestion or discharge, however bilateral middle ear effusion was noted. There were coarse crackles on the upper left lung lobe, in the absence of any dyspnea. CT of the lungs revealed consolidation in the lingula. COVID-19 was confirmed on the PCR assay of nasopharyngeal swab.
Patient 3. A 35-year-old woman working in the laboratory of a COVID-19-designated hospital presented with chronic cough, moderate to severe respiratory distress and bilateral pulmonary changes characteristic of COVID-19 on CT, with COVID-19 confirmed with positive PCR assay. She complained of unilateral earache and hearing loss, and otoscopic exam showed a distinctly red tympanic membrane (Figure 1).
Patient 4. A 20-year-old woman presented with left-sided ear pain and hearing loss. Ear examination showed effusion in the left middle ear and air-fluid level. The tympanic membrane was severely bulged and predisposed to perforation (Figure 2). On coronal views of high-resolution CT (HRCT) of temporal bones, opacification of the left middle air cavity was noted (Figure 2). She had a recent close contact with a family member with COVID19 but reported no other symptoms, and physical exam was otherwise normal. CT chest was normal. She underwent myringotomy. PCR on samples from oropharyngeal swab was negative, nonetheless the PCR performed on the middle ear fluid was positive for COVID-19.
Patient 5. A 22-year-old woman presented with nonproductive cough, left-sided ear pain, aural fullness, hearing loss and sensation of ear popping. Otoscopic exam showed decreased mobility of the left tympanic membrane with bulging contour and hypervascularity and purulent middle ear effusion. Audiogram revealed conductive hearing loss (15 dB) on the left side, with mild sensory-neural hearing loss at high frequency (Figure 3). Axial images on HRCT of the temporal bones revealed opacification of the left middle air cavity, suggestive of otitis media (Figure 3). PCR on oropharyngeal swab was negative but was positive for COVID-19 PCR on nasopharyngeal swab.
Patient 6. A 25-year-old woman with nonproductive cough for the past 3 weeks presented with right-sided hearing loss and otalgia. Otoscopic exam showed serous otitis media with decreased tympanic membrane movement. There were mixed coarse and fine crackles on auscultation of the right lung. HRCT of the lungs confirmed right-sided foci of ground-glass opacity consistent with viral pneumonia. PCR assay performed on the oropharyngeal and nasopharyngeal swabs was positive for COVID-19.
Patient 7. A 22-year-old woman presented with sudden loss of smell and taste and left-sided otalgia and hearing loss for the past week. Otoscopic exam shows typical signs of otitis media with effusion and air-fluid level. She had a unilateral C type tympanogram. Axial non-contrast CT of lungs showed patchy foci of ground-glass opacities in the right upper lobe. PCR assay performed on the oropharyngeal swab was positive for COVID-19.
Patient 8. A 45-year-old woman presented with severe acute otalgia, ear fullness and hearing loss. Ear examination revealed a new central perforation with purulent otorrhea (Figure 4). She had a mild cough but no dyspnea, with bilateral coarse crackles on auscultation of the lungs. Axial non-contrast CT chest revealed bilateral patchy ground-glass opacities in the peripheries of the lower lobes.