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.