Dysphagia has emerged as a ‘top’ clinical symptom in COVID-19 patients
SARS-CoV-2 infection has been linked to approximately 360 million cases and 5.6 million deaths since the start of the COVID-19 pandemic. While vaccine protection against the SARS-CoV-2 virus is increasing globally, the first incidence of Omicron disease—a disturbing new form—has been reported. Since then, Omicron has rapidly spread around the world, displacing the Delta form and creating new outbreaks in several countries.
“Since the start of the pandemic, ZOE has consistently documented the most common COVID symptoms and how they have changed over time,” according to ZOE Health Research, which collects patient data on their symptoms.
“These symptoms have developed due to many factors, including the introduction of vaccines and the emergence of new variants.”
“The SARS-CoV-2 coronavirus that causes COVID-19, like all viruses, is constantly evolving in terms of its transmissibility and the symptoms it produces.”
A case series of COVID-19-positive patients seeking treatment in the otolaryngology department for acute dysphagia, severe sore throat, and fever have been presented.
During the first weeks of the Omicron wave in Sweden, “we saw a large number of young patients with clinical signs of SARS-CoV-2 infection. Laryngitis and/or acute pharyngitis associated related to COVID-19 occurs in all populations.”
The triad of clinical symptoms displayed by these patients suggests that they are suffering from potentially fatal epiglottitis. Therefore, a prompt clinical examination, including laryngoscopy, is required to confirm the diagnosis and guide treatment.
“None of the individuals in this trial had epiglottitis swelling or edema requiring airway care. Only one patient had arytenoid edema.”
“However, we found 7 cases of acute epiglottitis with concomitant COVID-19 infection in the literature, so this diagnosis needs to be investigated and quickly ruled out, especially if the patient has characteristic clinical triad,” states ZOE Health Research.
The clinical presentation of SARS-CoV-2 infection has become a common symptom of COVID-19 in the Omicron form, with acute painful swallowing, severe sore throat, and fever. Symptoms such as cough, fever, and loss of taste or smell were more common in previous episodes. Currently, patients with Omicron infection rarely report these symptoms.
Preliminary research suggests that Omicron causes milder symptoms than Delta, although it remains unclear whether the lower severity is due to variant features or to increased global immunization immunity. Although preliminary research suggests that Omicron is milder, a significant number of patients require hospitalization to control their symptoms. In the described cohort, 20% required hospitalization for symptomatic treatment. All patients received at least two doses of COVID-19 vaccine.
The study’s authors added: “After excluding epiglottitis, the patients in the described group were given diagnoses as acute viral laryngitis or acute viral pharyngitis based on endoscopic images of the larynx and pharynx.”
Some patients with secondary bacterial infections received oral antibiotics. Traditionally, acute laryngitis was treated with rest, analgesics, and moisturization. According to the results of the Cochrane review of the benefits of antibiotic treatment for acute laryngitis in adults, antibiotics do not appear to be effective in treating this condition.
Finally, we provide a case series of 20 patients admitted to our ENT department during the SARS-CoV-2 Omicron episode with COVID-19-associated laryngitis and pharyngitis. The most common symptoms in these patients were acute sore throat, severe sore throat, and fever.
The majority of patients are young, healthy people who have been vaccinated against COVID-19. This clinical presentation of COVID-19 is unusual in previous episodes. Because a similar set of symptoms is associated with potentially fatal epiglottitis, a rapid laryngoscopy should be performed to rule out emphysema due to upper respiratory tract inflammation.
None of the patients with COVID-19-associated dysphagia had edema in the larynx or epiglottis, resulting in airway obstruction. Despite being vaccinated against COVID-19, 20% of patients were hospitalized for symptomatic treatment. In the absence of airway edema, acute dysphagia is treated with high-dose analgesics, NSAIDs, and local anesthetics to numb the lining of the mouth and throat. In severe cases, inhaled epinephrine and oral/intravenous corticosteroids may be needed to relieve symptoms.
Authority to solve :
- Acute painful swallowing: A new symptom of COVID-19 in the Omicron variant SARS-CoV-2 outbreak in Sweden – (https:pubmed.ncbi.nlm.nih.gov/35170099/)