Dysphonia, dysphagia common in COVID-related pediatric multisystem inflammation
Dysphonia, dysphagia and anosmia/hyposmia were the most common otolaryngologic manifestations among a small cohort of children with pediatric inflammatory multisystem syndrome temporally associated with COVID-19, according to data.
“As a consequence of increasing reports of an unusual and novel presentation of a multisystem inflammatory disease in the UK, the Royal College of Pediatrics and Child Health published a case definition on May 1, 2020, of pediatric inflammatory multisystem syndrome temporally associated with coronavirus disease 2019 (COVID-19) (PIMS-TS),” Ryan C. T. Cheong, BSc (Hons), MBBS, of the Great Ormond Street Hospital for Children NHS Trust, in London, and colleagues wrote in a research letter published in JAMA Otolaryngology–Head & Neck Surgery.
“They defined PIMS-TS as persistent fever, inflammation, and evidence of single or multiorgan dysfunction, with exclusion of any other microbial cause and with positive or negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test results,” they added. “In the U.S., this condition has been defined by the CDC as multisystem inflammatory syndrome in children [MIS-C], with a more specific case definition.”
To analyze the otolaryngologic manifestations of PIMS-TS in children, Cheong and colleagues conducted a single-center exploratory observational cohort study. The researchers reviewed anonymized electronic health record data from 50 juvenile patients who met the case definition of PIMS-TS between April 1, 2020, and June 22, 2020, retrieving clinical and demographic data. Additional data were collected through follow-up telephone screening for otolaryngologic symptoms. Analyses were later performed using Microsoft Excel 2010 on August 10, 2020.
The median age among the 50 included patients was 10 years. Two-thirds were identified as male, and 72% were of Black, Asian or other underrepresented race or ethnicity, the researchers wrote. The median time between acute presentation with PIMS-TS and follow-up screening for otolaryngologic manifestations was 60 days. Nearly a quarter of the children had positive COVID-19 results from polymerase chain reaction tests, while 84% demonstrated positive immunoglobulin G antibodies against the disease based on serology testing. In addition, 76% required admission to a pediatric ICU, and 36% required intubation for mechanical ventilation.
Following the initial telephone screening for otolaryngologic manifestations, 38% required an additional in-person follow-up with an otolaryngologist. These follow-ups were required for otolaryngologic symptoms, the most common of which were dysphonia, dysphagia, and anosmia/hyposmia. These were persistent in 30% of patients at the time of follow-up screening, and significantly present during acute PIMS-TS presentation in 8%.
“Elevated rates of otolaryngology manifestations, such as dysphonia, dysphagia, and anosmia/hyposmia, persisting for longer than 6 weeks warrant otolaryngologic follow-up screening and review as required through the multidisciplinary team for all children recovering from PIMS-TS,” Cheong and colleagues wrote. “Because the long-term sequelae of this disease are unknown, it is prudent for children with a history of PIMS-TS to be reevaluated by the infectious diseases team within 12 months and referred to otolaryngology for any persistent symptoms.”