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Research ArticleOriginal Article
Open Access

Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia

A multicenter study

Laila M. Telmesani, Danah H. Althomaly, Lamia A. Buohliqah, Roa T. Halawani, Mona M. Ashoor, Marwan J. Alwazzeh, Suad A. Al Mubarak, Maha A. AlHarbi, Rana F. AlMuslem, Sahal S. Arabi, Waleed E. Saleh, Amal Y. ALYosif, Mohammad R. Al Eid, Lena S. Telmesani and Abdulaziz S. AlEnazi
Saudi Medical Journal March 2022, 43 (3) 266-274; DOI: https://doi.org/10.15537/smj.2022.43.3.20210501
Laila M. Telmesani
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Danah H. Althomaly
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Lamia A. Buohliqah
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Roa T. Halawani
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Mona M. Ashoor
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Marwan J. Alwazzeh
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Suad A. Al Mubarak
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Maha A. AlHarbi
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Rana F. AlMuslem
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Sahal S. Arabi
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Waleed E. Saleh
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Amal Y. ALYosif
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Mohammad R. Al Eid
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Lena S. Telmesani
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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Abdulaziz S. AlEnazi
From the Department of Otolaryngology Head and Neck Surgery (L.M. Telmesani, Ashoor, L.S. Telmesani, AlEnazi); from the Department of Internal Medicine (Alwazzeh), College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, from the Department of Otolaryngology - Head and Neck Surgery (Althomaly, AlHarbi), Ministry of Health, Al-Khobar, from the Department of Otorhinolaryngology - Head and Neck Surgery (Buohliqah, Al Mubarak, AlMuslem, ALYosif, Al Eid), Qatif Center Hospital, Ministry of Health, AL Qatif, and from the Department of Otorhinolaryngology - Head and Neck Surgery (Halawani, Arabi, Saleh), Ohud General Hospital, Ministry of Health, AL Medina Al Munawarah, Kingdom of Saudi Arabia.
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    Figure 1

    - Severity of coronavirus disease-19 (N=1734).

Tables

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    Table 1

    - Demographics of cases with COVID-19 according to severity (N=1734).

    CharacteristicsTotalCovid-19 severityP-value
    nMildModerateSevere
    Gender
    Male926452 (48.8)445 (48.1)29 (3.1)0.017
    Female808446 (55.2)346 (42.8)16 (2) 
    Nationality
    Saudi1564808 (51.3)722 (46.2)40 (2.6)0.38
    Non-Saudi17096 (56.5)69 (40.6)5 (2.9) 
    Age (years)
    >188041 (51.2)36 (45)3 (3.8)0.04
    21-401057555 (52.5)480 (45.4)22 (2.1) 
    41-60528265 (50.2)249 (47.2)14 (2.7) 
    >6069 26 (37.7)6 (8.7) 
    Smoking
    Smokers29176 (26.1)194 (66.7)21 (7.2)<0.001
    Non-smokers1443822 (57)597 (41.4)24 (1.7) 
    Chronic disease
    Yes662327 (49.4)313 (47.3)22 (3.3)0.134
    No1072571 (53.3)478 (44.6)23 (2.1) 

    Values are persented as number and precenteges (%), n: number, COVID-19: coronavirus disease-19

      • View popup
      Table 2

      - Initial presented symptoms in COVID-19 cases (N=1734).

      Symptomsn (%)
      Otorhinolaryngological symptoms
      Anosmia269 (15.5)
      Hyposmia173 (10.0)
      Loss of taste198 (11.4)
      Nasal congestion126 (7.3)
      Pharyngodynia167 (9.6)
      Rhinorrhea83 (4.8)
      Sore throat363 (20.9)
      None80 (4.6)
      Anosmia, hyposmia and loss of taste275 (15.9)
      General symptoms
      None140 (8.1)
      Fever362 (20.9)
      Cough118 (6.8)
      Shortness of breath29 (1.7)
      Headache47 (2.7)
      Myalgia20 (1.2)
      Arthralgia8 (0.5)
      Fatigue35 (2.0)
      Nausea or vomiting18 (1.0)
      Abdominal pain2 (0.1)
      Diarrhea8 (0.5)
      Loss of appetite25 (1.4)
      Fever, cough, headache, shortness of breath, muscle pain, and joint pain342 (19.7)
      Headache, muscle pain, joint pain, and fatigue258 (14.9)
      • View popup
      Table 3

      - Comparison of ORL symptoms according to severity of COVID-19 (N=1734).

      SymptomsSeverity of COVID-19P-value*
      Mild (n=898)Moderate - severe (n=836)
      n (%)
      Anosmia408 (45.4)393 (47.0)0.504
      Loss of taste398 (44.3)385 (46.1)0.451
      Waking up at night348 (38.8)350 (41.9)0.183
      Excessive daytime sleep337 (37.5)348 (41.6)0.081
      Morning headache342 (38.1)336 (40.2)0.399
      Sore throat331 (36.9)322 (38.5)0.49
      Hyposmia316 (35.2)313 (37.4)0.331
      Nasal congestion302 (33.6)297 (35.5)0.405
      Difficulty falling asleep296 (33.0)283 (33.9)0.685
      Sneezing255 (28.4)240 (28.7)0.89
      Voice change260 (29.0)233 (27.9)0.612
      Rhinorrhea253 (28.2)236 (28.2)0.909
      Foreign body sensation in throat245 (27.3)227 (27.2)0.95
      Hoarseness of voice231 (25.7)226 (27.0)0.539
      Voice fatigue235 (26.2)221 (26.4)0.924
      Dizziness217 (24.2)208 (24.9)0.69
      Breathlessness during speaking215 (23.9)200 (23.9)0.99
      Odynophagia204 (22.7)197 (23.6)0.68
      Heart burn190 (21.2)199 (23.8)0.181
      Facial pain/pressure166 (18.5)173 (20.7)0.3
      Postnasal drip172 (19.2)161 (19.3)0.908
      Abrupt awakenings accompanied by gasping148 (16.5)159 (19.0)0.161
      Dysphagia145 (16.1)148 (17.7)0.374
      Ear pain pressure137 (15.3)143 (17.1)0.301
      Loud snoring112 (12.5)133 (15.9)0.042
      Tinnitus106 (11.8)126 (15.1)0.041
      Ear fullness99 (11.0)100 (12.0)0.514
      Epistaxis42 (4.7)46 (5.5)0.39
      Loss of voice40 (4.5)45 (5.4)0.387
      Hearing loss22 (2.4)47 (5.6)0.001
      Otorrhea22 (2.4)23 (2.8)0.689

      ORL: otorhinolaryngology, COVID-19: coronavirus disease-19, *Chi-square test

        • View popup
        Table 4

        - Comparison of otorhinolaryngology symptoms between different age groups (N=1734).

        SymptomsAge (years)P-value*
        ≤40>40
        n (%)
        Anosmia602 (52.9)199 (33.3)<0.0001
        Loss of taste575 (50.6)208 (34.8)<0.0001
        Waking up at night455 (40.0)243 (40.7)0.779
        Excessive daytime sleep491 (43.2)194 (32.5)<0.0001
        Morning headache476 (41.9)202 (33.8)0.001
        Sore throat436 (38.3)217 (36.3)0.407
        Hyposmia445 (39.1)184 (30.8)0.0006
        Nasal congestion416 (36.6)183 (30.7)0.014
        Difficulty falling asleep375 (33.0)204 (34.2)0.619
        Sneezing352 (31.0)143 (24.0)0.002
        Voice change334 (29.4)159 (26.6)0.195
        Rhinorrhea338 (29.7)151 (25.3)0.053
        Foreign body sensation in throat316 (27.8)156 (26.1)0.425
        Hoarseness of voice310 (27.3)147 (24.6)0.201
        Voice fatigue290 (25.5)166 (27.8)0.279
        Dizziness287 (25.2)138 (23.1)0.307
        Breathlessness during speaking262 (23.0)153 (25.6)0.207
        Odynophagia270 (23.7)131 (21.9)0.401
        Heart burn241 (21.2)148 (24.8)0.0749
        Facial pain/pressure225 (19.8)114 (19.1)0.727
        Postnasal drip217 (19.1)116 (19.4)0.88
        Abrupt awakenings accompanied by gasping193 (17.0)114 (19.1)0.256
        Dysphagia189 (16.6)104 (17.4)0.703
        Ear pain pressure189 (16.6)91 (15.2)0.426
        Loud snoring125 (11.0)120 (20.1)<0.0001
        Tinnitus148 (13.0)84 (14.1)0.503
        Ear fullness134 (11.8)65 (10.9)0.555
        Epistaxis58 (5.1)30 (5.0)0.928
        Loss of voice46 (4.0)39 (6.5)0.021
        Hearing loss35 (3.1)34 (5.7)0.008
        Otorrhea23 (2.0)22 (3.7)0.032
        • View popup
        Table 5

        - Incidence of otorhinolaryngological symptoms as the only presenting symptoms of COVID-19 (n=70).

        Symptomsn (%)
        Anosmia22 (31.4)
        Hyposmia16 (22.9)
        Loss of taste1 (1.4)
        Nasal congestion4 (5.7)
        Pharyngodynia5 (7.1)
        Rhinorrhea11 (15.7)
        Sore throat11 (15.7)
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      Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia
      Laila M. Telmesani, Danah H. Althomaly, Lamia A. Buohliqah, Roa T. Halawani, Mona M. Ashoor, Marwan J. Alwazzeh, Suad A. Al Mubarak, Maha A. AlHarbi, Rana F. AlMuslem, Sahal S. Arabi, Waleed E. Saleh, Amal Y. ALYosif, Mohammad R. Al Eid, Lena S. Telmesani, Abdulaziz S. AlEnazi
      Saudi Medical Journal Mar 2022, 43 (3) 266-274; DOI: 10.15537/smj.2022.43.3.20210501

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      Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia
      Laila M. Telmesani, Danah H. Althomaly, Lamia A. Buohliqah, Roa T. Halawani, Mona M. Ashoor, Marwan J. Alwazzeh, Suad A. Al Mubarak, Maha A. AlHarbi, Rana F. AlMuslem, Sahal S. Arabi, Waleed E. Saleh, Amal Y. ALYosif, Mohammad R. Al Eid, Lena S. Telmesani, Abdulaziz S. AlEnazi
      Saudi Medical Journal Mar 2022, 43 (3) 266-274; DOI: 10.15537/smj.2022.43.3.20210501
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