Novel ENT triad of anosmia, ageusia and hearing impairment in COVID‐19

In this report, we present the case of a 61‐year‐old woman who experienced a hearing impairment in addition to anosmia and ageusia in the setting of SARS‐CoV‐2 infection.

The 2020 SARS‐CoV‐2 pandemic that originated in Wuhan, China, in December 2019 has had a global impact. The disease process and natural history are variable, causing mild illness in a majority of cases1, 2 and acute respiratory distress syndromes requiring invasive ventilation in severe cases. Anosmia and ageusia have been described in mild to moderate cases. However, the presence of other upper respiratory tract symptoms is rare.3, 4, 5 The American Academy of Otolaryngology – Head & Neck Surgery has proposed adding anosmia and dysgeusia to the list of screening items for novel coronavirus disease.

A 61‐year‐old woman presented to the hospital with increasing lethargy, headaches, hearing impairment (to the extent that she found it difficult to communicate), anosmia, ageusia and worsening dyspnoea on minimal exertion over the 3 days before presentation. Her ear, nose and throat (ENT) symptoms were present at the outset of her becoming symptomatic. Her relevant history included cruise ship travel with known SARS‐CoV‐2 cases. She had been self‐isolating for 2 weeks since disembarking.

On examination, her blood pressure was 121/63, with heart rate of 85 b.p.m. Her oxygen saturations were 97% on room air, her respiratory rate was 16, and her temperature was 37.3°C. Her mucous membranes were dry. Her cardiovascular and respiratory examinations were unremarkable. Detailed hearing assessments were not performed within the context of suspected COVID‐19.

Investigations revealed mildly elevated inflammatory markers and liver function tests, and a mild lymphopenia. A chest radiograph showed mild infiltrate in the left lower zone.

She was treated with a short course of intravenous fluids at the emergency department and admitted for supportive care. The SARS‐CoV‐2 swab performed in the community returned as positive on Day 3 of her admission, by which time she had improved in both her hearing and general well‐being. She was discharged on Day 4. On the day of her discharge, her hearing impairment, anosmia and ageusia had completely resolved. She was given a follow‐up call 48 h later, during which she reported having completely recovered.

The temporal relationship between hearing loss and viral illness suggests infectious aetiology. This is supported by the resolution of her hearing loss with supportive care. This may have been due to Eustachian tube involvement. While it is accepted that respiratory virus infection may cause hearing loss due to Eustachian tube blockage, this has not been described in SARS‐CoV‐2. This case highlights the variability in the clinical presentation of SARS‐CoV‐2 infection. It is clear that the ENT system can be involved and aid in clinical diagnosis in the early symptomatic phase before results are available or where concern is present about sensitivity of viral polymerase chain reaction. Clinicians should be aware of this association and the possible triad of anosmia, ageusia, and hearing impairment.