Associate professor Children's National George Washington University Washington, District of Columbia
Introduction: Patients presenting with changes in smell and taste to tertiary pediatric ENT during the COVID pandemic often have a history of COVID exposure.
Methods: During the pandemic, through August 2021, patients presenting to the ENT clinic with changes in smell or taste were systematically evaluated with SNOT-22, pediatric smell wheel, and SARS CoV2 IgG testing, treated with topical steroids, zinc, and smell retraining when applicable, and observed with follow up MRI in cases of persistent symptoms. We present an overview of these patients.
Results: 18 patients presented to Pediatric ENT with a chief complaint of smell or taste abnormality. The median age was 15 (range 11-17). Females were more likely to present with anosmia, 67% vs 33%. Half (9/18) of patients were Hispanic with others identifying as Black or African American 6/18 (33%) and the remaining patients as either Caucasian (2/18) or not specified (1/18). 12/18 (67%) had had a report of prior PCR testing, with 5 positive and 7 negative. Of the 7 patients with a negative PCR test, 6 (86%) had a positive antibody test confirming history of infection (the 1 patient did not receive an antibody test). Testing was prior to implementation of vaccinations in pediatric population. 1/18 (6%) reported systemic symptoms other than related to smell and taste during infection. The median SNOT 22 score was 16 (0-52). The median smell wheel score was 6.5/11, (range 1-11). Patients with significant score ( <8/11) on the smell wheel were more likely to have high quantitative antibody load >80 AU/mL, consistent with a level adequate for neutralization, with an average smell wheel score of 4/11. Patients with taste difficulty were more likely to have a score <8/11. 33% had an MRI scan. 78% had positive antibody testing. All patients were provided with smell retraining. 66% received nasal corticosteroids. Patients with dysgeusia were asked to take zinc. 10/18 presented in follow up.
Conclusion: Adolescents presenting to a tertiary pediatric ENT during the COVID pandemic are likely to have prolonged (>6 weeks) symptoms and have had COVID-19. The majority do not report positive PCR testing but do report systemic symptoms including anosmia, and therefore we suggest anosmia may be a late and prolonged symptom of COVID-19 in some cases.