Epidemiological Characteristics, Pathogenesis and Clinical Implications of Sinusitis in the Era of COVID-19: A Narrative Review

Figures & data

Table 1 Summary of Studies That Demonstrated the Association Between Chronic Rhinosinusitis (CRS) and COVID – 19

Authors	Study Design	Sample Size	Findings
Lee SW et al^Citation11	Nested case-control study	Matched (both groups) – 12,217	SARS- CoV- 2 infections were significantly higher among CRS patients [Adjusted odds ratio (AOR) = 1.22 and 95% confidence interval (CI) = 1.04–1.42] COVID-19 patients with CRS had more negative outcomes [AOR = 1.71, 95% of CI = 1.09–2.71]
Wang H et al^Citation12	Cohort study	1172 hospitalized COVID – 19 patients	COVID – 19 patients with CRS did not significantly develop severe illness. However, this study had several limitations, such as assessing the CRS through self-reported telephonic interviews and excluding the fatal cases.
Sbeih F et al^Citation13	Retrospective cohort study	COVID – 19 positive patients = 998 COVID – 19 Negative patients – 996	COVID – 19 positive patients with CRS had significantly more risk of hospitalization than those without CRS (AOR = 3.19, 95% CI = 1.12–10.68)
Workman AD et al^Citation14	Matched cohort	CRS Patients – 12,000 Controls – 12, 000	No statistical significance in contracting COVID – 19 infections among the patients with and without CRS
Miller LE et al^Citation15	Historical cohort	1707 CRS patients (197 – Received oral corticosteroids 1510 – Did not receive oral corticosteroids)	There was no statistically significant difference in COVID – 19 positive results between the CRS patients who received oral corticosteroids with the CRS patients who did not receive them.

Note: Data presented in this table is authors, study design, sample size, and important findings with the level of evidence.

Table 2 Summary of Studies That Demonstrated the Risk Factors for Developing Acute Invasive Fungal Rhinosinusitis Among COVID – 19 Patients

Authors	Study Design	Sample Size	Findings
Pradhan P et al^Citation90	Retrospective hospital-based study	46 Covid-associated mucormycosis (CAM) patients	Forty-four patients had diabetes. No significant association between old and newly diagnosed diabetes mellitus for the development of CAM (P > 0.05). Patients who were given steroids had a significant factor in the development of CAM.
Moorthy A et al^Citation91	Retrospective study	18 COVID-19 patients with maxillofacial and rhino-cerebro-orbital fungal infections	Uncontrolled diabetes (p = 0.03) and patients who received steroids at some point of time during the treatment (p = 0.0013) had significantly higher chance of developing the fungal infections
Singh AK et al^Citation92	Systematic review	101 CAM cases	Mucormycosis were commonly noted in males (78.9%) and patients with the pre-existing diabetes mellitus (80%)
Nayak PS et al^Citation93	Case-series	30 CAM patients	Increased serum ferritin levels with a mean (± standard deviation) of 662.01 (±129.2) ng/mL and raised levels of D-Dimer 761.33 (± 151.8) as the associated and interlinked factors along with the diabetes mellitus for increased risk of developing mucormycosis
Rao C et al^Citation95	Cross-sectional study	75 CAM patients	The most commonly associated comorbidities were diabetes mellitus (60%), elevated mean serum iron level, and total iron binding capacity.

Lee SW, Kim SY, Moon SY, et al. Estimating COVID-19 infection and severity risks in patients with chronic rhinosinusitis: a Korean nationwide cohort study. J Allergy Clin Immunol Pract. 2021;9(6):2262–2271.e2. doi:10.1016/j.jaip.2021.03.044

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Wang H, Song J, Pan L, et al. The characterization of chronic rhinosinusitis in hospitalized patients with COVID-19. J Allergy Clin Immunol Pract. 2020;8(10):3597–3599.e2. doi:10.1016/j.jaip.2020.09.013

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Sbeih F, Gutierrez J, Saieed G, Chaaban MR. Chronic rhinosinusitis is associated with increased risk of COVID-19 hospitalization. Am J Otolaryngol. 2022;43(4):103469. doi:10.1016/j.amjoto.2022.103469

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Workman AD, Bhattacharyya N. Do patients with chronic rhinosinusitis exhibit elevated rates of covid-19 infection? Laryngoscope. 2022;132(2):257–258. doi:10.1002/lary.29961

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Miller LE, Bhattacharyya N. Risk of COVID-19 infection among chronic rhinosinusitis patients receiving oral corticosteroids. Otolaryngol Head Neck Surg. 2022;166(1):183–185. doi:10.1177/01945998211006931

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Pradhan P, Shaikh Z, Mishra A, et al. Predisposing factors of rhino-orbital-cerebral mucormycosis in patients with COVID 19 infection. Indian J Otolaryngol Head Neck Surg. 2021;2021:1–7.

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Moorthy A, Gaikwad R, Krishna S, et al. SARS-CoV-2, uncontrolled diabetes and corticosteroids-an unholy trinity in invasive fungal infections of the maxillofacial region? A retrospective, multi-centric analysis. J Maxillofac Oral Surg. 2021;20(3):418–425. doi:10.1007/s12663-021-01532-1

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Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021;15(4):102146. doi:10.1016/j.dsx.2021.05.019

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Nayak PS, Katyal I, Kumar AD, Prasheetha B, Harugop AS, Reshma R. COVID 19 associated mucormycosis: preventable risk factors leading to a better prognosis: a case series. Indian J Otolaryngol Head Neck Surg. 2022;74(2):3536–3540. doi:10.1007/s12070-022-03163-5

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Rao C. Association of serum iron studies in COVID associated mucormycosis with stage of the disease. J Assoc Physicians India. 2022;70(4):11–12.

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