Friday, March 1, 2024

SARS-CoV-2 Lurking in the Middle Ear

From the common rhinovirus to infamous coronavirus, respiratory viruses can trigger a cascade of ear complications, including acute otitis media (AOM). This roster includes syncytial virus, rhinovirus, adenovirus, coronavirus, bocavirus, influenza virus, parainfluenza virus, enterovirus, human metapneumovirus and SARS-Cov2. Moreover, Otitis media can often manifest as the initial sign of COVID-19 and be associated with hearing loss. Otitis media secretory is one of the most common ear complications after infection with the Omicron strain of SARS-CoV-2 virus, and the significantly higher incidence is associated with middle ear viral infection. Middle ear effusion SARS-CoV-2 virus antigen test detected the virus, which survived longer in the middle ear effusion than in the nasal cavity. The middle ear effusion test can detect SARS-CoV-2 virus antigen and determine whether the organism contains virus residue. 

Recent findings have unveiled a potentially alarming revelation - individuals diagnosed with otitis media with effusion (OME) post-COVID-19 may harbor traces of the virus within their middle ear. In this study, a striking 12.0% of middle ear effusion samples tested positive for SARS-CoV-2, hinting at the possibility of viral persistence and recurrence.

The study examined 23 patients, ranging from 32 to 84 years of age, who presented with OME following Omicron infection. 91.3% of these patients showcased unilateral symptoms, with fluid accumulation observed in 88.0% of ears. The median duration from infection to middle ear effusion sampling was 21 days, showcasing the potential for prolonged viral presence in this concealed reservoir.

Adding to the intrigue is the elusive nature of OME itself. Characterized by fluid accumulation in the middle ear sans acute infection, OME has long puzzled experts in otolaryngology and audiology. While bacterial infections and immunological responses have been implicated, the precise mechanisms remain veiled in mystery.


Chengzhou Han, Huifang Wang, Ying Wang, Chao Hang, Yangyang Wang, Xiangming Meng, The silent reservoir? SARS-CoV-2 detection in the middle ear effusion of patients with Otitis media with effusion after omicron infection, American Journal of Otolaryngology, 2024, 104229, ISSN 0196-0709, 

Zhang Y, Liu J, Yang F, He Y, Yan S, Bai Y, Zhang Z, Luan F. COVID-19-related secretory otitis media in the omicron era: a case series. Eur Arch Otorhinolaryngol. 2023 Oct;280(10):4697-4700. doi: 10.1007/s00405-023-08075-w. Epub 2023 Jun 21. PMID: 37341758.

Fan Y, Gao R, Shang Y, Tian X, Zhao Y, Chen X. Presence of SARS-CoV-2 in middle ear fluid and characterization of otitis media with effusion in patients with COVID-19. International Journal of Infectious Diseases. 2023 Nov 1;136:44-8.

Karimi-Galougahi M, Raad N, Ghorbani J, Mikaniki N, Haseli S. Otitis Media in COVID-19: A Case Series. Authorea Preprints. 2020 Jul 7.