Otorhinolaryngological presentations of mucormycosis amid COVID-19 pandemic in a tertiary care hospital

Objective: To describe presentations, comorbidities, investigations, and surgical treatment of patients with mucormycosis amid the COVID-19 pandemic in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan.

Methods: This descriptive study was conducted at the department of ENT, and Head and Neck Surgery, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan from June 2020 to June 2021. All the patients fulfilling the inclusion criteria were included. Patients with COVID-19 were diagnosed based on real-time polymerase chain reaction (RT-PCR). After diagnosing mucormycosis computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were performed for subsequent surgical clearance. After taking informed consent demographic data were collected on a proforma and analyzed using SPPS version 25.

Results: Out of 23 patients males were 14(60.9%), females were 9 (39.1%) with a male: female ratio of 1.5:1. Mean ± SD age was 51.26 ± 1.41 years. Nasal obstruction and headache were the most common (8, 34.8%) presentations. The commonest co-morbidities were hypertension with diabetes mellitus (8, 34.8%). Out of 23 patients, 16(69.6%) had COVID-19 PCR positive. The majority of patients (17, 73.9%) were not vaccinated against COVID-19. Most of the patients (9, 39.1%) had HbA1c levels of 7% to 8.9%. The commonest surgery was endoscopic debridement of paranasal sinuses (9, 39.1%), while the commonest CT scan finding was a heterogeneous lesion involving the nose, maxillary and ethmoid sinuses (12, 52.2%).

Conclusion: Mucormycosis of paranasal sinuses with/or without intracranial extension is frequently seen in unvaccinated patients having uncontrolled diabetes and COVID-19 infection.