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The authors present the case of a young boy who experienced progressive unilateral hearing loss initially believed to be unrelated to any other medical condition. Methods: The patient received a thorough evaluation, which included a comprehensive battery of audiological tests, a CT scan, and a gadolinium-enhanced MRI. Results: A repeated imaging investigation revealed the presence of a mass that mimicked a vestibular schwannoma (VS), but despite this, the boy was ultimately diagnosed with cerebral manifestations of B-cell acute lymphoblastic leukemia (B-ALL). Conclusions: Cerebral lesions originating from the internal auditory canal are rare in cases of B-ALL. In this case, the initial signs and symptoms of the disease were solely related to the audiovestibular system, making the diagnostic process particularly complicated. Unilateral hearing loss cases may indicate the presence of potentially life-threatening conditions, even if the hearing loss appears to be clinically non-syndromic. For these reasons, unilateral hearing losses necessitate a comprehensive interdisciplinary diagnostic approach from the very start of auditory manifestation and, in particular, if the hearing impairment demonstrates threshold progression.

Introduction: No studies have reported data on 3-year prevalence and recovery rates of self-reported COVID-19-related olfactory and gustatory dysfunction. The aim of the present study was to estimate the 3-year prevalence and recovery rate of self-reported COVID-19-related chemosensory dysfunction in a cohort of patients with antecedent mild COVID-19., Methods: This is a prospective observational study, measuring the prevalence of altered sense of smell or taste at follow-up and their variation from baseline, on adult patients consecutively assessed at Treviso and Trieste University Hospitals, who tested positive for SARS-CoV-2 RNA by polymerase chain reaction during March 2020., Results: Overall, out of 403 respondents, 267 patients (66.3%) reported an altered sense of smell or taste (SNOT-22 > 0) at baseline, while 56 (13.9%), 29 (7.2%), and 21 (5.2%) reported such alterations at 6-24 months, 2 years, and 3 years, respectively. Among the 267 patients with COVID-19-associated smell or taste dysfunction at baseline, 246 (92.1%) reported complete resolution at 3 years. Of the patients who still experienced smell or taste dysfunction 2 years after COVID-19, 27.6% and 37.9% recovered completely and partially, respectively, at the 3-year follow-up., Conclusion: Among subjects with antecedent mildly symptomatic SARS-CoV-2 infection, the 3-year prevalence and recovery rate of COVID-19-related alteration in sense of smell or taste was 5% and 92%, respectively. In approximately two-thirds of patients experiencing chemosensory dysfunction still 2 years after COVID-19, it is still possible to observe a delayed complete or partial recovery after a period of 3 years, while the remaining one-third of individuals continues to have unchanged persistent chemosensory alteration., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The aim of the present study was to estimate the 1 year prevalence and recovery rate of self-reported chemosensory dysfunction in a series of subjects with previous mild-to-moderate symptomatic COVID-19., Methods: Prospective study based on the SNOT-22, item "sense of smell or taste" and additional outcomes., Results: 268/315 patients (85.1%) completing the survey at baseline also completed the follow-up interview. The 12 months prevalence of self-reported COVID-19 associated chemosensory dysfunction was 21.3% (95% CI 16.5-26.7%). Of the 187 patients who complained of COVID-19 associated chemosensory dysfunction at baseline, 130 (69.5%; 95% CI 62.4-76.0%) reported complete resolution of smell or taste impairment, 41 (21.9%) reported a decrease in the severity, and 16 (8.6%) reported the symptom was unchanged or worse 1 year after onset. The risk of persistence was higher for patients reporting a baseline SNOT-22 score ≥ 4 (OR = 3.32; 95% CI 1.32-8.36) as well as for those requiring ≥ 22 days for a negative swab (OR = 2.18; 95% CI 1.12-4.27)., Conclusion: A substantial proportion of patients with previous mild-to-moderate symptomatic COVID-19 characterized by new onset of chemosensory dysfunction still complained on altered sense of smell or taste 1 year after the onset., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Optimal laryngeal exposure during transoral laryngeal surgery is fundamental. We aimed to evaluate the reliability of a recently proposed score (Laryngoscore) in predicting difficult laryngeal exposure (DLE) in an independent cohort of patients undergoing elective microlaryngoscopy. We also verified the relation between DLE, surgeon's expertise, and difficult intubation, and investigated possible areas for score improvement., Study Design: Prospective validation study., Methods: A total of 136 patients were preoperatively evaluated using the Laryngoscore. Patients were divided into three classes according to patient position, type of laryngoscope, and need for external counterpressure to expose the anterior commissure. Based on their mean scores, two groups were identified: good laryngeal exposure (GLE) and DLE. A receiver operating characteristic curve with the Youden index was used to calculate the optimal cutoff value. The χ 2 and Fisher exact test were used to correlate GLE and DLE to the surgeon's expertise and difficult intubation. The intraoperative anatomical parameters underlying DLE were also recorded., Results: The optimal cutoff value for differentiating GLE and DLE was 4, which identified 80.6% of DLE cases. No statistically significant difference in GLE and DLE distribution was found between surgeons (P = 0.43). The correlation between difficult intubation and DLE was statistically significant (P = 0.03). The intraoperative parameters determining DLE were epiglottis characteristics (floppy, tight, or short), bulky abdomen and chest, bulky tongue base, mobile teeth, and a narrow laryngeal aditus., Conclusion: The Laryngoscore is reliable for detecting DLE preoperatively. The inclusion of additional parameters may allow a more complete assessment and maximize its diagnostic accuracy., Level of Evidence: 2b Laryngoscope, 129:1438-1443, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

This study explores the role of inflammation and oxidative stress, hallmarks of COVID-19, in accelerating cellular biological aging. We investigated early molecular markers—DNA methylation age (DNAmAge) and telomere length (TL)—in blood leukocytes, nasal cells (NCs), and induced sputum (IS) one year post-infection in pauci- and asymptomatic healthcare workers (HCWs) infected during the first pandemic wave (February–May 2020), compared to COPD patients, model for "aged lung". Data from questionnaires, Work Ability Index (WAI), blood analyses, autonomic cardiac balance assessments, heart rate variability (HRV), and pulmonary function tests were collected. Elevated leukocyte DNAmAge significantly correlated with advancing age, male sex, daytime work, and an aged phenotype characterized by chronic diseases, elevated LDL and glycemia levels, medications affecting HRV, and declines in lung function, WAI, lymphocyte count, hemoglobin levels, and HRV (p < 0.05). Increasing age, LDL levels, job positions involving intensive patient contact, and higher leukocyte counts collectively contributed to shortened leukocyte TL (p < 0.05). Notably, HCWs exhibited accelerated biological aging in IS cells compared to both blood leukocytes (p ≤ 0.05) and NCs (p < 0.001) and were biologically older than COPD patients (p < 0.05). These findings suggest the need to monitor aging in pauci- and asymptomatic COVID-19 survivors, who represent the majority of the general population. [ABSTRACT FROM AUTHOR]

The persistence of symptoms for more than three months following infection with severe acute respiratory syndrome coronavirus 2 is referred to as "Long COVID". To gain a deeper understanding of the etiology and long-term progression of symptoms, this study aims to analyze the prevalence of Long COVID and its associated factors in a cohort of Brazilian adults and elders, twelve months after hospital discharge. An observational, prospective, and follow-up study was performed with a cohort of adults and older adults diagnosed with COVID-19 in 2020 in the State of Paraná, Brazil. Twelve months after hospital discharge, patients answered a phone questionnaire about the persistence of symptoms after three levels of exposure to COVID-19's acute phase (ambulatory, medical ward, and intensive care unit). According to the characteristics of participants, the prevalence of Long COVID-19 was calculated, and logistic regression analyses were conducted. We analyzed data from 1822 participants (980 adults [≥18–<60 years] and 842 older people [≥60 years]) across three exposure levels. The overall Long COVID prevalence was 64.2%. Long COVID was observed in 646 adults (55%; of which 326 were women) and 523 older people (45%; of which 284 were women). Females had a higher prevalence of long-term symptoms (52%) compared with men. The most common post-COVID-19 conditions in the 12-month follow-up were neurological (49.8%), followed by musculoskeletal (35.1%) and persistent respiratory symptoms (26.5%). Male individuals were less likely to develop Long COVID (aOR = 0.50). Other determinants were also considered risky, such as the presence of comorbidities (aOR = 1.41). Being an adult and having been hospitalized was associated with the development of Long COVID. The risk of developing Long COVID was twice as high for ward patients (aOR = 2.53) and three times as high for ICU patients (aOR = 3.56) when compared to non-hospitalized patients. Presenting clinical manifestations of digestive (aOR = 1.56), endocrine (aOR = 2.14), cutaneous (aOR = 2.51), musculoskeletal (aOR = 2.76) and psychological systems (aOR = 1.66) made adults more likely to develop Long COVID. Long COVID was present in a large proportion of people affected by the SARS-CoV-2 infection. Presence of Long COVID symptoms displayed a dose–response relationship with the level of disease exposure, with a greater prevalence of symptoms associated with the severe form in the acute period. [ABSTRACT FROM AUTHOR]

Long COVID presents with diverse symptoms after COVID-19. Different clusters of symptoms have been reported; however, their persistence beyond 2 years after COVID-19 remains unclear. In this cohort study, we prospectively evaluated individuals with previous severe COVID-19 presenting with long COVID at a two-year follow-up. We characterized the included patients and performed a cluster analysis of symptoms through multiple correspondence analysis and hierarchical clustering. A total of 199 patients with long COVID were included. The median age was 58 years (48–69), 56% were male, and the median follow-up time since the COVID-19 diagnosis was 26 months (IQR: 25, 27). Three symptom clusters were identified: Cluster 1 is characterized by fatigue, myalgia/arthralgia, a low prevalence of symptoms, and a lack of specific symptoms; Cluster 2 is defined by a high prevalence of fatigue, myalgia/arthralgia, and cardiorespiratory symptoms, including palpitations, shortness of breath, cough, and chest pain; and Cluster 3 is demonstrated a high prevalence of ageusia, anosmia, fatigue, and cardiorespiratory symptoms. Our study reinforces the concept of symptom clustering in long COVID, providing evidence that these clusters may persist beyond two years after a COVID-19 diagnosis. This highlights the chronic and debilitating nature of long COVID and the importance of developing strategies to mitigate symptoms in these patients. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to assess the prevalence of long COVID-19 and estimate the average time to its diagnosis and meta-regression for covariates. Methods: We conducted a systematic review, meta-analysis, and meta-regression from 43 studies (367,236 patients) (June 2020–August 2022). With the random-effects model, the pooled prevalence of long COVID-19 was measured. Publication bias was ascertained, and meta-regression analysis was performed on predetermined covariates. The trial was registered with PROSPERO (CRD42022328509). Results: The pooled prevalence of long COVID-19 was 42.5% (95% CI 36% to 49.3%), with 25% and 66% at four and two months, respectively. Mostly, long COVID-19 signs and symptoms occurred at three (54.3%) to six (57%) months (p < 0.0001), further increasing at 12 months (57.9%, p = 0.0148). Hypertension was significantly associated with long COVID-19 at 32% (0.322 (95% CI 0.166, 0.532) (p < 0.001) and hospital re-admission contributed to 17% (Q = 8.70, df = 1, p = 0.0032) (R2 = 0.17). All the covariates explained at least some of the variance in effect size on long COVID-19 at 53% (Q = 38.81, df = 19, p = 0.0047) (R2 analog = 0.53). Conclusion: The prevalence of long COVID-19 was 42.5% when linked with a cardiovascular disorder. Hospital re-admission majorly predicted the incidence of long COVID-19. Clinical and methodological characteristics in a specific study contributed to over 50% of long COVID-19 events, with most signs and symptoms occurring between 3 and 6 months and increasing at 12 months. [ABSTRACT FROM AUTHOR]

Background and Objectives: The ARNE score was developed for the prediction of a difficult airway for both general and ear, nose and throat (ENT) surgery with a universal cut-off value. We tested the accuracy of this score in the case of laryngeal surgery and provided an insight into its effects in combination with flexible laryngoscopy. Materials and Methods: This prospective pilot clinical study included 100 patients who were being scheduled for microscopic laryngeal surgery. We calculated the ARNE score for every patient, and flexible laryngoscopy was provided preoperative. Difficult intubation was assessed according to the intubation difficulty score (IDS). Results: A total of 33% patients had difficult intubation according to the IDS. The ARNE score showed limited accuracy for the prediction of difficult intubation in laryngology with p < 0.0001 and an AUC of 0.784. Flexible laryngoscopy also showed limitations when used as an independent parameter with p < 0.0001 and an AUC of 0.766. We defined a new cut-off value of 15.50 for laryngology, according to the AUC. After the patients were divided into two groups, according to the new cut-off value and provided cut-off value, the AUC improved to 0.707 from 0.619, respectively. Flexible laryngoscopy improved the prediction model of the ARNE score to an AUC of 0.882 and of the new cut-off value to an AUC of 0.833. Conclusions: It is recommended to use flexible laryngoscopy together with the ARNE score in difficult airway prediction in patients with laryngeal pathology. Also, the universally recommended cut-off value of 11 cannot be effectively used in laryngology, and a new cut-off value of 15.50 is recommended. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has been defined as the greatest global health and socioeconomic crisis of modern times. While most people recover after being infected with the virus, a significant proportion of them continue to experience health issues weeks, months and even years after acute infection with SARS-CoV-2. This persistence of clinical symptoms in infected individuals for at least three months after the onset of the disease or the emergence of new symptoms lasting more than two months, without any other explanation and alternative diagnosis have been named long COVID, long-haul COVID, post-COVID-19 conditions, chronic COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Long COVID has been characterized as a constellation of symptoms and disorders that vary widely in their manifestations. Further, the mechanisms underlying long COVID are not fully understood, which hamper efficient treatment options. This review describes predictors and the most common symptoms related to long COVID’s effects on the central and peripheral nervous system and other organs and tissues. Furthermore, the transcriptional markers, molecular signaling pathways and risk factors for long COVID, such as sex, age, pre-existing condition, hospitalization during acute phase of COVID-19, vaccination, and lifestyle are presented. Finally, recommendations for patient rehabilitation and disease management, as well as alternative therapeutical approaches to long COVID sequelae are discussed. Understanding the complexity of this disease, its symptoms across multiple organ systems and overlapping pathologies and its possible mechanisms are paramount in developing diagnostic tools and treatments. [ABSTRACT FROM AUTHOR]

(1) Background: One of the possible symptoms of COVID-19 is a sudden loss of smell and taste. The main aim of the study was to evaluate the severity of post-COVID-19 olfactory dysfunction (OD). A secondary aim was to assess the relationship between OD and gustatory (taste) dysfunction (GD). Margins: 2.5 cm (1 inch) at top, bottom, right, and left. (2) Methods: The study group consisted of 81 subjects (16 men and 65 women) aged between 12 and 73 years. All of the patients presented to a center for subjective OD associated with COVID-19. They were tested with a Sniffin' Sticks test (SST) for OD and a Taste Strip test (TS) for GD. (3) Anosmia was present in 18 participants (22%), hyposmia in 52 (64%), and normosmia in 11 (14%). Some 36% of the patients reported imaginary smells (phantosmia), but it did not correlate with olfactory sensitivity. Comparing the different parts of the SST showed that subjects scored lowest on the threshold part of the test. The results of the discrimination and identification parts of the test were better, implying that if the stimulus is intense enough, incorrect discrimination and identification of odors is less frequent. A sweet taste was the easiest to recognize (78% could do so), while the most difficult to recognize was salty (68%). There were weak and statistically non-significant correlations between olfactory and taste dysfunction. (4) Conclusions: The results suggest that post-COVID-19 olfactory dysfunction was more peripheral than central. Testing patients for the severity of post-COVID-19 OD may help clinicians treat the condition. Because there is no fully effective treatment, research on post-COVID-19 OD is needed. [ABSTRACT FROM AUTHOR]

Background: Transoral laser microsurgery, the standard surgical approach for early-stage laryngeal cancer, necessitates an unobstructed line of sight to the operating field. However, achieving adequate laryngeal exposure can be challenging, potentially compromising treatment outcomes., Methods: We developed a 3D-printed curved laryngoscope (sMAC), designed to match the upper airway anatomy. In a user study (n = 15) with a human body donor we compared the sMAC system to conventional microlaryngoscopy regarding laryngeal exposure and accessibility in a difficult exposure scenario., Results: All 15 participants achieved complete glottic exposure and successfully manipulated laryngeal landmarks using the sMAC system. Only four participants achieved partial exposure using microlaryngoscopy. Positioning of the sMAC system was significantly faster (p = 0.023). A vocal cord resection was conducted successfully (n = 2) using the sMAC system., Conclusion: The sMAC system effectively addresses challenges associated with transoral laryngeal surgery. Ongoing development aims to overcome current limitations of the system and prepare first clinical trials., (© 2024 The Author(s). Head & Neck published by Wiley Periodicals LLC.)

Purpose: Chemotherapy can lead to malnutrition and post-menopausal recurrence among breast cancer (BC) patients, who need to achieve nutritional literacy (NL) to cope. The objective of this study was to explore the NL level in Chinese BC patients receiving chemotherapy and its predictors including both internal motivation and the external environment. Methods: A total of 326 BC female patients from three hospitals were enrolled. Participants completed the Nutrition Literacy Measurement Scale for Chinese Adult (NLMS-CA), Chinese version from the Treatment Self-Regulation Questionnaire (TSRQ-C), and the Perceived Social Support Scale (PSSS) to assess NL, treatment self-regulation, and social support. Stepwise multivariate linear regression was used to identify the main factors of NL. Results: The total NL score was 151.31 ± 16.85, the “knowledge understanding” dimension had the lowest score. In the final regression model, patients with higher scores for “autonomous motivation” and “introjected regulation” on the TSRQ-C and “family support” and “other support” on the PSSS, higher educational levels and average monthly household incomes and endocrine therapy had higher NL levels (adjusted R2 = 66.7%, p < 0.05). Conclusions: The overall NL score among Chinese BC patients receiving chemotherapy was satisfactory, but the knowledge understanding score was low. Higher autonomous motivation, introjected regulation, family support and other support scores, higher educational and household income levels, and endocrine therapy were predictors of NL in female patients. Interventions should be designed according to the specific performances and predictors of NL in female patients. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence and the evolution of olfactory disorders (OD) related to coronavirus disease 2019 (COVID-19) in patients infected during the first and the second European waves. Methods: From March 2020 to October 2020, COVID-19 patients with OD were recruited and followed over the 12-month post-infection. The following data were collected: demographic, treatments, vaccination status, and olfactory function. Olfaction was assessed with the Olfactory Disorder Questionnaire (ODQ), and threshold, discrimination, and identification (TDI) test. Outcomes were compared between patients of the first wave (group 1: wild/D614G virus) and the second wave (group 2: B.1.1.7. Alpha variant) at 1-, 3- and 12-month post-infection. Results: Sixty patients completed the evaluations accounting for 33 and 27 patients in group 1 and 2, respectively. The 1-month TDI score (23.7 ± 5.3) was significantly lower in group 2 compared to group 1 (29.8 ± 8.7; p = 0.017). Proportion of normosmic patients at 1-month post-infection was significantly higher in group 1 compared to group 2 (p = 0.009). TDI scores only significantly increased from 1- to 3-month post-infection in anosmic and hyposmic patients. Focusing on There was a negative association between the 1-month ODQ and the 1-month TDI (rs = − 0.493; p = 0.012). ODQ was a significant predictor of TDI scores at 3- and 12-month post-infection. The 12-month prevalence of parosmia was 60.6% in group 1 and 42.4% in group 2, respectively. There was no significant influence of oral corticosteroid treatment, adherence to an olfactory training and vaccination status on the olfactory outcomes. Conclusions: Patients of the second wave (Alpha B.1.1.7. variant) reported significant higher proportion of psychophysical test abnormalities at 1-month post-infection than patients infected during the first wave (D614G virus). [ABSTRACT FROM AUTHOR]

Since the worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, treating taste and saliva secretory disorders associated with coronavirus disease 2019 (COVID-19) has become a critical issue. The aim of the present study was to update information on treatments applicable to such oral symptoms and discuss their pathogenic mechanisms. The literature search indicated that different treatments using tetracycline, corticosteroids, zinc, stellate ganglion block, phytochemical curcumin, traditional herbal medicine, nutraceutical vitamin D, photobiomodulation, antiviral drugs, malic acid sialagogue, chewing gum, acupuncture, and/or moxibustion have potential effects on COVID-19-associated ageusia/dysgeusia/hypogeusia and xerostomia/dry mouth/hyposalivation. These treatments have multiple modes of action on viral cellular entry and replication, cell proliferation and differentiation, immunity, and/or SARS-CoV-2 infection-induced pathological conditions such as inflammation, cytokine storm, pyroptosis, neuropathy, zinc dyshomeostasis, and dysautonomia. An understanding of currently available treatment options is required for dental professionals because they may treat patients who were infected with SARS-CoV-2 or who recovered from COVID-19, and become aware of their abnormal taste and salivary secretion. By doing so, dentists and dental hygienists could play a crucial role in managing COVID-19 oral symptoms and contribute to improving the oral health-related quality of life of the relevant patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate safety, feasibility, and effectiveness of platelet-rich plasma (PRP) injection into the olfactory clefts of COVID-19 patients with persistent olfactory dysfunction (OD). Methods: From March 2022 to July 2022, COVID-19 patients with persistent OD were consecutively recruited to benefit from PRP injection into the olfactory clefts. Patient pain, annoyance, time of procedure, and adverse events were evaluated. Olfactory function was evaluated at baseline and 2-month post-injection with the olfactory disorder questionnaire (ODQ) and threshold, discrimination, and identification (TDI) test. Results: Eighty-seven patients with anosmia (N = 30), hyposmia (N = 40), or parosmia (N = 17) with a mean OD duration of 15.7 months completed the evaluations. The PRP injection was successfully performed in all patients with a mean procedure time of 18.4 ± 3.4 min. The adverse events included transient epistaxis (N = 31), parosmia related to xylocaine spray (N = 10), and vasovagal episode (N = 2). The injection procedure was evaluated as somewhat or moderately painful by 41 (47%) and 22 (25%) patients, respectively. Thirty-seven patients were assessed after 2 months post-injection. The mean ODQ and TDI scores significantly improved from baseline to 2-month post-injection (p < 0.01). The olfactory improvement occurred after a mean of 3.6 ± 1.9 weeks. Conclusion: The injection of PRP into the olfactory clefts is safe and associated with adequate patient-reported outcomes. The findings of this preliminary study suggest possible efficacy on subjective and psychophysical evaluations, but future randomized controlled studies are needed to determine the superiority of PRP injection over placebo. [ABSTRACT FROM AUTHOR]

People affected by the Long COVID-19 (LC) syndrome often show clinical manifestations that are similar to those observed in patients with mild cognitive impairments (MCI), such as olfactory dysfunction (OD), brain fog, and cognitive and attentional diseases. This study aimed to investigate the chemosensory-evoked related potentials (CSERP) in LC and MCI to understand if there is a common pathway for the similarity of symptoms associated with these disorders. Eighteen LC patients (mean age 53; s.d. = 7), 12 patients diagnosed with MCI (mean age 67; s.d. = 6), and 10 healthy control subjects (mean age 66; s.d. = 5, 7) were recruited for this exploratory study. All of them performed a chemosensory event-related potentials (CSERP) task with the administration of trigeminal stimulations (e.g., the odorants cinnamaldehyde and eucalyptus). Study results highlighted that MCI and LC showed reduced N1 amplitude, particularly in the left frontoparietal network, involved in working memory and attentional deficits, and a reduction of P3 latency in LC. This study lays the foundations for evaluating aspects of LC as a process that could trigger long-term functional alterations, and CSERPs could be considered valid biomarkers for assessing the progress of OD and an indicator of other impairments (e.g., attentional and cognitive impairments), as they occur in MCI. [ABSTRACT FROM AUTHOR]

Medical specialty usage of COVID-19 survivors after hospital discharge is poorly understood. This study investigated medical specialty usage at 1–12 and 13–24 months post-hospital discharge in critically ill and non-critically ill COVID-19 survivors. This retrospective study followed ICU (N = 89) and non-ICU (N = 205) COVID-19 survivors who returned for follow-up within the Stony Brook Health System post-hospital discharge. Follow-up data including survival, hospital readmission, ongoing symptoms, medical specialty care use, and ICU status were examined 1–12 and 13–24 months after COVID-19 discharge. "New" (not previously seen) medical specialty usage was also identified. Essentially all (98%) patients survived. Hospital readmission was 34%, but functional status scores at discharge were not associated with hospital readmission. Many patients reported ongoing [neuromuscular (50%) respiratory (39%), chronic fatigue (35%), cardiovascular (30%), gastrointestinal (28%), neurocognitive (22%), genitourinary (22%), and mood-related (13%)] symptoms at least once 1–24 months after discharge. Common specialty follow-ups included cardiology (25%), vascular medicine (17%), urology (17%), neurology (16%), and pulmonology (14%), with some associated with pre-existing comorbidities and with COVID-19. Common new specialty visits were vascular medicine (11%), pulmonology (11%), and neurology (9%). ICU patients had more symptoms and follow-ups compared to the non-ICU patients. This study reported high incidence of persistent symptoms and medical specialty care needs in hospitalized COVID-19 survivors 1–24 months post-discharge. Some specialty care needs were COVID-19 related or exacerbated by COVID-19 disease while others were associated with pre-existing medical conditions. Longer follow-up studies of COVID-19 survivor medical care needs are necessary. [ABSTRACT FROM AUTHOR]

With the routine use of effective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines, the number of life-threatening coronavirus disease 2019 (COVID-19) courses have largely been reduced. However, multiple COVID-19 convalescents, even after asymptomatic to moderate disease, suffer from post-COVID syndrome, with relevant limitations in daily life. The pathophysiologic mechanisms of post-COVID syndrome are still elusive, with dysregulation of the immune system suggested as a central mechanism. Here, we assessed COVID-19 post-infectious symptoms (5–6 months after PCR-confirmed acute infection) together with the humoral immune response against SARS-CoV-2 in non-hospitalized COVID-19 convalescents, early (5–6 weeks) and late (5–6 months) after their first positive SARS-CoV-2 PCR result. Convalescents reporting several post-infectious symptoms (>3) showed higher anti-spike and anti-nucleocapsid antibody levels 5–6 weeks after PCR-confirmed infection with the latter remained increased 5–6 months after positive PCR. Likewise, a higher post-infectious symptom score was associated with increased antibody levels. Of note, convalescents displaying neuro-psychiatric symptoms such as restlessness, palpitations, irritability, and headache, as well as general symptoms such as fatigue/reduced power had higher SARS-CoV-2-specific antibody levels compared with asymptomatic cases. The increased humoral immune response in convalescents with post-COVID syndrome might be useful for the detection of individuals with an increased risk for post-COVID syndrome. [ABSTRACT FROM AUTHOR]

Purpose: Successful microlaryngeal surgery relies on an adequate laryngeal exposure. Recognizing the likelihood of challenging exposure prior to microlaryngeal surgery may assist in selecting the appropriate surgical approach and even prompt consideration of alternative treatment options. We aim to apply the mini-Laryngoscore, a preoperative assessment tool, to our study population and incorporate novel variables to optimize the prediction model., Methods: This single-center prospective cohort study included 80 consecutive patients undergoing elective microlaryngeal surgery, from January 1, to June 30, 2023. Each patient underwent a presurgical evaluation of 15 parameters and an intraoperative scoring of the anterior commissure visualization. These parameters were assessed for their association with difficult laryngeal exposure, using multiple logistic regression analysis. We created a novel prediction model for DLE and compared it with the existing model, the mini-Laryngoscore., Results: Out of 80 patients, 24 (30%) patients had difficult laryngeal exposure, including 3 cases (3.8%) in which visualization of the anterior commissure was not possible. A large neck diameter (OR, 1.4; CI 1.1-1.9) and the presence of upper teeth (OR, 8.9; CI 1.3-62.8) were independent risk factors for a difficult laryngeal exposure, while a larger interincisors gap was the only independent protector factor (OR, 0.3; CI 0.1-0.8). The logistic regression model combining these three independent risk factors displayed a high discriminative value AUC = 0.89 (CI 0.81-0.97). The predictive performance of the mini-Laryngoscore was 0.73 (CI 0.62-0.85)., Conclusion: Combining two parameters from the mini-Laryngoscore (upper jaw dental state and interincisors gap distance) with neck circumference measurement can accurately predict the risk of difficult laryngeal exposure., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The Laryngoscore was described in 2014 as a practical preoperative assessment tool to predict difficult laryngeal exposure (DLE) during transoral approaches to the larynx. In 2019 the authors proposed a version with a reduced number of variables, called the mini-Laryngoscore. We aim to critically appraise and externally validate these two tools and if needed and possible, to optimize these tools., Methods: 103 consecutive patients who underwent a microlaryngoscopy between November 2017 and June 2020 at the Leuven University Hospitals were prospectively included and subjected to a presurgical evaluation of 15 parameters and a peroperative scoring of the anterior commissure visualization. Subsequent analysis focused on the concordance of our findings with those of Piazza et al., the discriminatory ability of the test, and the validity of the included items. We then evaluated a modified prediction tool., Results: Of 103 patients, 18 (17.5%) had DLE. The Laryngoscore and mini-Laryngoscore predicted this with a "good" C-index of respectively 0.727 (95%CI: 0.608-0.846) and 0.714 (95%CI: 0.605-0.823). A newly created prediction tool including only three parameters (Interincisors gap, upper jaw dental status and previous treatments) showed a better discriminatory ability (C-index = 0.835, 95%CI: 0.726-0.944) than the original Laryngoscore, a finding that needs further external validation., Conclusion: The original Laryngoscore and the mini-Laryngoscore displayed a good discriminative ability. Some parameters can be left out of the Laryngoscore without losing discrimination. An even better prediction model seems possible, using a weighted sum of selected predictor variables and by using the parameters in their continuous form., Level of Evidence: 2 Laryngoscope, 134:1807-1812, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Aims: The aim of the study was to analyze objective and subjective olfactory/gustatory function in post-COVID-19 infection (PCI)., Materials and Methods: Patients with past PCR-confirmed COVID-19 infection and persistent olfactory/gustatory complaints were investigated. Olfactory threshold and identification, gustatory detection, identification, and magnitude scaling were tested., Results: A total of 42 PCI subjects were compared to 41 age- and gender-matched controls with no COVID-19 history. All PCI tested had mild COVID-19 disease. Mean interval between COVID-19 confirmations to testing was 7.4 ± 3.1 months. PCI subjects complained of combined dysfunction in 85.7%, isolated olfactory or gustatory dysfunction in 7.1% each. Combined complaints were significantly higher in PCI (p < 0.001). Objective testing showed significantly higher prevalence of dysfunction in PCI versus controls for hyposmia (73.8%, 12.2%), anosmia (11.9%, 0%), odor identification (68.5%, 83.0%), hypogeusia (23% and 2.4%, respectively), and impaired magnitude scaling, (p < 0.05). All PCI subjects with hypogeusia had abnormal gustatory magnitude scaling., Conclusions: While most PCI subjects complained of combined gustatory and olfactory dysfunction, objective testing showed in the majority an isolated single sense dysfunction, with a low level of agreement between subjective and objective findings. Abnormal objective results for all olfactory and gustatory functions tested may suggest a central rather than peripheral mechanism, although concomitant mechanisms cannot be excluded., (© 2023 Wiley Periodicals LLC.)

10.4193/Rhin21.249 11 Lechien J.R., Vaira L.A., Saussez S. Prevalence and 24-month recovery of olfactory dysfunction in COVID-19 patients: A multicentre prospective study. It has now been two years since the publication in I Pathogens i of our European multicenter study on the prevalence of olfactory dysfunctions (OD) during COVID-19 [[1]]. 10.3390/pathogens10060698 30 Lechien J.R., Vaira L.A., Saussez S. Effectiveness of olfactory training in COVID-19 patients with olfactory dysfunction: A prospective study. 33445604 2 Saniasiaya J., Islam M.A., Abdullah B. Prevalence of olfactory dysfunction in coronavirus disease 2019 (COVID-19): A meta-analysis of 27,492 patients. [Extracted from the article]

As of 2022, close to 90 million persons in the United States, 243 million persons in Europe and 585 million worldwide have been infected with the novel SARS‐CoV‐2 (COVID‐19) virus and survived. Estimates vary but suggest that up to 50% may experience long‐term sequelae, termed 'Long‐COVID'. While Long‐COVID is a new condition, the phenomenon of disabling long‐term effects following an illness requiring ongoing surveillance and management is not. In this commentary, we discuss how Long‐COVID parallels the experiences of long‐term cancer survivors, highlight shared challenges and offer opportunities to improve research and clinical care for both growing populations of patients as well as other long‐term chronic, disabling conditions. [ABSTRACT FROM AUTHOR]

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Persistent chemosensory dysfunction (PCD) is a common symptom of long-COVID. Chemosensory dysfunction (CD) as well as SARS-CoV-2-specific antibody levels and CD8+ T-cell immunity were investigated in a cohort of 44 healthcare workers up to a median of 721 days after a positive PCR test. CD was assessed using questionnaires and psychophysical screening tests. After 721 days, 11 of 44 (25%) participants reported PCD, with five describing an impaired quality of life. One participant reported hyperosmia (increased sense of smell). The risk of PCD at 721 days was higher for participants reporting qualitative changes (parosmia (altered smell), dysgeusia (altered taste), or phantosmia (hallucination of smell)) during initial infection than in those with isolated quantitative losses during the first COVID-19 infection (62.5% vs. 7.1%). The main recovery rate occurred within the first 100 days and did not continue until follow-up at 2 years. No correlation was found between antibody levels and CD, but we observed a trend of a higher percentage of T-cell responders in participants with CD. In conclusion, a significant proportion of patients suffer from PCD and impaired quality of life 2 years after initial infection. Qualitative changes in smell or taste during COVID-19 pose a higher risk for PCD. [ABSTRACT FROM AUTHOR]

Adequate visualization of the vocal folds is essential for optimal phonosurgery. Pre-operative knowledge of a difficult laryngeal exposure (DLE) can alert the surgeon regarding the need for alternative measures. Our study is based on the hypothesis that a patient who has difficult intubation (DI) is likely to have DLE, thus scales anticipating DI should also anticipate DLE. Our aims were to correlate patients of actual DI on table with patients who had DLE, secondly to assess the ability of grading scales of DI to predict DLE and finally to obtain a cut-off value of neck circumference and length for predicting DLE. This is a prospective, observational study wherein four grading scales; Modified Mallampati Classification (MMC), 3–3–2, Upper lip bite test (ULBT) and Neck Mobility (NM) were used for anticipating DI and correlated with DLE during MLS. Occurrence of actual DI and DLE was correlated. Neck circumference and neck length was correlated with incidence of DLE. Out of 42 patients, 22 were anticipated to have DI (52.38%). Actual incidence of DI was 6 (14.28%) and DLE was 10 (23.80%). Correlation between actual DI and DLE was statistically significant. Of the 4 grading scales, ULBT was significant in predicting DLE. Neck circumference more than 37.5 cm and neck length less than 15.3 cm was significant in anticipating DLE. There is a significant correlation between DI and DLE. A positive ULBT, neck circumference more than 37.5 cms and neck length less than 15.3 cms are independently suggestive of a DLE. [ABSTRACT FROM AUTHOR]

Objectives: Olfactory dysfunction (OD) is a common symptom of Coronavirus Disease 2019 (COVID-19). Although many patients have been reported to regain olfactory function within the first month, long-term observation reports vary. Therefore, we aimed to assess the course of chemosensory function in patients diagnosed with COVID-19 within 3–15 months after the infection. Methods: One hundred and two patients (71 females and 31 males; mean age 38.8 years) diagnosed with laboratory-confirmed COVID-19 and subjective OD participated in this single-center study 111–457 days after onset of OD. Patients first performed chemosensory tests at home, followed by psychophysical testing (Sniffin' Sticks (TDI), 27-item Candy Smell Test (CST), Taste Strips Test (TST)) in the clinic. Questionnaires regarding importance of olfaction (IOQ) and olfactory-specific quality of life (QOD) were applied at both timepoints. Results: After a mean 216 days (SD 73; range 111–457) between OD onset and follow-up testing, the mean Sniffin' Sticks (TDI) score was 27.1 points (SD 5.8; range 4.25–38.5): 4.0% were anosmic, 72.5% hyposmic, and 23.5% normosmic. At follow-up testing, 73.5% of patients reported improvement, 5.9% deterioration, and 20.6% no change in OD. Moreover, full recovery of self-perceived smell, flavor, and taste was not observed. According to questionnaires, the individual importance of smell did not change, but participants showed improvement in OD-related quality of life (p < 0.001) and had increased parosmia scores (p = 0.014) at follow-up. Conclusion: Our results show that long-lasting OD after SARS-CoV-2 infection is a common symptom. The majority of patients had OD in the range of hyposmia, which was confirmed by comprehensive smell tests. [ABSTRACT FROM AUTHOR]

(1) Background: Persistent post-viral olfactory disorders (PPVOD) are estimated at 30% of patients one year after COVID-19 infection. No treatment is, to date, significantly effective on PPVOD with the exception of olfactory training (OT). The main objective of this work was to evaluate OT efficiency on post-COVID-19 PPVOD. (2) Methods: Consecutive patients consulting to the ENT department with post-COVID-19 PPVOD were included after completing clinical examination, the complete Sniffin' Stick Test (TDI), the short version of the Questionnaire of olfactory disorders and the SF-36. Patients were trained to practice a self-olfactory training with a dedicated olfactory training kit twice a day for 6 months before returning to undergo the same assessments. (3) Results: Forty-three patients were included and performed 3.5 months of OT in average. We observed a significant TDI score improvement, increasing from 24.7 (±8.9) before the OT to 30.9 (±9.8) (p < 0.001). Based on normative data, a significant increase in the number of normosmic participants was observed only for the threshold values (p < 0.001). Specific and general olfaction-related quality of life improved after the OT. (4) Conclusions: Olfactory function appeared to improve only in peripheral aspects of post-COVID-19 PPVOD after OT. Future controlled studies must be performed to confirm the OT role and justify new therapeutic strategies that may focus on the central aspects of post-COVID-19 PPVOD. [ABSTRACT FROM AUTHOR]

An altered sense of smell and taste was recognized as one of the most characteristic symptoms of coronavirus infection disease (COVID-19). Despite most patients experiencing a complete functional resolution, there is a 21.3% prevalence of persistent alteration at 12 months after infection. To date, magnetic resonance imaging (MRI) findings in these patients have been variable and not clearly defined. We aimed to clarify radiological alterations of olfactory pathways in patients with long COVID-19 characterized by olfactory dysfunction. A comprehensive review of the English literature was performed by analyzing relevant papers about this topic. A case series was presented: all patients underwent complete otorhinolaryngology evaluation including the Sniffin' Sticks battery test. A previous diagnosis of SARS-CoV-2 infection was confirmed by positive swabs. The MRIs were acquired using a 3.0T MR scanner with a standardized protocol for olfactory tract analysis. Images were first analysed by a dedicated neuroradiologist and subsequently reviewed and compared with the previous available MRIs. The review of the literature retrieved 25 studies; most cases of olfactory dysfunction more than 3 months after SARS-CoV-2 infection showed olfactory bulb (OB) reduction. Patients in the personal case series had asymmetry and a reduction in the volume of the OB. This evidence was strengthened by the comparison with a previous MRI, where the OBs were normal. The results preliminarily confirmed OB reduction in cases of long COVID-19 with an altered sense of smell. Further studies are needed to clarify the epidemiology, pathophysiology and prognosis. [ABSTRACT FROM AUTHOR]

Given the ever-progressing studies on coronavirus disease 2019 (COVID-19), it is critical to update our knowledge about COVID-19 symptomatology and pathophysiology. In the present narrative review, oral symptoms were overviewed using the latest data and their pathogenesis was hypothetically speculated. PubMed, LitCovid, ProQuest, and Google Scholar were searched for relevant studies from 1 April 2021 with a cutoff date of 31 January 2022. The literature search indicated that gustatory dysfunction and saliva secretory dysfunction are prevalent in COVID-19 patients and both dysfunctions persist after recovery from the disease, suggesting the pathogenic mechanism common to these cooccurring symptoms. COVID-19 patients are characterized by hypozincemia, in which zinc is possibly redistributed from blood to the liver at the expense of zinc in other tissues. If COVID-19 induces intracellular zinc deficiency, the activity of zinc-metalloenzyme carbonic anhydrase localized in taste buds and salivary glands may be influenced to adversely affect gustatory and saliva secretory functions. Zinc-binding metallothioneins and zinc transporters, which cooperatively control cellular zinc homeostasis, are expressed in oral tissues participating in taste and saliva secretion. Their expression dysregulation associated with COVID-19-induced zinc deficiency may have some effect on oral functions. Zinc supplementation is expected to improve oral symptoms in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Olfactory and gustatory dysfunctions (OD, GD) are prevalent symptoms following COVID-19 and persist in 6%–44% of individuals post-infection. As only few reports have described their prognosis after 6 months, our main objective was to assess the prevalence of OD and GD 11-month post-COVID-19. We also aimed to determine intraclass correlation coefficients (ICC) of chemosensory self-ratings for the follow-up of chemosensory sensitivity. We designed an observational study and distributed an online questionnaire assessing chemosensory function to healthcare workers with a RT-PCR-confirmed SARS-CoV-2 infection 5- and 11-month post-COVID-19. Specifically, we assessed olfaction, gustation, and trigeminal sensitivity (10-point visual analog scale) and function (4-point Likert scale). We further measured clinically relevant OD using the Chemosensory Perception Test, a psychophysical test designed to provide a reliable remote olfactory evaluation. We included a total of 366 participants (mean [SD] age of 44.8 (11.7) years old). They completed the last online questionnaire 10.6 months (0.7) after the onset of COVID-19 symptoms. Of all participants, 307 (83.9%) and 301 (82.2%) individuals retrospectively reported lower olfactory or gustatory sensitivity during the acute phase of COVID-19. At the time of evaluation, 184 (50.3%) and 163 (44.5%) indicated reduced chemosensory sensitivity, 32.2% reported impairment of olfactory function while 24.9% exhibited clinically relevant OD. Olfactory sensitivity had a high test–retest reliability (ICC: 0.818; 95% CI: 0.760–0.860). This study suggests that chemosensory dysfunctions persist in a third of COVID-19 patients 11 months after COVID-19. OD appears to be a common symptom of post-COVID-19 important to consider when treating patients. [ABSTRACT FROM AUTHOR]

Objectives: In most cases, suspension laryngoscopy (SL) is efficient, bloodless and with minimal post‐procedure discomfort. We aimed to identify predictive patient factors for acceptable surgical views at SL as well as quantify our tertiary airway unit's complication rates. Design: Prospective cohort study of 150 consecutive microlaryngoscopy procedures involving SL over an 8‐month period between November 2019 and July 2020. Patients were assessed preoperatively for pre‐existing oral, temporomandibular, dental, pharyngeal or laryngeal pathology, interincisor distance and qualitative gross limitations to neck extension and forward head posture. Intraoperatively, the laryngoscopic view was graded by anaesthetic and surgical teams, and complications were recorded on patient interview in recovery. Setting: Tertiary adult airway service for predominantly benign pathology. Results: Adequate surgical views were obtained in 149/150 procedures. BMI had a weak positive correlation with a more difficult view (r =.22, p =.008) but did not correlate with a statistically significant increase in any complication. There was a weak negative correlation between age and interincisor gap (r = −.20, p =.014), and wider mouth opening correlated very weakly with a lower incidence of sore throat (r = −.19, p =.023). Gross macroglossia showed a significant moderate positive correlation with tongue symptoms (r =.45, p = 1.611 × 10−8). Conclusion: In the context of an experienced airway unit with a high caseload of predominantly benign pathology, SL is very effective and safe with low associated morbidity and no mortality. The most common complication of SL is temporary sore throat and there remain recognised risks of temporary tongue and dental symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT]. Methods: Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process. Results: The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up. Conclusion: Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented. [ABSTRACT FROM AUTHOR]

Sudden olfactory loss in the absence of concurrent nasal congestion is now a well‐recognized symptom of COVID‐19. We examined olfaction using standardized objective tests of odour detection, identification and hedonics collected from asymptomatic university students before and as SARS‐CoV‐2 emerged locally. Olfactory performance of students who were tested when the virus is known to be endemic (n = 22) was compared to students tested in the month prior to viral circulation (n = 25), a normative sample assessed during the previous 4 years (n = 272) and those tested in prior years during the same time period. Analyses showed significantly reduced odour detection for the virus exposed cohort compared to students tested before (t = 2.60; P =.01; d = 0.77; CI 0.17, 1.36) and to the normative sample (D = 0.38; P =.005). Odour identification scores were similar, but the exposed cohort rated odours as less unpleasant (P <.001, CLES = 0.77). Hyposmia increased 4.4‐fold for students tested 2 weeks before school closure (N = 22) and increased 13.6‐fold for students tested in the final week (N = 11). While the unavailability of COVID‐19 testing is a limitation, this naturalistic study demonstrates week‐by‐week increase in hyposmia in asymptomatic students as a virus was circulating on campus, consistent with increasing airborne viral loads. The specific hedonic deficit in unpleasantness appraisal suggests a deficit in the TAAR olfactory receptor class, which conveys the social salience of odours. Assessment of odour detection and hedonic ratings may aid in early detection of SARS‐CoV‐2 exposure in asymptomatic and pre‐symptomatic persons. [ABSTRACT FROM AUTHOR]

Background: There are no outcome studies for coronavirus disease 2019 (COVID-19) survivors one year after hospital discharge in Germany., Methods: This retrospective cohort study included all patients with polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospitalized in the departments of internal medicine of the Klinikum Saarbrücken, a tertiary care hospital, between March 15 and December 31, 2020. A telephone interview with survivors was conducted at least 12 months after discharge. The interview was initiated with an open-ended question whether the patient had fully recovered from the disease. In the event of a subjective incomplete recovery, the patient was prompted to report any continuous or frequent symptoms that had not occurred prior to COVID-19. Finally, independent of the open-ended question response, all patients were asked closed questions which addressed new symptom onset of persistent fatigue, cognitive dysfunction, headache, muscle and joint pain following COVID-19., Results: In all, 235 survivors were contacted and 162 could be included in the analysis. In 55 of 162 interviews (34.0%) at least one persistent COVID-19 symptom (PCS) was spontaneously reported. Four of 55 survivors with PCS reported five additional symptoms on the closed questions. One survivor, who responded positively to the open-ended question, reported new onset PCS in response to the closed questions. Physical fatigue (24.7%), cognitive dysfunction (14.8%), shortness of breath (8.6%), muscle and joint pain (6.8%) and headache (6.2%) were the most frequently reported PCS., Conclusions: Despite an interview technique aimed to reduce attribution bias by patients, one third of COVID-19 inpatient survivors report PCS one year after hospitalization. The complete article is written in English., (© 2022. The Author(s).)

While numerous studies have already compared the immune responses against SARS-CoV-2 in severely and mild-to-moderately ill COVID-19 patients, longitudinal trajectories are still scarce. We therefore set out to analyze serial blood samples from mild-to-moderately ill patients in order to define the immune landscapes for differently progressed disease stages. Twenty-two COVID-19 patients were subjected to consecutive venipuncture within seven days after diagnosis or admittance to hospital. Flow cytometry was performed to analyze peripheral blood immune cell compositions and their activation as were plasma levels of cytokines and SARS-CoV-2 specific immunoglobulins. Healthy donors served as controls. Integrating the kinetics of plasmablasts and SARS-CoV-2 specific antibodies allowed for the definition of three disease stages of early COVID-19. The incubation phase was characterized by a sharp increase in pro-inflammatory monocytes and terminally differentiated cytotoxic T cells. The latter correlated significantly with elevated concentrations of IP-10. Early acute infection featured a peak in PD-1+ cytotoxic T cells, plasmablasts and increasing titers of virus specific antibodies. During late acute infection, immature neutrophils were enriched, whereas all other parameters returned to baseline. Our findings will help to define landmarks that are indispensable for the refinement of new anti-viral and anti-inflammatory therapeutics, and may also inform clinicians to optimize treatment and prevent fatal outcomes. [ABSTRACT FROM AUTHOR]