Article Figures & Data
Figures
- Figure 1
(A) Illustrated on this coronal view of a normal CT scan of the sinus are the nasal septum (NS), inferior turbinate (IT), and middle turbinate (MT). The asterisk (*) depicts the location of the retained swab tip in our case with it being anchored between the MT and NS (Imaging was not performed for presented case as not indicated. If it were performed it would have shown nasal edema and possible evidence of sinusitis.). (B) The nasal swab tip, which was removed from the patient’s left naris.
- Figure 2
Flow chart of article selection from the literature search strategy.
- Figure 3
(A) This sagittal view of the CT of the sinus demonstrates the nasal anatomy encountered when performing a transnasal swab. The floor of the nasal cavity and nasopharynx (NP) is constituted by the hard palate (HP) and soft palate (SP). Within the nasal cavity, there are 3 shelves like projection from the lateral wall, inferior turbinate (IT), middle turbinate (MT) and superior turbinate (not demonstrated). The cribriform plate (CP), ethmoid sinus (ES) and sphenoid sinus (SS) form the nasal cavity roof. (B) As demonstrated by the solid line swab when performing transnasal testing, the swab should either not be advanced beyond a depth of 2 cm or if deeper testing is being performed, the swab should be advanced along the floor of the nasal cavity. The dash swab demonstrates a swab advanced following the exterior projection of the nose, which is a common misconception of the direction of the NP.
Tables
- Table 1
A summary of all included articles
First author Article type Transnasal swab
methodReported
complications (n)Reported outcome(s) Gupta4 LTE Nasopharyngeal Epistaxis12
Nasal discomfort10
Headache7
Ear discomfort6
Rhinorrhea6Majority of complications mild and self-limiting
A single case of epistaxis required presentation to the emergency department
Fabbris et al 5 LTE Nasopharyngeal Epistaxis4
Retained swabs3
Nasal septal abscess1Three cases of epistaxis required nasal packing under local anesthesia
Endoscopic cauterization and nasal packing under local anesthesia were required in the case of one epistaxis
Two retained swabs retrieved with nasal endoscopy
One retained swab was not located on nasal endoscopy and assumed swallowed
Nasal abscess incised and drained under local anesthesia
Pagella et al 6 LTE Not applicable Not applicable Patients with hemorrhagic telangiectasia should undergo non-transnasal SARS-CoV-2 testing
Föh7 LTE Nasopharyngeal
middle turbinateRetained swabs2
TMJ dislocation1*Adverse events were reported in 3 out of 11,476 swab procedures performed
One retained swab was endoscopically removed
One retained swab was not located on nasal endoscopy and assumed swallowed
Mughal8 Case report Nasopharyngeal Retained swabs1 Retained swab retrieved with nasal endoscopy
Azar et al 9 Case report Nasopharyngeal Retained swabs1 Retained swab retrieved with nasal endoscopy
Gaffuri et al 10 Case report Nasopharyngeal Retained swabs1 Retained swab retrieved under general anesthesia using a bronchoscope with an operative channel and flexible endoscopy forceps
Medas11 Case report Nasopharyngeal Retained swabs1 Retained swab not located on nasal endoscopy
An esophagogastroduodenoscopy was performed and swab located in stomach
Retrained swab removed using endoscope-grasping forceps
Sullivan et al 12 Case report Nasopharyngeal CSF leak1 Required surgical repair of skull base defect
Alberola-Amores et al 13 Case report Nasopharyngeal CSF leak complicated by meningitis1 Meningitis managed with antibiotics and steroids
Skull base defect closed spontaneously
Rajah14 Case report Nasopharyngeal CSF leak1 Required surgical repair of skull base defect
*Local protocol required both transnasal and oropharynx testing with the swab. There was a reported case of mandibular dislocation due to mouth opening for oropharynx swabbing.
CSF, cerebrospinal fluid; LTE, letter to editor; TMJ, temporomandibular joint.
