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Complications of nasal SARS-CoV-2 testing: a review

James H Clark, Sharon Pang, Robert M Naclerio, Matthew Kashima
DOI: 10.1136/jim-2021-001962 Published 25 November 2021
James H Clark
Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Sharon Pang
Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Robert M Naclerio
Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Matthew Kashima
Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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    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.

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    Figure 2

    Flow chart of article selection from the literature search strategy.

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    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

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  • Table 1

    A summary of all included articles

    First authorArticle typeTransnasal swab
    method
    Reported
    complications (n)
    Reported outcome(s)
    Gupta4 LTENasopharyngealEpistaxis12
    Nasal discomfort10
    Headache7
    Ear discomfort6
    Rhinorrhea6
    • Majority of complications mild and self-limiting

    • A single case of epistaxis required presentation to the emergency department

    Fabbris et al 5 LTENasopharyngealEpistaxis4
    Retained swabs3
    Nasal septal abscess1
    • Three 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 LTENot applicableNot applicable
    • Patients with hemorrhagic telangiectasia should undergo non-transnasal SARS-CoV-2 testing

    Föh7 LTENasopharyngeal
    middle turbinate
    Retained 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 reportNasopharyngealRetained swabs1
    • Retained swab retrieved with nasal endoscopy

    Azar et al 9 Case reportNasopharyngealRetained swabs1
    • Retained swab retrieved with nasal endoscopy

    Gaffuri et al 10 Case reportNasopharyngealRetained swabs1
    • Retained swab retrieved under general anesthesia using a bronchoscope with an operative channel and flexible endoscopy forceps

    Medas11 Case reportNasopharyngealRetained 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 reportNasopharyngealCSF leak1
    • Required surgical repair of skull base defect

    Alberola-Amores et al 13 Case reportNasopharyngealCSF leak complicated by meningitis1
    • Meningitis managed with antibiotics and steroids

    • Skull base defect closed spontaneously

    Rajah14 Case reportNasopharyngealCSF 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.

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Vol 69 Issue 8 Table of Contents
Journal of Investigative Medicine: 69 (8)
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Complications of nasal SARS-CoV-2 testing: a review
James H Clark, Sharon Pang, Robert M Naclerio, Matthew Kashima
Journal of Investigative Medicine Dec 2021, 69 (8) 1399-1403; DOI: 10.1136/jim-2021-001962

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Complications of nasal SARS-CoV-2 testing: a review
James H Clark, Sharon Pang, Robert M Naclerio, Matthew Kashima
Journal of Investigative Medicine Dec 2021, 69 (8) 1399-1403; DOI: 10.1136/jim-2021-001962
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Complications of nasal SARS-CoV-2 testing: a review
James H Clark, Sharon Pang, Robert M Naclerio, Matthew Kashima
Journal of Investigative Medicine Dec 2021, 69 (8) 1399-1403; DOI: 10.1136/jim-2021-001962
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