Otitis media comorbidity to Covid-19?

Otitis media possible comorbidity to Covid-19?

To all my colleagues and to the medical world in general i wish to share the following observation which may contribute in a more effective handling of the decease, possible faster recovery and maybe limit the loss of life in this pandemic.

At this point i admit my observation is not extensive and based on three cases of undiagnosed flu-like symptoms and not on positively diagnosed Covid-19 patiënts. But in a time where the threat is serieus enough and casualties are high a sense of urgency outweigh my fear of being wrong about this. So premature as it is i am highly motivated to share this hypothesis.

All three observed cases presented symptoms as a dry, unproductive cough, sore throat and sneezing. They presented no shortness of breath and they showed no signs of pneumonia. They did present possible symptoms of a changed sense of taste. So some, but not all symptoms of corona where present, and if these cases where Covid-19 cases, they presented only mild symptoms.

A perculiar smell

The first thing that struck me when confronted with these cases was a strange smell. Having experience with otitis media with my eldest son, this smell reminded me of these incidences. It led me to perform an otoscopy and saw the typical white aspect of the eardrum surrounded with a red, inflamed border associated with otitis media. The same finding i had with the other two cases.

"Earwax and its uses"

This findings of otitis media in these cases presenting flu-like symptoms reminded my of de passage "Earwax and its uses" in chapter XIV of "The Philosophy and Mechanical Principle of Osteopathy" written by our Founder Andrew Taylor Still.

He describes three cases (a "fat boy of two summers" and "two ladies"), suffering with sore throat, tonsillitis and pneumonia (in the case of the fat boy) and "sore in the lungs, necks tied up, sore throats, fevers and headache" (in case of the two ladies). He found in these cases a peculiar hardend state of the earwax in the external auditory meatus.
In addition to osteopathic treatment he soften the earwax with glycerine and water.

Although much of Still's thought on the nature and function of earwax is nowadays less relevant, its mainly the relationship he sees between this area and the lungs that are relevant here.

Now here i am not so much interested in the treatment of these cases and i am certainly not implying that this approach would in any way be effective in treating Covid-19, but the theoretical explanation he gives does interest me.

Could it be that a middle ear infection accompanying Covid-19 disturbs the blood flow through the internal carotic artery causing headache (which can be migraine-like in nature where it's Covid-19 concerns, i hear) and the respiratory problem be (partly) caused by interference of the neurological innervation of the lungs through disturbance of the superior cervical ganglia?

Sniper in hiding

If these finding are corroborated by others, actually dealing with Covid-19, the decease may be discovered to be a sniper hiding in the bell-tower, picking off its victims undetected.

The mechanical reasoning is sound. What if Covid-19 does not primarily target the lungs at all, but the mucous membrane of the eustachian tube? Sore throat and loss of smell and taste being the first symptoms of the decease.

Closing off the eustachian tube by swelling inhibiting proper drainage and causing rising pressure and infection in the middle ear. 

The raised pressure inhibiting blood-flow in the internal Carotic artery, and pressing on the nerves passing in the vicinity causing the lung problems. It could be a dysfunction-mechanism, couldn't it?

I am not fully aware of the medical assistance given to the Covid-19 victims in ICU's at the moment, but as things are, waiting for a working vaccine, any additional care with any positive effect is helpful.

No claim, no science

I can not stress this point enough, i do not make claims in this article. It is not a claim to a treatment, nor a scientifically based hypothesis on the nature of Covid-19.

Many times in my career, particularly as a student, i have said stupid things and asked stupid questions. They derive mainly from my naïf way of observing. I find i take the world around me with just a little less prejudices as some of the people around me. This talking before thinking does occasionally put me on a right track, dismissed beforehand by others.

The observation of the peculiar smell, combined with a sense of association drove me to inspect the middle ears of these three cases of flu-like symptoms. Again, i do not know if these cases were Covid-19 or not. But not fearing scorning and ridicule on the meagerness of my scientific reasoning i thought it important to put the idea into the world.

Lets just consider 

Lets consider what could happen if this findings are corroborated by others and the medical approach to Covid-19 could be supplemented with a targeting of a co-morbid otitis media. If an anti-biotic in this case could be effective and save lives, not for its effect on viruses (which is knowingly non-existent) but because of its effect on the middle ear-infection. Maybe drainage of the middle ear, through for example tympanostomy tubes, could relieve pressure, freeing nerve function and alleviate the shortness of breath. Wouldn't that be great?

Maybe also, but let's hope not, the amount of cases will exceed hospital and ICU capacity and are we, osteopaths, called upon to do what can be done. With our ability to free up temporal bones, restore freedom of mobility to the cervical spine, lymphatic techniques and all our other tools, we may play a role in fighting this global threat alongside our medical brethren.

In the milder cases regular "clearing" of the ears may already improve health and speed up recovery.

I bow to my peers

For the last time i state the humble circumstances in which i write this piece. I know this is not a scientific article at all, far from it. It's nothing more than a hunch. It has no pretenses. Maybe it may inspire you to perform an otoscopy when confronted with a patiënt suspected of having a Covid-19 infection. Corroboration of this finding, and the possible positive effect treating the otitis mediamay have on Covid-19 associated symptoms may be of value. On the other hand failure in corroboration has no negative effect other than the time wasted by performing  the otoscopy.

I find the most meager of chances in bettering the handling of Covid-19 important enough to hang my head in the proverbial noose and welcome all feedback from all directions.

Good health to you all!

Axel Staps D.O.-mro, osteopaat