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Hsin-Chi Chen, MD; Yi-Ho Young, MD; Jyh-Perng Luo, MD; Hui-Ju Tsai, MD; Sung-Jung Ho, MD; Chi-Huang Yeh, MD; Lien-Chi Huang, MD

Arch Otolaryngol Head Neck Surg. 2003;129:1157-1160.

Objective  To provide a clue for screening severe acute respiratory syndrome (SARS), a highly transmissible disease with health care workers at particular risk, in the early stage from an otolaryngological perspective.

Design  Prospective study.

Setting  Community hospital.

Patients  Between April 17 and April 26, 2003, 32 consecutive patients with SARS were encountered. Investigation consisted of local examination of ear, nose, and throat fields; palpation of the nuchal areas; and plain chest radiography. Analyses of throat swab samples using reverse transcription–polymerase chain reaction were conducted.

Results  Clinical manifestations included fever in 31 patients (97%), followed by cough, dyspnea, chill, headache, sore throat, diarrhea, rhinorrhea, and otalgia. Neither the pharyngeal wall nor the tonsillar area demonstrated hyperemia. There was no lymphadenopathy in the neck. Plain chest radiographs revealed consolidation in 25 (78%) of 32 patients. Results of reverse transcription–polymerase chain reaction analysis targeting the novel coronavirus present in throat swab samples were positive in 19 (66%) of 29 patients tested. Twenty-eight patients required supplemental oxygen, and 14 patients were intubated with mechanical ventilation. Twenty-eight patients survived and 4 patients died.

Conclusions  When presented with a patient with flulike symptoms such as fever and/or cough, but no pharyngeal hyperemia or neck lymphadenopathy, physicians should be alerted to the possibility of SARS. In contrast, evidence of inflammatory signs in the otolaryngological field may explain the flulike symptoms, and serve as a differential diagnostic tool between influenza and SARS.

From the Departments of Otolaryngology (Dr Chen) and Medicine (Drs Luo, Tsai, Ho, Yeh, and Huang), Municipal Ho-Ping Hospital; and Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine (Dr Young), Taipei, Taiwan. The authors have no relevant financial interest in this article.