{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:46:16Z","timestamp":1782265576539,"version":"3.54.5"},"reference-count":9,"publisher":"Royal College of Surgeons of England","issue":"S2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p> Since the start of the pandemic, over 400 million COVID-19 swab tests have been conducted in the UK with a non-trivial number associated with skull base injury. Given the continuing use of nasopharyngeal swabs, further cases of swab-associated skull base injury are anticipated. We describe a 54-year-old woman presenting with persistent colourless nasal discharge for 2 weeks following a traumatic COVID-19 nasopharyngeal swab. A \u03b22-transferrin test confirmed cerebrospinal fluid (CSF) rhinorrhoea and a high-resolution sinus computed tomography (CT) scan demonstrated a cribriform plate defect. Magnetic resonance imaging showed radiological features of idiopathic intracranial hypertension (IIH): a Yuh grade V empty sella and thinned anterior skull base. Twenty-four hour intracranial pressure (ICP) monitoring confirmed raised pressures, prompting insertion of a ventriculoperitoneal shunt. The patient underwent CT cisternography and endoscopic transnasal repair of the skull base defect using a fluorescein adjuvant, without complications. A systematic search was performed to identify cases of COVID-19 swab-related injury. Eight cases were obtained, of which three presented with a history of IIH. Two cases were complicated by meningitis and were managed conservatively, whereas six required endoscopic skull base repair and one had a ventriculoperitoneal shunt inserted. A low threshold for high-resolution CT scanning is suggested for patients presenting with rhinorrhoea following a nasopharyngeal swab. The literature review suggests an underlying association between IIH, CSF rhinorrhoea and swab-related skull base injury. We highlight a comprehensive management pathway for these patients, including high-resolution CT with cisternography, ICP monitoring, shunt and fluorescein-based endoscopic repair to achieve the best standard of care. <\/jats:p>","DOI":"10.1308\/rcsann.2022.0128","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T23:00:33Z","timestamp":1690844433000},"page":"S69-S74","source":"Crossref","is-referenced-by-count":5,"title":["COVID-19 nasopharyngeal swab and cribriform fracture"],"prefix":"10.1308","volume":"105","author":[{"given":"AM","family":"Vasilica","sequence":"first","affiliation":[{"name":"University College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Reka","sequence":"additional","affiliation":[{"name":"Bedfordshire Hospitals NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Mallon","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AK","family":"Toma","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HJ","family":"Marcus","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AS","family":"Pandit","sequence":"additional","affiliation":[{"name":"University College London, UK"},{"name":"University College London Hospitals NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"171","reference":[{"key":"C2","doi-asserted-by":"publisher","DOI":"10.4103\/0972-2327.112476"},{"key":"C6","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms10030598"},{"key":"C7","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjab456"},{"key":"C8","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14736"},{"key":"C10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2021.01.003"},{"key":"C11","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.3579"},{"key":"C17","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29462"},{"key":"C18","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51082"},{"key":"C19","doi-asserted-by":"publisher","DOI":"10.1016\/j.xocr.2021.100370"}],"container-title":["The Annals of The Royal College of Surgeons of England"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/pdf\/10.1308\/rcsann.2022.0128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T23:01:45Z","timestamp":1690844505000},"score":1,"resource":{"primary":{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/rcsann.2022.0128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":9,"journal-issue":{"issue":"S2","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1308\/rcsann.2022.0128"],"URL":"https:\/\/doi.org\/10.1308\/rcsann.2022.0128","relation":{},"ISSN":["0035-8843","1478-7083"],"issn-type":[{"value":"0035-8843","type":"print"},{"value":"1478-7083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8]]}}}