{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:31:25Z","timestamp":1753893085465,"version":"3.41.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral. Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>COVID-19 is a respiratory disease, and its symptoms may be affected by the upper airways of adolescents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the effect of parameters of adolescents\u2019 upper airways on COVID-19 symptom severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study was performed from January to March 2022 at the Hospital of Stomatology, Xi\u2019an Jiaotong University, Xi\u2019an, China. The inclusion criteria were patients who started orthodontic treatment for the first time, who experienced initial onset of laboratory-confirmed COVID-19, and who received two intramuscular doses of the SARS-CoV-2 vaccine. Participants\u2019 COVID-19 symptom severity was recorded by a questionnaire including seven different dimensions. The three-dimensional parameters of the upper airway were obtained by cone beam computed tomography (CBCT) and measured by Dolphin Imaging software by blinded orthodontic investigators. The correlation between COVID-19 symptom severity and three-dimensional upper airway parameters was analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>64 males (46.4%) and 74 females (53.6%) were included in the study, with the median age of 9.5 years. The severity score of dimension 3 (headache, muscle pain, fatigue, shortness of breath, diarrhea and smell affects) showed a linear relationship with age. Spearman's rank correlation showed that the severity score of dimension 1 (nasal symptoms) was negatively correlated with nasal volume (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.325). The severity score of dimension 6 was negatively correlated with the height of the nasopharynx (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.325) and positively correlated with the horizontal-to-vertical ratio of the oropharynx (<jats:italic>r<\/jats:italic>\u2009=\u20090.385).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and relevance<\/jats:title><jats:p>The COVID-19 symptom severity was aggravated with the increase of age. Nasal and throat pain and dry mouth was negatively correlated with nasal volume and nasopharyngeal height. The COVID-19 symptom severity among individuals is relavant to age and upper airway.<\/jats:p><\/jats:sec>","DOI":"10.3389\/froh.2024.1458368","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T06:22:04Z","timestamp":1731565324000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The relationship between upper airway parameters and COVID-19 symptom severity in adolescents"],"prefix":"10.3389","volume":"5","author":[{"given":"Tianjing","family":"Du","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Mei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongning","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiamin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianglin","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun","family":"Qi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1001\/jama.2020.12839","article-title":"Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review","volume":"324","author":"Wiersinga","year":"2020","journal-title":"JAMA"},{"key":"B2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3390\/ijms25020859","article-title":"Post COVID-19 reflections and questions: how prepared are we for the next pandemic?","volume":"25","author":"Kontoghiorghes","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B3","doi-asserted-by":"publisher","first-page":"113","DOI":"10.46234\/ccdcw2020.032","article-title":"The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)\u2014China, 2020","volume":"2","year":"2020","journal-title":"China CDC Weekly"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2307","DOI":"10.1002\/jmv.26699","article-title":"Risk factors prediction, clinical outcomes, and mortality in COVID-19 patients","volume":"93","author":"Alizadehsani","year":"2021","journal-title":"J Med Virol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China (vol 395, pg 497, 2020)","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1002\/jmv.26424","article-title":"Epidemiology of COVID-19: a systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes","volume":"93","author":"Li","year":"2021","journal-title":"J Med Virol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"19","DOI":"10.2196\/28005","article-title":"Clinical, laboratory, and imaging features of COVID-19 in a cohort of patients: cross-sectional comparative study","volume":"7","author":"Qaisieh","year":"2021","journal-title":"JMIR Public Health Surveill"},{"key":"B8","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","article-title":"Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China","volume":"77","author":"Mao","year":"2020","journal-title":"JAMA Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1002\/rmv.2345","article-title":"Prevalence of oral manifestations in COVID-19: a systematic review","volume":"32","author":"Sharma","year":"2022","journal-title":"Rev Med Virol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study (vol 395, pg 1054, 2020)","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1038\/s41598-023-33314-9","article-title":"Global prevalence and effect of comorbidities and smoking status on severity and mortality of COVID-19 in association with age and gender: a systematic review, meta-analysis and meta-regression","volume":"13","author":"Chenchula","year":"2023","journal-title":"Sci Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1038\/s41586-020-2918-0","article-title":"Age-specific mortality and immunity patterns of SARS-CoV-2","volume":"590","author":"O'Driscoll","year":"2021","journal-title":"Nature"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1002\/jmv.26398","article-title":"A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19)","volume":"93","author":"Cui","year":"2021","journal-title":"J Med Virol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1007\/s12519-020-00392-y","article-title":"Why COVID-19 is less frequent and severe in children: a narrative review","volume":"17","author":"Sinaei","year":"2021","journal-title":"World J Pediatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/S0140-6736(22)01214-4","article-title":"Persistence of somatic symptoms after COVID-19 in The Netherlands: an observational cohort study","volume":"400","author":"Ballering","year":"2022","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"publisher","first-page":"13","DOI":"10.17219\/dmp\/157457","article-title":"Upper airway dimensions and the skeletal parameters in orthodontic patients who developed moderate-severe COVID-19 symptoms during the pandemic","volume":"60","author":"Al Maaitah","year":"2023","journal-title":"Dent Med Probl"},{"key":"B17","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1001\/jamafacial.2013.344","article-title":"Development of a severity classification system for subjective nasal obstruction","volume":"15","author":"Lipan","year":"2013","journal-title":"JAMA Facial Plast Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.ijnurstu.2013.10.005","article-title":"On exploratory factor analysis: a review of recent evidence, an assessment of current practice, and recommendations for future use","volume":"51","author":"Gaskin","year":"2014","journal-title":"Int J Nurs Stud"},{"key":"B19","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.pedhc.2018.08.002","article-title":"Exploratory factor analysis of the Mishel uncertainty in illness scale among adolescents and young adults with chronic medical conditions","volume":"33","author":"Sharkey","year":"2019","journal-title":"J Pediatr Health Care"},{"key":"B20","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.ajodo.2018.06.019","article-title":"Three-dimensional airway changes after adenotonsillectomy in children with obstructive apnea: do expectations meet reality?","volume":"155","author":"Bertoz","year":"2019","journal-title":"Am J Orthod Dentofac Orthop"},{"key":"B21","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1002\/lary.28863","article-title":"Evaluation of upper airway in children with obstructive sleep apnea using cone-beam computed tomography","volume":"131","author":"Hsu","year":"2021","journal-title":"Laryngoscope"},{"key":"B22","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.pt.2019.12.012","article-title":"Spatial lifecourse epidemiology and infectious disease research","volume":"36","author":"Jia","year":"2020","journal-title":"Trends Parasitol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"10","DOI":"10.26416\/Pedi.58.2.2020.3572","article-title":"Pathogenesis of SARS-CoV-2 infection in humans","volume":"2","author":"Incu","year":"2020","journal-title":"Pediatru Ro"},{"key":"B24","doi-asserted-by":"publisher","first-page":"917","DOI":"10.2319\/101218-738.1","article-title":"Effects of rapid maxillary expansion on upper airway volume: a three-dimensional cone-beam computed tomography study","volume":"89","author":"Abdalla","year":"2019","journal-title":"Angle Orthod"},{"key":"B25","doi-asserted-by":"crossref","DOI":"10.1101\/2021.06.24.21259087","article-title":"Pre-activated anti-viral innate immunity in the upper airways controls early SARS-CoV-2 infection in children","volume-title":"medRxiv","author":"Loske","year":"2021"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1259\/bjr.20180363","article-title":"The role of upper airway morphology in apnea versus hypopnea predominant obstructive sleep apnea patients: an exploratory study","volume":"91","author":"Xu","year":"2018","journal-title":"Br J Radiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"75","DOI":"10.26355\/eurrev_202310_34073","article-title":"Etiology of narrow maxilla creating orthodontic and prosthetic treatment difficulties","volume":"27","author":"Ozdemir Akkus","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"106267","DOI":"10.1016\/j.jinf.2024.106267","article-title":"Antecedent and persistent symptoms in COVID-19 and other respiratory illnesses: insights from prospectively collected data in the BRACE trial","volume":"89","author":"McDon Ald","year":"2024","journal-title":"The Journal of Iinfection"},{"key":"B29","doi-asserted-by":"publisher","first-page":"761","DOI":"10.55730\/1300-0144.5846","article-title":"Do patients infected with human coronavirus before the COVID-19 pandemic have less risk of being infected with COVID-19?","volume":"54","author":"\u015eanlida\u011f I\u015fbilen","year":"2024","journal-title":"Turk J Med Sci"},{"key":"B30","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ortho.2023.100745","article-title":"Effectiveness of orthopaedic treatments on the enlargement of the upper airways: overview of systematic reviews","volume":"21","author":"Bellon","year":"2023","journal-title":"Int Orthod"},{"key":"B31","doi-asserted-by":"publisher","first-page":"566","DOI":"10.2319\/070818-507.1","article-title":"Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion","volume":"89","author":"Kavand","year":"2019","journal-title":"Angle Orthod"},{"key":"B32","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1007\/s00405-016-4118-y","article-title":"Letter to editor on \u201cefficiency of bimaxillary advancement surgery in increasing the volume of the upper airways: a systematic review of observational studies and meta-analysis\u201d","volume":"274","author":"Rana","year":"2017","journal-title":"Eur Arch Oto-Rhino-Laryn"}],"container-title":["Frontiers in Oral Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/froh.2024.1458368\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T06:22:08Z","timestamp":1731565328000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/froh.2024.1458368\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,14]]},"references-count":32,"alternative-id":["10.3389\/froh.2024.1458368"],"URL":"https:\/\/doi.org\/10.3389\/froh.2024.1458368","relation":{},"ISSN":["2673-4842"],"issn-type":[{"type":"electronic","value":"2673-4842"}],"subject":[],"published":{"date-parts":[[2024,11,14]]},"article-number":"1458368"}}