{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T11:31:03Z","timestamp":1774438263707,"version":"3.50.1"},"reference-count":53,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T00:00:00Z","timestamp":1629849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The presence of SARS-CoV-2 in the middle ear reveals the etiopathogenesis of otitis media in COVID-19, as well as an epidemiological risk during otologic examination and surgical procedures in COVID-19 patients. The study included 8 deceased patients with COVID-19. Tissue samples from the middle ear were subjected to virology, histopathology, scanning (SEM) and transmission (TEM) electron microscopy investigation. Ethmoidal mucosa samples were processed for virology analyses. qPCR resulted positive for 75% of nasal mucosa samples and 50% of middle ear samples. Ct values showed lower viral loads in middle ear samples. A proportion of 66.6% patients with positive results in the nasal mucosa showed positive results in the middle ear, and the subtype analysis of the complete genome sequences indicated B.1.1.7 lineage for all samples. In histopathological and SEM samples, no pathological aspects were identified. TEM revealed on the background of death critical alteration of cellular morphology, suggestive structures resembling SARS-CoV-2, goblet cells and immune cells. SARS-CoV-2 can be present in the middle ear of COVID-19 patients even if there is not clinical evidence of acute otitis media. Otolaryngologists could be particularly exposed to COVID-19 infection.<\/jats:p>","DOI":"10.3390\/diagnostics11091535","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:19:26Z","timestamp":1629937166000},"page":"1535","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Evidence of SARS-CoV-2 Virus in the Middle Ear of Deceased COVID-19 Patients"],"prefix":"10.3390","volume":"11","author":[{"given":"Ionu\u021b Isaia","family":"Jeican","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"},{"name":"Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7051-3758","authenticated-orcid":false,"given":"Maria","family":"Alua\u0219","sequence":"additional","affiliation":[{"name":"Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8226-6026","authenticated-orcid":false,"given":"Mihaela","family":"Laz\u0103r","sequence":"additional","affiliation":[{"name":"Viral Respiratory Infections Laboratory, Cantacuzino National Military-Medical Institute for Research and Development, 050096 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0360-016X","authenticated-orcid":false,"given":"Lucian","family":"Barbu-Tudoran","sequence":"additional","affiliation":[{"name":"Electron Microscopy Laboratory, Faculty of Biology and Geology, Babe\u0219-Bolyai University, 400006 Cluj-Napoca, Romania"},{"name":"Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Gheban","sequence":"additional","affiliation":[{"name":"Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"},{"name":"Department of Pathology, Emergency Clinical Hospital for Children, 400370 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Ini\u0219ca","sequence":"additional","affiliation":[{"name":"Department of Pathology, County Emergency Hospital, 330084 Deva, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camelia","family":"Albu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"},{"name":"Imogen Medical Research Institute, County Clinical Emergency Hospital, 400014 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Septimiu","family":"Tripon","sequence":"additional","affiliation":[{"name":"Electron Microscopy Laboratory, Faculty of Biology and Geology, Babe\u0219-Bolyai University, 400006 Cluj-Napoca, Romania"},{"name":"Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2858-8470","authenticated-orcid":false,"given":"Silviu","family":"Albu","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Costel","family":"Siserman","sequence":"additional","affiliation":[{"name":"Department of Legal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"},{"name":"Institute of Legal Medicine, Department of Legal Medicine, \u2018Iuliu Ha\u0163ieganu\u2019 University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0811-0821","authenticated-orcid":false,"given":"Mihaela Laura","family":"Vica","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, Department of Legal Medicine, \u2018Iuliu Ha\u0163ieganu\u2019 University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"},{"name":"Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Muntean","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Clinical Hospital of Infectious Disease, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iulian","family":"Opincariu","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3550-7966","authenticated-orcid":false,"given":"Lia Monica","family":"Junie","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1038\/s41586-021-03777-9","article-title":"Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization","volume":"596","author":"Planas","year":"2021","journal-title":"Nature"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1016\/B978-0-12-415847-4.00101-4","article-title":"Middle Ear and Eustachian Tube Mucosal Immunology","volume":"2","author":"Massa","year":"2015","journal-title":"Mucosal. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1038\/s41385-020-00359-2","article-title":"The central role of the nasal microenvironment in the transmission, modulation, and clinical progression of SARS-CoV-2 infection","volume":"14","author":"Gallo","year":"2021","journal-title":"Mucosal. Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.anorl.2020.04.012","article-title":"COVID-19 and ENT Surgery","volume":"137","author":"Couloigner","year":"2020","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e651","DOI":"10.1097\/SCS.0000000000006694","article-title":"COVID-19 Pandemic and Otologic Surgery","volume":"31","author":"Cetinkaya","year":"2020","journal-title":"J. Craniofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102487","DOI":"10.1016\/j.amjoto.2020.102487","article-title":"New type of corona virus induced acute otitis media in adult","volume":"41","author":"Fidan","year":"2020","journal-title":"Am. J. Otolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1001\/jamaoto.2020.1922","article-title":"SARS-CoV-2 Virus Isolated from the Mastoid and Middle Ear: Implications for COVID-19 Precautions during Ear Surgery","volume":"146","author":"Frazier","year":"2020","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1017\/S0022215120002741","article-title":"Otitis media in coronavirus disease 2019: A case series","volume":"135","author":"Raad","year":"2021","journal-title":"J. Laryngol. Otol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1002\/lio2.498","article-title":"Otologic dysfunction in patients with COVID-19: A systematic review","volume":"5","author":"Maharaj","year":"2020","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1001\/jamaoto.2020.0780","article-title":"Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic","volume":"146","author":"Givi","year":"2020","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_11","unstructured":"WHO (2021, February 03). Infection Prevention and Control for the Safe Management of a Dead Body in the Context of COVID-19. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/331538\/WHO-COVID-19-lPC_DBMgmt-2020.1-eng.pdf."},{"key":"ref_12","unstructured":"Centers for Disease Control and Prevention (2021, March 26). Collection and Submission of Postmortem Specimens from Deceased Persons with Known or Suspected COVID-19, Available online: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/guidance-postmortem-specimens.html."},{"key":"ref_13","unstructured":"European Centre for Disease Prevention and Control (2021, March 26). Considerations Related to the Safe Handling of Bodies of Deceased Persons with Suspected or Confirmed COVID-14. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/considerations-related-safe-handling-bodies-deceased-persons-suspected-or."},{"key":"ref_14","unstructured":"Romanian Health Ministry (2020). Order No. 436 of March 13, 2020 on Specific Protocol on the Management in Case of Death of Patients Infected with the New Coronavirus (SARS-CoV2), Romanian Health Ministry."},{"key":"ref_15","unstructured":"Romanian National Institute for Public Health (2021, July 20). Methodology for Surveillance of Acute Respiratory Syndrome with the New Coronavirus (COVID-19). Available online: https:\/\/www.cnscbt.ro\/index.php\/info-medical\/2047-metodologia-de-supraveghere-a-covid-19-actualizare-23-10-2020-1\/file."},{"key":"ref_16","unstructured":"Quick, J., and Loman, N. (2021, January 31). hCoV-2019\/nCoV-2019 Version 3 Amplicon Set. Available online: https:\/\/artic.network\/resources\/ncov\/ncov-amplicon-v3.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.cell.2020.05.042","article-title":"SARS-CoV-2 Reverse Genetics Reveals a Variable Infection Gradient in the Respiratory Tract","volume":"182","author":"Hou","year":"2020","journal-title":"Cell"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E2013","DOI":"10.1002\/lary.29324","article-title":"Expression of ACE2, TMPRSS2, and Furin in Mouse Ear Tissue, and the Implications for SARS-CoV-2 Infection","volume":"131","author":"Uranaka","year":"2021","journal-title":"Laryngoscope"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Martines, F., Dispenza, F., Sireci, F., Gallina, S., and Salvago, P. (2021). Eustachian Tube Function Assessment after Radiofrequency Turbinate Reduction in Atopic and Non-Atopic Patients. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18030881"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1097\/INF.0000000000002486","article-title":"Comprehensive Detection of Respiratory Bacterial and Viral Pathogens in the Middle Ear Fluid and Nasopharynx of Pediatric Patients with Acute Otitis Media","volume":"38","author":"Sawada","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1542\/peds.102.2.291","article-title":"Detection of rhinovirus, respiratory syncytial virus, and coronavirus infections in acute otitis media by reverse transcriptase polymerase chain reaction","volume":"102","author":"Virolainen","year":"1998","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1590\/S1808-86942012000100006","article-title":"Method for removal of samples from the external ear canal and the tympanic membrane for histological and immunohistochemical studies","volume":"78","author":"Pereira","year":"2012","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41421-021-00282-1","article-title":"Potential transmission chains of variant B.1.1.7 and co-mutations of SARS-CoV-2","volume":"7","author":"Zhang","year":"2021","journal-title":"Cell Discov."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.ijporl.2007.12.008","article-title":"The incidence, prevalence and burden of OM in unselected children aged 1-8 years followed by weekly otoscopy through the \u201ccommon cold\u201d season","volume":"72","author":"Mandel","year":"2008","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1001\/archotol.135.1.17","article-title":"Rate of concurrent otitis media in upper respiratory tract infections with specific viruses","volume":"135","author":"Alper","year":"2009","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1128\/CMR.16.2.230-241.2003","article-title":"Importance of respiratory viruses in acute otitis media","volume":"16","author":"Heikkinen","year":"2003","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1128\/iai.62.5.1710-1718.1994","article-title":"Synergistic effect of adenovirus type 1 and nontypeableHaemophilus influenzae in a chinchilla model of experimental otitis media","volume":"62","author":"Suzuki","year":"1994","journal-title":"Infect. Immun."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1128\/JVI.80.4.1629-1636.2006","article-title":"Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species- and cell type-dependent manner","volume":"80","author":"Avadhanula","year":"2006","journal-title":"J. Virol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1128\/iai.63.4.1153-1157.1995","article-title":"Effect of experimental influenza A virus infection on isolation of Streptococcus pneumoniae and other aerobic bacteria from the oropharynges of allergic and nonallergic adult subjects","volume":"63","author":"Wadowsky","year":"1995","journal-title":"Infect. Immun."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1177\/000348940010901106","article-title":"Effect of adenovirus type 1 and influenza A virus on Streptococcus pneumoniae nasopharyngeal colonization and otitis media in the chinchilla","volume":"109","author":"Tong","year":"2000","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3109\/00016489309135771","article-title":"Cytological and histological changes in the middle ear after inoculation of influenza A virus","volume":"113","author":"Chung","year":"1993","journal-title":"Acta Otolaryngol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1177\/000348949310200711","article-title":"Effect of influenza A virus on ciliary activity and dye transport function in the chinchilla eustachian tube","volume":"102","author":"Park","year":"1993","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4588","DOI":"10.1038\/s41598-017-04639-z","article-title":"The Role of the Notch Signal Pathway in Mucosal Cell Metaplasia in Mouse Acute Otitis Media","volume":"7","author":"Liu","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1159\/000276931","article-title":"Morphological distribution of middle-ear epithelium in the Wistar rat: A functional hypothesis","volume":"59","author":"Scarano","year":"1997","journal-title":"ORL J. Otorhinolaryngol. Relat. Spec."},{"key":"ref_35","unstructured":"Ansari, A., Tariq, M.A., and Sadiq, N.M. (2021, March 26). Histology, Ear, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK545170\/."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3109\/00016488409122876","article-title":"Ultrastructure of the middle ear mucosa","volume":"414","author":"Hentzer","year":"1984","journal-title":"Acta Otolaryngol. Suppl."},{"key":"ref_37","first-page":"296","article-title":"Insights in the physiology of the human mastoid: Message to the surgeon","volume":"8","author":"Ars","year":"2012","journal-title":"J. Int. Adv. Otol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/joa.12389","article-title":"Surgical anatomy and pathology of the middle ear","volume":"228","author":"Luers","year":"2016","journal-title":"J. Anat."},{"key":"ref_39","unstructured":"Danishyar, A., and Ashurst, J.V. (2021, March 26). Acute Otitis Media, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470332\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1177\/000348940811700814","article-title":"Interleukin-10 is an essential modulator of mucoid metaplasia in a mouse otitis media model","volume":"117","author":"Tsuchiya","year":"2008","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1038\/s41593-020-00758-5","article-title":"Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19","volume":"24","author":"Meinhardt","year":"2021","journal-title":"Nat. Neurosci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.kint.2021.01.004","article-title":"Best practices for correctly identifying coronavirus by transmission electron microscopy","volume":"99","author":"Bullock","year":"2021","journal-title":"Kidney Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1016\/S0140-6736(20)32079-1","article-title":"Why misinterpretation of electron micrographs in SARS-CoV-2-infected tissue goes viral","volume":"396","author":"Dittmayer","year":"2020","journal-title":"Lancet"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"P\u00e9rez, A., Torregrosa, I., D\u2019Marco, L., Juan, I., Terradez, L., Sol\u00eds, M.\u00c1., Moncho, F., Carda-Batalla, C., Forner, M.J., and Gorriz, J.L. (2021). IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection. Viruses, 13.","DOI":"10.3390\/v13040587"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1002\/lary.28655","article-title":"A Novel Coronavirus Pneumonia Case Report from an Ear, Nose, and Throat Clinic","volume":"130","author":"Ye","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1177\/0003489420958443","article-title":"Considerations in Management of Acute Otitis Media in the COVID-19 Era","volume":"130","author":"Mohan","year":"2021","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1097\/MAO.0000000000002851","article-title":"Covid-19 and Otologic\/Neurotologic Practices: Suggestions to Improve the Safety of Surgery and Consultations","volume":"41","author":"Ayache","year":"2020","journal-title":"Otol. Neurotol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/MAO.0000000000002986","article-title":"Middle Ear Viral Load Considerations in the COVID-19 Era: A Systematic Review","volume":"42","author":"Liaw","year":"2021","journal-title":"Otol. Neurotol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1097\/01.mlg.0000177459.80574.2d","article-title":"Mastoidectomy and trans-corneal viral transmission","volume":"115","author":"Hilal","year":"2005","journal-title":"Laryngoscope"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1002\/alr.22577","article-title":"Endonasal instrumentation and aerosolization risk in the era of COVID-19: Simulation, literature review, and proposed mitigation strategies","volume":"10","author":"Workman","year":"2020","journal-title":"Int. Forum. Allergy Rhinol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1007\/s00405-020-06309-9","article-title":"COVID-19 and ear endoscopy in otologic practices","volume":"278","author":"Ayache","year":"2021","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1002\/jmv.25944","article-title":"Epidemiological and clinical features of asymptomatic patients with SARS-CoV-2 infection","volume":"92","author":"Xu","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1177\/0194599820919741","article-title":"A Commentary on Safety Precautions for Otologic Surgery during the COVID-19 Pandemic","volume":"162","author":"Saadi","year":"2020","journal-title":"Otolaryngol. Head Neck Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/9\/1535\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:51:27Z","timestamp":1760165487000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/9\/1535"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,25]]},"references-count":53,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["diagnostics11091535"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11091535","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,25]]}}}