Critical Alert for Otolaryngologists: Earache May be the Early Signs of COVID-19

Introduction: The pandemic coronavirus disease 2019 or COVID-19 is infecting as fast as possible in more than 200 countries and creating the most horrible domino-like demolition ever seen. From its beginning in Wuhan, China, the SARS-CoV-2 infected the similar groups of 100,000 patients in 67, 11, 4, and 2 days. Healthcare workers are in the frontline of attacking by SARS-CoV-2, especially those who are in close contact with upper respiratory mucosa like otolaryngologists. Objectives: To describe ear pain as one of the first clinical manifestations of COVID-19, we present two cases of a family (a mother and her daughter) with a positive RT-PCR test for COVID-19 who presented earache as their first symptoms. Case Presentation: The first case was a 32 years old female patient (stewardess of an international airline, Tehran, Iran) was labeled as at risk due to her air flight to China in Dec 2019. She was first admitted for moderate ear pain in her left ear with mild itching of the external ear to an otolaryngology outpatient clinic by a general practitioner. After 7 days, her test for RT-PCR against COVID-19 was positive. No lung involvement was reported by high-resolution computed tomography (HRCT) of the thorax. Another case was her mother who were in close contact with each other and experienced severe ear pain after 7 days. She acquired mild COVID-19 symptoms with anosmia was a positive test result for COVID-19. Conclusions: The earache must be considered as their first clinical symptoms during the early phase of the coronavirus outbreak. It seems that local and international scientific groups of otolaryngologists must prepare their national guidelines to protect their practitioners against COVID-19 based on practical strategies. Using personal protective equipment is of utmost importance in reducing the risk of nosocomial infection among otolaryngologists.