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Comprehensive Otolaryngology

(356) Otorhinolaryngologic Manifestations Among Mpox Patients: A Systematic Review and Meta-Analysis

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • TS

    Tiana M. Saak, BA

    Medical Student
    Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
    Cooperstown, New York, United States

    • Co-Author(s)

  • JS

    Jaffer Shah, BS

    New York State Department of Health, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA, USA

    • Co-Author(s)

  • Angel N. Desai, MD, MPH

    Assistant Professor
    Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA; Associate Editor, JAMA Network Open
    Sacramento, California, United States

  • David A. Gudis, MD

    Associate Professor of Rhinology, Skull Base Surgery, and Pediatric Otolaryngology
    Division of Rhinology & Anterior Skull Base Surgery, Department of Otolaryngology–Head & Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
    New York, New York, USA

    • Co-Author(s)

  • HA

    Huzaifa Ahmad Cheema

  • MA

    Mohamed Abuelazm

    • Co-Author(s)

  • DP

    Diego A. Preciado, MD, PHD

    Chief of Otolaryngology
    Department of Otolaryngology–Head & Neck Surgery, George Washington University, Children's National Hospital, Washington, DC, USA; Editorial Board JAMA Otolaryngol Head Neck Surg
    Washington, DC, United States

  • JZ

    Jason Zucker, MD

    Division of Infectious Disease, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA, USA

    • Senior Author(s)

  • Jonathan B. Overdevest, MD, PhD

    Assistant Professor of Otolaryngology
    Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center
    New York, NY, United States

Disclosure(s):
Tiana M. Saak, BA: No relevant relationships to disclose.
Angel N. Desai, MD, MPH: No relevant relationships to disclose.
Jonathan B. Overdevest, MD, PhD: No relevant relationships to disclose.


Introduction: Monkeypox (mpox) has a variety of otolaryngology presentations that have been recognized as important in the clinical setting, especially with the onset of the 2022 outbreak. The objective here is to identify the otolaryngologic manifestations of mpox across previous and current outbreaks and among endemic and non-endemic regions to aid in the recognition of the infection in an otolaryngology setting, as these variations have yet to be elucidated.

Methods: Observational studies reporting data on laboratory-confirmed mpox patients with otolaryngologic symptoms from a variety of data sources searched through August 2022 were included. Data were extracted by two authors independently. A meta-analysis of the prevalence rate of the otorhinolaryngologic symptoms was performed using MetaXL software (version 5.3) under a random-effects model. The main outcome measurements included the otolaryngologic presentation of mpox in past vs. current outbreaks and endemic vs. non-endemic regions.

Results: 38 studies with 5952 patients were included. The four most prevalence manifestations were headache at 31% (95% CI [0.16-0.49], I^2=99%), sore throat at 22% (95% CI [0.09-0.37], I^2=99%), cough at 16% (95% CI [0.05-0.30], I^2=99%), and cervical lymphadenopathy at 10% (95% CI [0.01-0.26], I^2=100%). Otolaryngologic features more prevalent in previous outbreaks as compared to the 2022 outbreak include headache, cough, sore throat, cervical lymphadenopathy, oral ulcers, oral exanthem, and dysphagia. Features that were more prevalent in endemic areas versus non-endemic areas include cough, tonsillar signs, and cervical lymphadenopathy, while headache was the only feature more prevalent in non-endemic areas.

Conclusions: Four symptoms – headache, sore throat, cough, and cervical lymphadenopathy – were found to be the most prevalent otolaryngologic features of mpox. Otolaryngologic manifestations of mpox were more pronounced in prior outbreaks and in endemic areas as compared to the 2022 outbreak and non-endemic areas. These findings can aid mpox recognition in an otolaryngology setting.