Deformabilidad eritrocitaria patológica en pacientes con sordera súbita

Blood viscosity in COVID-19 patients with sudden deafness

Background

Changes in blood viscoelastic properties have been proposed previosuly as etiopathogenesis for severe complications in COVID-19 and some cases of Sudden Deafness (SD). This is an attempt to verify if SD cases in patients admitted for SARS-Cov-2 infection can be correlated.

Patients and methods

A prospective follow-up was carried out with COVID-19 patients, monitoring their blood viscosity (BV) at high shear rate (300 s⁻¹) and inquiring them periodically for eventual hearing loss. This measurement was extended to cases bearing of SD in 2019 and 2020 without infection and a control group of healthy normoacoustic subjects.

Results

The normality range was 4,16 ± 0,62 cps. 330 cases admitted for COVID-19 were evaluated from February 24th, 2020 to March 24th, 2021, 85 of them attended in ICU. After anamnesis and Audiometric Tone Thresholds developed as soon as possible, 9 SD were detected, all belonging to ICU group. The mean BV was 4,38 ± 0,43 cps in the ward group, 4,53 ± 0,39 cps in the ICU patients without SD, and 4,85 ± 0,52 cps in the cases with SD, with statistically significant differences. Highest BV elevations in the SD cases were detected between days 6 and 10 of hospital admission. In 2019 four cases consulted with SD, and another two did it in 2020 without a diagnosis of COVID-19, with normal BV values.

Conclusions

During SARS-Cov-2 infection, patients may show high BV and SS, although an inpatients control group and a larger sample volume are necessary to confirm the predisposition to hyperviscosity. The incidence of hearing damage is considerable if its possible appearance is taken into account, within the limitations of critical patients with COVID-19.

[Blood viscosity in Covid-19 patients with sudden deafness]

Antecedentes

La alteración en las propiedades viscoelásticas de la sangre ha sido anteriormente propuesta como etiopatogenia de complicaciones severas por COVID-19 y algunos casos de sordera súbita (SS). Pretendemos verificar si la aparición de casos de SS en pacientes ingresados por infección por SARS-CoV-2 puede correlacionarse de este modo.

Pacientes y métodos

Estudio longitudinal prospectivo de pacientes ingresados en nuestro Centro por COVID-19, efectuando monitorización de la viscosidad sanguínea (VS) a alta velocidad de cizallamiento (300 seg^-1) y un requerimiento periódico personal sobre hipoacusia. Esta determinación se extendió a casos atendidos por SS sin infección en 2019 y 2020 y un grupo control de sujetos sanos normoacúsicos.

Resultados

El rango de normalidad se situó en 4,16±0,62 cps. Entre el 24 de febrero de 2020 y el 24 de marzo de 2021 se evaluaron 330 casos ingresados por COVID-19, 85 asistidos en la Unidad de Cuidados Intensivos (UCI). Fueron identificadas tras anamnesis y Audiometría Tonal Liminar (ATL) todo lo inmediata que el status clínico lo permitió hasta nueve casos con SS, todos pertenecientes al grupo de UCI. La VS media fue 4,38±0,43 cps en el grupo de sala, 4,53±0,39 cps en los pacientes en UCI sin SS, y 4,85±0,52 cps en los casos con SS, con diferencias estadísticamente significativas. Las mayores elevaciones de la VS en los casos con SS se detectaron entre los días seis y 10 del ingreso hospitalario. En 2019 consultaron cuatro casos y otros 2 en 2020 sin diagnóstico de COVID-19, con valores normales de VS.

Conclusiones

Durante la infección por SARS-CoV-2 los pacientes pueden presentar elevación en la VS y SS, si bien se hacen necesarios un grupo control hospitalario y un volumen muestral mayor para confirmar la predisposición a la hiperviscosidad. La incidencia del daño auditivo resulta considerable si se tiene en cuenta su posible aparición en pacientes críticos con COVID-19.

Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage

OBJECTIVES

To evaluate the influence of cerebral venous drainage on the pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) and Ménière syndrome (MD).

DESIGN

Observational, prospective, cohort study.

SETTING

ENT and Cardiology Departments (University of Bari, Policlinico Hospital, Bari, Italy).

PARTICIPANTS

We enrolled 59 consecutive patients (32 males, mean age 53.05 + 15.37 years): 40 ISSHL and 19 MD.

MAIN OUTCOME MEASURE

All patients underwent physical examination, biochemical evaluation (glycemic and lipid profile, viral serology, C reactive protein, etc), audiometric (tonal, vocal, vestibular evoked myogenic potentials and auditory brainstem response test) and impedentiometric examination. The pure tone average (PTA) was calculated for the following frequencies: 250, 500, 1000, 2000, 3000, 4000, 8000. An echo-color Doppler evaluation of the venous cerebral veins, internal jugular (IJV) and vertebral veins (VV) at supine and 90° position was performed.

RESULTS

No morphological alterations were found both in patients and controls. There were no signs of stenosis, blocked flow, membranes, etc. We found lower minimum, mean and maximum velocities in distal IJVs (P = .019; P = .013; P = .022; respectively) and left VVs (P = .027; P = .008; P = .001; respectively) in supine (0°) position in both MD and ISSHL patients as compared to controls. The same was for orthostatic position (90°). We found negative correlations between the velocities in extracranial veins and PTA values: therefore, the worst the audiometric performance of the subjects, the lower the velocities in the venous cerebral drainage.

CONCLUSIONS

Idiopathic sudden sensorineural hearing loss and Ménière syndrome patients showed altered venous flow in IJVs and VVs as compared to controls, independently from posture. This different behavior of venous tone control can influence the ear performance and may have a role in the pathogenesis of both diseases.