Sudden irreversible hearing loss post COVID-19

Peripheral and brainstem auditory evaluation in post-COVID-19 individuals

PURPOSE

The purpose of this study was to investigate the peripheral and central auditory pathways in adult individuals after COVID-19 infection.

METHOD

A total of 44 individuals aged between 19 and 58 years, of both genders, post-COVID-19 infection, confirmed by serological tests, with no previous hearing complaints and no risk factors for hearing loss, were assessed. All the participants underwent the following procedures: pure tone audiometry, logoaudiometry, immitanciometry, and Brainstem Auditory Evoked Potentials (BAEP), in addition to answering a questionnaire about auditory symptoms.

RESULTS

Thirteen individuals (29.5 %) had some hearing threshold impairment, mainly sensorineural hearing loss. In the BAEP, 18 individuals (40.9 %) presented longer latencies, mainly in waves III and V. According to the questionnaire answers, 3 individuals (9.1 %) reported worsened hearing and 7 (15.9 %) tinnitus that emerged after the infection. As for the use of ototoxic drugs during treatment, 7 individuals (15.9 %) reported their use, of which 5 showed abnormalities in peripheral and/or central auditory assessments.

CONCLUSION

Considering the self-reported hearing complaints after COVID-19 infection and the high rate of abnormalities found in both peripheral and central audiological assessments, it is suggested that the new COVID-19 may compromise the auditory system. Due to the many variables involved in this study, the results should be considered with caution. However, it is essential that audiological evaluations are carried out on post-COVID-19 patients in order to assess the effects of the infection in the short, medium, and long term. Future longitudinal investigations are important for a better understanding of the auditory consequences of COVID-19.

Sudden Sensorineural Hearing Loss Before COVID-19, During COVID-19, and After Inactivated Vaccination: Experience From a Tertiary Referral Center in China

OBJECTIVE

The purpose of this study was to investigate the incidence rate and audiological characteristics of sudden sensorineural hearing loss (SSHL) before the COVID-19 pandemic, during the COVID-19 pandemic, and after inactivated vaccination, and to analyze whether the novel coronavirus or inactivated vaccination have an impact on hearing loss.

MATERIALS AND METHODS

The clinical data of all patients who visited the hospital in July 2019 (before pandemic), July 2020 (during pandemic) and July 2021 (after the inactivated vaccination at least the first basic dose of COVID-19 vaccination) were retrospective analyzed. All patients diagnosed with sudden sensorineural hearing loss in these three periods were screened, and their incidence rate, hearing characteristics, and prognosis were compared.

RESULTS

Overall, the incidence rates of sudden hearing loss in July 2019, July 2020, and July 2021 were 0.59, 0.60, and 0.52% (25 of 4225, 20 of 3322, 28 of 5432), respectively, without significant difference ( χ2 = 0.372, p = 0.830). A significant difference was noted in the incidence of hypertension ( p = 0.02), whereas no significant difference was noted in age ( p = 0.591, p = 0.66), sex ( p = 0.19, p = 0.08), main symptoms ( p = 0.18, p = 0.15), side ( p = 0.483, p = 0.89), audiogram shape ( p = 0.56, p = 0.989), average hearing threshold of affected frequency ( p = 0.81, p = 0.89), average hearing threshold of normal ear affected frequency ( p = 0.65, p = 0.68), average hearing threshold of affected frequency after treatment ( p = 0.49, p = 0.38), days between symptoms onset and hospital visit ( p = 0.62, p = 0.85), treatment plan ( p = 0.551, p = 0.474), and effectiveness ( p = 0.104, p = 0.050).

CONCLUSION

Our study failed to find a correlation between the novel coronavirus pandemic and inactivated vaccination and SSHL, and there was no direct evidence supporting that COVID-19 or inactivated vaccination had an impact on the incidence rate and prognosis of SSHL patients.

COVID-19 Infection During Pregnancy and Hearing Loss in Infants: A Clinical Study

Aims

To find the prevalence of hearing loss in children born to mothers who had COVID-19 infection during pregnancy.

Materials and Methods

This was a prospective observational study conducted on 1960 babies born to mothers who were COVID positive during their pregnancy .All children born to RTPCR positive COVID-19 pregnant women were included in the study and babies who had any other risk factor for neonatal SNHL were excluded from the study. All the babies were subjected to OAE, and if it came pass, the test was repeated 2 weeks later. Those patients with repeat OAE also as refer were subjected to Brainstem Evoked Response Audiometry and findings correlated.

Results

The study included 1960 neonates who were subjected to neonatal hearing screening by OAE. There were 1020 males (52.04%) and 940(47.96%) females and 80 cases of consanguinity. Fifty babies were excluded due to comorbidities. In the initial OAE test 380 neonates failed (19.9%) following which BERA was done and ten patients was found to Sensorineural hearing loss.

Conclusion

The prevalence of hearing loss in our study on babies born to mothers with COVID-19 infection during pregnancy is 0.005. Although these primary results from our study does not indicate any immediate effect of SARS-COV-2 maternal infection on neonatal hearing. More children need to be tested and followed up over an extended period of time to detect any possible delayed auditory effects. Those patients who were identified to have hearing loss in our study will have to be on long term follow-up as we see long terms effects on cognition, memory, heart health, etc. in COVID survivors.

Level of evidence

Level 1.

Bilateral, Sequential Sudden Hearing Loss in a Patient With Multiple COVID-19 Infections and Potential Implications on Subsequent Cochlear Implant Performance

Viruses are often implicated as a cause of sensorineural hearing loss (SNHL), particularly sudden cases, including COVID-19. Determining the viral mechanism that leads to hearing loss is necessary for its future prevention and treatment. The 47-year-old woman who is the subject of this case study presented with sudden SNHL following multiple infections of COVID-19. Following a trial of a contralateral routing of sound device, she received a right cochlear implant (CI). Following a period of high performance, additional cases of COVID-19 infection and device failure issues resulted in the explant/reimplant of 1 ear and implantation of the contralateral ear. Despite extensive rehabilitation after these events, the patient continues to experience difficulties in speech understanding, not reaching her initial high levels of right ear performance. Further research is needed to determine the implications of COVID-19 as it relates to SNHL. This case study aimed to highlight the course of treatment and provide insight into the impact of COVID-19 on sudden hearing loss and its relationship to CI performance.

Sudden Sensorineural Hearing Loss after COVID-19 Vaccination: A Review of the Available Evidence through the Prism of Causality Assessment

Sudden sensorineural hearing loss (SSNHL), a rare audiological condition that accounts for 1% of all cases of sensorineural hearing loss, can cause permanent hearing damage. Soon after the launch of global COVID-19 vaccination campaigns, the World Health Organization released a signal detection about SSNHL cases following administration of various COVID-19 vaccines. Post-marketing studies have been conducted in different countries using either pharmacovigilance or medico-administrative databases to investigate SSNHL as a potential adverse effect of COVID-19 vaccines. Here, we examine the advantages and limitations of each type of post-marketing study available. While pharmacoepidemiological studies highlight the potential association between drug exposure and the event, pharmacovigilance approaches enable causality assessment. The latter objective can only be achieved if an expert evaluation is provided using internationally validated diagnostic criteria. For a rare adverse event such as SSNHL, case information and quantification of hearing loss are mandatory for assessing seriousness, severity, delay onset, differential diagnoses, corrective treatment, recovery, as well as functional sequelae. Appropriate methodology should be adopted depending on whether the target objective is to assess a global or individual risk.

[Pediatric sensorineural hearing loss related COVID-19. Clinical cases]

COVID-19 is an acute respiratory coronavirus infection in 2019 caused by the SARS-CoV-2 virus. Currently, the number of neurological complications in the acute or delayed period of coronavirus disease is increasing, including peripheral disorders of the auditory analyzer.

OBJECTIVE

To present clinical cases of sensorineural hearing loss in children under 5 years of age after a novel coronavirus infection.

MATERIAL AND METHODS

We report 3 cases of unilateral and 1 case of bilateral acquired deep sensorineural hearing loss, while the association with SARS-CoV-2 has been confirmed anamnetically and/or laboratory.

RESULTS

The SARS-CoV-2 virus can have a depressing effect on the cochlea on its own or enhance the toxic effect of viruses during the recovery period after COVID-19. The true frequency of acute sensorineural hearing loss of infectious origin in childhood and, as its outcome, the formation of persistent hearing impairment has not been determined.

CONCLUSION

Viruses are volatile, contagious, and clinically dangerous due to their complications. Vaccination is the most effective measure for the prevention of infectious diseases.

A review on the impacts of COVID-19 on the auditory system: Implications for public health promotion research

Background

Currently, there are few studies on the relationship between COVID-19 and the auditory system. In the current study, a review of the studies conducted in the fields of etiopathology, clinical manifestations, research, and treatment of hearing loss caused byCOVID-19 was conducted, which can be used as a baseline for future studies.

Methods

We utilized the research approach suggested by Arksey and O'Malley to carry out this scoping review. Search was conducted in Farsi and English with a focus on the onset of hearing loss in patients with COVID-19 through Medline and PubMed, and Google Scholar search engine. Studies included were those involving adult patients diagnosed with COVID-19 who experienced hearing loss, ear pain, ear discharge, and otitis media. Studies were eligible for inclusion if there was a description of the otologic dysfunction, specifically onset, duration, or clinical outcomes.

Results

Among 90 studies identified, 35 studies were included in the review process. Our findings suggest several possible mechanisms for sudden sensorineural hearing loss (SSNHL) in COVID-19 patients, and COVID-19 infection could have deleterious effects on the inner ear, specifically on the hair cells of the cochlea despite patients being asymptomatic and early identification of SSNHL in COVID-19patients can save the hearing and also patient.

Conclusion

Hearing loss in COVID-19 infection has not received much attention by health care professionals. Sensorineural hearing loss (SNHL), tinnitus, and/or vertigo have been shown to occur during and following COVID-19 infection. Due to lack of research studies, and the inconsistency and even contradictory of the findings, it remains questionable whether COVID-19 contributes to the high incidence of hearing loss. The proper understanding of the mechanisms behind hearing loss in COVID-19 infections needs further research. However, it seems likely that SNHL could be included among the manifestations of those-called "long COVID" syndrome.

Acute and Longer-Term Effects of COVID-19 on Auditory and Vestibular Symptoms

OBJECTIVE

To evaluate long-term effects of COVID-19 on auditory and vestibular symptoms in a diverse cohort impacted by the initial 2020 COVID-19 infection in the pandemic's epicenter, before vaccine availability.

STUDY DESIGN

Cohort study of individuals with confirmed COVID-19 infection, diagnosed in the March-May 2020 infection wave. A randomized, retrospective chart review of 1,352 individuals was performed to identify those with documented new or worsening auditory (aural fullness, tinnitus, hyperacusis, hearing loss) or vestibular (dizziness, vertigo) symptoms. Those with documented symptoms (613 of the 1,352 initial cohort) were contacted for a follow-up telephone survey in 2021-2022 to obtain self-report of aforementioned symptoms.

SETTING

Academic tertiary hospital system in Bronx, NY.

PATIENTS

Adults 18 to 99 years old with confirmed COVID-19 infection, alive at time of review. One hundred forty-eight charts were excluded for restricted access, incomplete data, no COVID-19 swab, or deceased at time of review.

INTERVENTION

Confirmed COVID-19 infection, March to May 2020.

MAIN OUTCOMES MEASURES

Auditory and vestibular symptoms documented in 2020 medical records and by self-report on 2021 to 2022 survey.

RESULTS

Among the 74 individuals with documented symptoms during the first 2020 COVID-19 wave who participated in the 2021 to 2022 follow-up survey, 58% had documented vestibular symptoms initially in 2020, whereas 43% reported vestibular symptoms on the 2021 to 2022 survey ( p = 0.10). In contrast, 9% had documented auditory symptoms initially in 2020 and 55% reported auditory symptoms on the 2021 to 2022 survey ( p < 0.01).

CONCLUSIONS

COVID-19 may impact vestibular symptoms early and persistently, whereas auditory effects may have more pronounced long-term impact, suggesting the importance of continually assessing COVID-19 patients.

Simultaneous Sudden Hearing Loss and Peripheral Facial Paralysis in a Patient With Covid-19

Although peripheral facial paralysis and sudden sensorineural hearing loss are not as common as anosmia, they are reported neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a 62-year-old, serologically COVID-19 positive woman with seventh and eighth nerve involvement showed electrophysiologically with Auditory Brainstem Response and electroneurography and radiologically with internal acoustic canal magnetic resonance imaging. This single case report suggests a possible association between the SARS-CoV-2 infection with simultaneous sudden sensorineural hearing loss and isolated facial paralysis. However, further studies are needed to determine whether this relationship is coincidental or occasional.

Special Sensory Function Deficit among Patients with Post-COVID-19 Visiting a Tertiary Care Centre

Introduction

Several patients who recover from COVID-19 infection continue to have persistent symptoms even after recovery from the disease. The special sensory functions such as taste, smell and hearing are affected by COVID-19 infection even after recovery from the illness. The aim of the study was to find out the prevalence of special sensory deficits among patients with post-COVID-19 visiting a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among adult patients who recovered from COVID-19 visiting a tertiary care centre from 1 January 2022 to 31 December 2022. After obtaining ethical approval from the Research Ethics Board of Health, data on patients who were diagnosed with COVID-19 one year ago was obtained from the surveillance register from the Ministry of Health. They were contacted by phone call and invited to the centre to participate in the study. Appropriate clinical examination and tests were carried out to assess the special sensory deficits. A convenience sampling technique was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 271 patients, the prevalence of sensory function deficit was 39 (14.39%) (10.21-18.57, 95% Confidence Interval).

Conclusions

The prevalence of special sensory deficits after recovery from COVID-19 infections was found to be similar to the findings of other studies.

Keywords

anosmia; COVID-19; hearing loss.

Long COVID-19 Pathophysiology: What Do We Know So Far?

Long COVID-19 is a recognized entity that affects millions of people worldwide. Its broad clinical symptoms include thrombotic events, brain fog, myocarditis, shortness of breath, fatigue, muscle pains, and others. Due to the binding of the virus with ACE-2 receptors, expressed in many organs, it can potentially affect any system; however, it most often affects the cardiovascular, central nervous, respiratory, and immune systems. Age, high body mass index, female sex, previous hospitalization, and smoking are some of its risk factors. Despite great efforts to define its pathophysiology, gaps remain to be explained. The main mechanisms described in the literature involve viral persistence, hypercoagulopathy, immune dysregulation, autoimmunity, hyperinflammation, or a combination of these. The exact mechanisms may differ from system to system, but some share the same pathways. This review aims to describe the most prevalent pathophysiological pathways explaining this syndrome.

Neurofilament Expression as a Biomarker of Post-COVID-19 Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss (SSHL) affects a patient's quality of life and requires rapid treatment. The etiology is viral, vascular, and autoimmune, even though, in most cases, it remains idiopathic SSHL. Since 2019, several different complications have been identified following COVID-19 infection. The post-COVID-19 ENT manifestations reported in the literature are sore throat, headache, pharyngeal erythema, nasal obstruction, rhinorrhea, upper respiratory tract infection, and tonsil enlargement. Cases of SSHL, vestibular neuronitis, and audio-vestibular disorders (such as tinnitus, dizziness, and vertigo) have also been reported, albeit in a smaller percentage of patients. We reported our experience of a case of post-COVID-19 SSHL in the absence of any other type of post-COVID symptoms or brain and internal auditory canal magnetic resonance imaging and magnetic resonance angiography modifications. We aimed to identify a serological biomarker of sudden sensorineural hearing loss, and we also dosed and monitored the value of the serum neurofilament light (NfL). the best of our knowledge, this is the first report that associates SSHL and the serological increase in NfL as a potential biomarker of neuronal-disease-related damage.

An online survey on clinical characteristics of otologic symptoms linked to COVID-19 infection

Objective

To report the otologic symptoms that present in patients with COVID-19 infection and investigate the pathogenic characteristics during the period of the pandemic.

Materials and methods

This cross-sectional descriptive study included participants with COVID-19 infection. COVID-19 infection was verified in these patients by nucleic acid test or antigen test. An online questionnaire was developed to analyze the association between the COVID-19 pandemic and the characteristics of otologic symptoms.

Results

This study included 2,247 participants, of which nearly half had one or more otologic symptoms. The presents of otologic symptoms were associated with gender (OR = 1.575, p < 0.0001), age (OR = 0.972, p < 0.0001), and occupation (healthcare worker: p < 0.0001; personnel of enterprises or institutions: OR = 1.792, p < 0.0001; student: OR = 0.712, p < 0.044). The otologic symptoms following COVID-19 infection in order were vertigo (25.95%), tinnitus (19.05%), otalgia (19.00%), aural fullness (17.18%), hearing loss (11.62%), otorrhea (1.25%), and facial paralysis (0.27%).

Conclusion

The present study shows that otologic symptoms are common among the COVID-19 infected participants and that these symptoms mostly recover spontaneously. During the corona-virus pandemic, the involvement of the cochleovestibular system and facial nerve should not be overlooked while treating the COVID-19 infected individuals.

Experience of sudden sensorineural hearing loss following a mild COVID-19 infection

A woman in her 30s was referred to an otolaryngologist with an acute onset of aural fullness, noise sensitivity, unilateral sudden onset hearing loss, vertigo and tinnitus. She had a confirmed COVID-19 infection 5 weeks prior. A pure tone audiogram confirmed sensorineural hearing loss. MRI identified an empty sella of the pituitary gland and without an obvious cause for hearing loss. Oral prednisolone and betahistine were prescribed, and her audiovestibular symptoms slowly improved over the subsequent months. The patient continues to experience intermittent tinnitus.

Intratemporal mucormycosis: a rare COVID-19 sequelae

A man in his 50s presented with a 2-month history of left ear discharge associated with hearing loss and weakness of left half of face since 15 days. The patient had no comorbidities, but he gave history of being treated for COVID-19 pneumonia 2 months ago post which he started experiencing left-sided aural symptoms. Clinical examination of ear revealed a subtotal perforation with multiple granulations in middle ear. Facial nerve examination revealed grade 3 lower motor neuron palsy. The biopsy of the granulations was sent to aid in diagnosis which later confirmed left ear mucormycosis. Otological involvement with facial palsy and sudden sensorineural loss in a patient with prior history of COVID-19 has not been reported until in literature. We try to communicate our experience to bridge the gap in understanding and managing this extremely rare occurrence of mucormycosis in the ear of a patient diagnosed with COVID-19 infection.

DOES AUDIOVESTIBULAR POST-COVID SYNDROME EXIST?

The purpose of this study was to present and analyze patients with audiovestibular post COVID-19 syndrome, and highlight the most characteristic and most common findings. We analyzed 87 patients aged between 20 and 86 years who presented to the Audiology Division between February 1, 2021 and July 1, 2021 after having been isolated due to the SARS-CoV-2 infection. Study patients presented with complaints of persistent hearing loss, tinnitus, and vertigo, lasting for more than 3 months. Study results showed that there was acute sensorineural hearing loss in 4 patients during the SARS-CoV-2 infection. None of the patients experienced complete hearing recovery after 3 months. High frequency hearing loss (at 4 kHz and 6 kHz) occurred bilaterally, and was found in 52 patients. This finding of gradual hearing loss was both the most characteristic and most common in COVID patients. Extensive damage can directly occur to inner ear structures, including hair cells, the Corti organ, and the cochlear nerve because of this viral infection. A total of 73 patients had tinnitus. 68 patients had unilateral tinnitus, and only 5 patients had bilateral tinnitus. Exacerbation of tinnitus was recorded in 12 patients and new-onset tinnitus in 61 patients. Vertigo occurred in 9 patients, all of which were new-onset. A conclusion of our research is that audiovestibular post-COVID syndrome does exist. Further research with more patients and over a longer period is needed to obtain a better and longer effect on the audiovestibular system and audiovestibular complications, as well as an insight into possible recovery.

The effects of COVID-19 on the vestibular system

Introduction

The symptoms and severity of SARS-CoV-2 infection vary greatly across the spectrum, from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and even death. Dizziness is a frequently reported symptom of SARS-CoV-2 viral infection. However, the extent to which this symptom results from the effect of SARS-CoV-2 on the vestibular system remains unclear.

Materials and methods

In the present single-center, prospective cohort study, patients with a previous SARS-CoV-2 infection underwent a vestibular assessment consisting of the Dizziness Handicap Inventory to assess dizziness during and after infection, a clinical examination, the video head impulse test, and the subjective visual vertical test. When the subjective visual vertical test result was abnormal, vestibular-evoked myogenic potentials were performed. Vestibular testing results were compared to pre-existing normative data of healthy controls. In addition, we performed a retrospective data analysis of patients admitted to hospital presenting with acute symptoms of dizziness who were also diagnosed with acute SARS-CoV-2 infection.

Results

A total of 50 participants have been enrolled. During and after the SARS-CoV-2 infection, women were significantly more likely than men to suffer from dizziness. A significantly reduced semicircular canal or otolith function was not observed in either women or men. Acute SARS-CoV-2 infection was diagnosed in nine patients who presented to the emergency room with acute vestibular syndrome. Six of the patients exhibited acute unilateral peripheral vestibulopathy upon diagnosis. A different patient was diagnosed with vestibular migraine, and two individuals had a posterior inferior cerebellar artery infarct revealed by magnetic resonance imaging.

Discussion/conclusion

Overall, a persisting structural affection of the vestibular system by SARS-CoV-2 seems to be unlikely and could not be confirmed by vHIT, SVV, and VEMPS in our study. It seems possible but unlikely that SARS-CoV-2 induces acute vestibulopathy. Nevertheless, dizziness is a common symptom in patients with COVID-19, which should be taken and worked through seriously.

Hearing screening test in neonates born to COVID-19-positive mothers

SARS-CoV-2, the responsible virus for the COVID-19 pandemic, has demonstrated neurotropic properties indicated by cases presenting with auditory and vestibular system insults. The expression of ACE-2 receptors in the placenta and the detection of IgM antibodies against the virus in the fetuses of pregnant women suffering from COVID-19 render vertical transmission of the infection to the fetus possible. Thus, our study aims to examine whether, similar to other viruses like CMV, SARS-CoV-2 is responsible for congenital hearing loss. This is a retrospective study in a regional pediatric hospital. The medical records of newborns (n = 111) born by mothers positive for COVID-19 during pregnancy who underwent screening hearing tests with Transient Evoked Otoacoustic Emissions (TEOAE) and Automatic Auditory Brainstem Response (AABR) from February 2020 to June 2022 were reviewed. Neonates with additional aggravating factors for congenital hearing loss were excluded from the study. For the study period, nine mothers were found positive during the first trimester, twenty mothers in the second trimester, and eighty-three mothers in the third trimester. TEOAEs test and AABR test scored PASS bilaterally in all neonates tested.

CONCLUSION

Infection with COVID-19 during pregnancy was not a risk factor for hearing loss, similar to other studies.

WHAT IS KNOWN

• The pathogenetic mechanism of the viral-induced impairment of the organ of Corti includes direct damage to the hair cells and indirect damage due to the induction of the innate inflammatory response. • Early data suggested that the SARS-CoV-2 virus also has neurotropic properties with manifestations from the sensory epithelia.

WHAT IS NEW

• Although the intrauterine infection remains controversial, the expression of the ACE-2 receptor on the placenta and the detection of IgM antibodies, as well as the covid-19 genome in fetuses, make the vertical transmission tenable. • In our study, the newborn hearing screening results indicate that COVID-19 infection during pregnancy is not a risk factor for hearing loss.

Characterization of otologic symptoms appearing after COVID-19 vaccination

OBJECTIVES

Anecdotal reports of sudden sensorineural hearing loss (SSNHL) following COVID-19 vaccination have emerged in the otolaryngology community. Studies have demonstrated no association between COVID-19 vaccination and SSNHL. We aim to characterize the spectrum of otologic symptoms following COVID-19 vaccination.

METHODS

A cross-sectional study of patients seen in the otology clinic at an academic center was performed. Patients completed a questionnaire on the development of new otologic symptoms within 4 weeks of COVID-19 vaccination. Diagnostic and audiometric data was collected retrospectively for patients reporting otologic symptoms.

RESULTS

Between May and July 2021, 500 patients were screened. Median age was 56.6 years old, with 59.4 % female and 40.2 % male. 420 patients (84.0 %) were vaccinated, with 58.4 % receiving Pfizer, 29.1 % receiving Moderna, and 3.8 % receiving Johnson & Johnson. 61 patients (14.5 %) reported one or more otologic symptoms within 4 weeks of vaccination, including 21 (5.0 %) with hearing loss, 26 (6.2 %) with tinnitus, 33 (7.9 %) with dizziness, and 19 (4.5 %) with vertigo. Of the 16 patients (3.2 %) reporting tinnitus with no associated hearing loss, 8 were diagnosed with subjective tinnitus and 4 were diagnosed with temporomandibular joint syndrome. Of the 18 patients reporting hearing loss, 11 had exacerbations of underlying pathologies (e.g. Meniere's disease, presbycusis) and 7 were newly diagnosed with SSNHL (1.4 %).

CONCLUSIONS

Patients reporting otologic symptoms following COVID-19 vaccination received various diagnoses of uncertain etiology. The incidence of SSNHL in these patients is comparable to the general otology patient population. Additional studies are required to determine the incidence of specific diagnoses following vaccination.

Sensorineural Hearing Loss in Patients with Long-COVID-19: Objective and Behavioral Audiometric Findings

Introduction

The symptoms of COVID-19 are primarily respiratory system disorders. Sensorineural hearing loss can be caused by COVID-19, as other symptoms in the nervous system. Hearing loss may also be the only symptom or complication of this disease or the symptoms of long COVID-19. The study aimed to assess hearing in patients after COVID-19 infection.

Material and Methods

The study conducted ENT and full hearing assessment in COVID-19 infection. All patients underwent complete audiological diagnostics, including threshold tonal audiometry, tympanometry, otoacoustic emissions, and auditory brainstem evoked potentials (ABR) tests. The study group included 58 patients aged 23 to 75 years who were diagnosed with COVID-19 infection six months before inclusion in the present study and reported post-COVID-19 hearing impairment.

Results

There were statistically significant differences between the control and study groups. Sensorineural hearing loss was found in 65.5% of the tonal audiometry test. The stapes reflex was absent in almost 20% of post-COVID-19 patients. The analysis of ABRs demonstrated longer latencies of wave III, V, and time intervals I-III, I-V in post-COVID-19 patients.

Conclusion

COVID-19 can damage the inner ear as well as the auditory pathway. Hearing loss may be the only symptom of COVID-19 or be a late complication of the disease due to postinfectious inflammation of the nerve tissue as a symptom of long COVID-19. Prolonged conduction of the auditory pathway shows the affinity of the virus to the nervous system as a symptom of long COVID. It is advisable to perform hearing diagnostics in patients after COVID-19 and provide them with specialist care.

A Prospective Study on Post Covid Sudden Onset Sensory Neural Hearing Loss and Its Recovery

Sudden sensorineural hearing loss (SSNHL) is a known complication of a number of viral infections, but there is little literature to date on its association to Corona virus disease 2019(COVID-19).This study aimed to investigate the incidence and recovery from SSNHL in post COVID-19 patients. A study was conducted in 6 months of duration at our tertiary care COVID dedicated hospital. Total 280 patients with age group of 12-70 years, laboratory confirmed COVID 19 positive patients having mild to moderate COVID symptoms were included. Patients were examined clinically along with all safety measures to analyze incidence and their recoveries from SSNHL by clinical examination and using Pure Tone Audiometry (PTA). Out of 280 patients the incidence of only SSNHL is 1.07% (3 patients) and SSNHL with tinnitus is 2.14%(6 patients).Total recovery(TR) regained in 2 patients of SSNHL, Partial recovery(PR) in 4 patients, Slight improvement(SI) in 1 patient and no recovery(NR) in 2 patients. The incidence of SSNHL in time of COVID 19 pandemic appears to be higher (3.2%) than before the pandemic (0.005%-0.16%). Incidence among younger age group and patients with no comorbidities has been also increased. In diagnosed case of SSNHL, early treatment with short term course of oral steroids and neuromodulator drugs are the mainstay treatment. Awareness of such non-specific presentation of COVID 19 patients is crucial and shared decision making with the patient and providing health care personnel is necessary for decreasing the hearing loss associated morbidity.

Sudden Hearing Loss Following Vaccination Against COVID-19

Importance

Spontaneous adverse reaction reports of sudden hearing loss have been observed, and a population-based cohort study conducted in Israel showed an increase in the incidence of sudden sensorineural hearing loss (SSNHL) following vaccination with messenger RNA COVID-19 vaccine BNT162b2 (Pfizer-BioNTech). However, in this setting, the possibility of confounding remained.

Objective

To assess a potential association between COVID-19 vaccinations and SSNHL.

Design, Setting, and Participants

This register-based country-wide retrospective cohort study of 5.5 million Finnish residents was conducted from January 1, 2019, to April 20, 2022, and included all individuals who were identified from the population information system who were alive or born during the study period except individuals who had SSNHL during 2015 to 2018 according to specialized care derived diagnosis codes for SSNHL (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code H91.2) as a primary or secondary diagnosis.

Exposures

The a priori primary risk period was 0 to 54 days following each COVID-19 vaccination. The risk periods for different vaccine doses did not overlap so that a later vaccine exposure ended the previous risk period. The secondary risk period was from 55 days following each COVID-19 vaccination until a subsequent COVID-19 vaccination. A secondary analysis included a risk time from 0 to 54 days following a positive polymerase chain reaction test result for SARS-CoV-2.

Main Outcomes and Measures

The incidences of SSNHL following COVID-19 vaccination were compared with the incidences before the COVID-19 epidemic in Finland. The Poisson regression model included calendar time, age, sex, diabetes, cardiovascular disease, other chronic diseases, and the number of visits in primary health care.

Results

For the 5.5 million Finnish residents included in the study, the comparison time comprised 6.5 million person-years, the primary risk time of 1.7 million person-years, and the secondary risk time of 2.1 million person-years. Before the COVID-19 epidemic in Finland, 18.7/100 000 people received a diagnosis of SSNHL annually. The study data suggested no increased risk for SSNHL following any COVID-19 vaccination. In particular, adjusted incidence rate ratios with 95% confidence intervals for the BNT162b2 vaccine's 3 doses were 0.8 (95% CI, 0.6-1.0), 0.9 (95% CI, 0.6-1.2), and 1.0 (95% CI, 0.7-1.4), respectively. There was no association between SARS-CoV-2 infection and an increased incidence of SSNHL.

Conclusions and Relevance

The results of this cohort study show no evidence of an increased risk of SSNHL following COVID-19 vaccination. The study accounted for previous disease and other potential confounding factors. These results are based on diagnosis codes in specialized care but still need to be verified in settings that are capable of evaluating the degree of hearing loss.

Tinnitus in patients recovering after COVID-19: observational and cross-sectional study

PURPOSE

In our study, it was aimed to determine the tinnitus rate in patients who recovered from COVID-19.

METHODS

The study included 279 individuals aged 18-60 years, who recovered from COVID-19 within the last month and did not have a chronic disease. Visual Analogue Scale and Tinnitus Handicap Inventory were used for assessment in participants with tinnitus.

RESULTS

While 201 participants (72.00%) included in the study stated that they did not have tinnitus, 78 participants (28.00%) reported that they had tinnitus. Twenty-eight (10%) of the participants stated that they had no tinnitus before COVID-19 and that tinnitus started with COVID treatment; 16 (5.70%) of the participants stated that tinnitus was not present before COVID-19 and started after recovery. The mean tinnitus severity was 4.50 ± 2.16; tinnitus frequency/duration was 4.19 ± 2.45; tinnitus discomfort was 4.41 ± 2.50, and the total scores of the tinnitus handicap inventory were 49.56 ± 9.81. There was statistically borderline significance between tinnitus frequency/duration scores according to age groups (p = 0.052). Statistically significant differences were found for tinnitus severity (p = 0.033) and discomfort scores (p = 0.014) according to age groups. In addition, a statistically significant difference was observed between the tinnitus severity scores of the participants with and without a history of hospitalization (p = 0.035).

CONCLUSION

Clinicians should keep in mind that tinnitus can be caused by COVID-19 as well as pre-existing tinnitus can be exacerbated by it but most participants in our study did not have post-COVID-19 tinnitus.

Sinus, middle-ear and mastoid radiological findings of severe acute respiratory syndrome coronavirus-2

OBJECTIVE

To assess the incidence of radiological inflammation within the paranasal sinuses, middle ear and mastoid in patients with confirmed severe acute respiratory syndrome coronavirus-2.

METHODS

A retrospective cohort study was conducted to examine consecutive adults (aged over 18 years) with coronavirus disease 2019 (confirmed on polymerase chain reaction within 7 days of imaging) who underwent computed tomography of the head between 1 March 2020 and 24 June 2020. Lund-Mackay and mastoid and middle-ear opacification scores were used to categorise the extent of sinus and mastoid opacification on axial and coronal computed tomography images.

RESULTS

Of 147 patients originally identified, only 83 met the inclusion criteria. Sinus opacification was present in 51.8 per cent of patients (n = 43), and middle-ear or mastoid opacification was observed in 24.1 per cent (n = 20). There was no statistically significant difference in sinus or middle-ear and mastoid opacification between patients after stratification based on 30-day all-cause mortality.

CONCLUSION

Radiological computed tomography findings suggest mild mucosal disease within the sinuses, middle ear and mastoid. There was no statistical correlation between such opacification and 30-day mortality.

The Incidence of Sudden Sensorineural Hearing Loss (SSNHL) in COVID-19 Patients in Tertiary Care Referral Units

COVID-19 is a new pandemic infectious disease that emerged in Wuhan, China, at the end of 2019. We aimed to evaluate the sudden sensorineural hearing loss (SSNHL) prevalence after COVID-19 infection or even vaccination. This is a two-center retrospective, observational cross-sectional study performed at tertiary care referral Audiovestibular Medicine Units at the period between August 1, 2020, and October 31, 2021. All SSNHL patients diagnosed in a period of a month with COVID-19 or vaccinated with a COVID-19 vaccine were included in this study. Fifty-three cases with confirmed COVID-19 and one patient vaccinated with a COVID-19 vaccine 1 week before, who reported sudden sensory neural hearing loss, were included in this study. Forty-eight patients had unilateral hearing loss and 6 patients had bilateral hearing loss. Forty-nine patients had typical COVID-19 symptoms; one patient discovered them after complaining of anosmia and ageusia and one patient after COVID-19 vaccination; and three patients were complaining only from hearing loss and had a PCR test for nasopharyngeal swabs to prove infection. Different degrees of SSNHL ranged from mild to severe and most of the patients had severe hearing loss. With more patients, COVID-19 may be a potential factor in sudden sensorineural hearing loss. It should be kept in mind that SSNHL may be the only indicator used to identify COVID-19 cases.

Assessment of Hearing and Vestibular Functions in a Post-COVID-19 Patient: A Clinical Case Study

SARS-CoV-2 infection may cause such complications as post-COVID-19 syndrome, which includes chronic fatigue, myalgia, arthralgia, as well as a variety of neurological manifestations, e.g., neuropathy of small fibers, hearing and vestibular dysfunction, and cognitive impairment. This clinical case describes a 41-year-old patient suffering from post-COVID-19 syndrome and chronic fatigue syndrome. A detailed examination was performed, including an in-depth study of peripheral and central hearing and vestibular functions, as well as small nerve fibers length and density in the skin and cornea of the eye. Contrary to expectations, no peripheral nervous system dysfunction was detected, despite the presence of dizziness and gait instability in the patient. Hearing tests (gap detection test and dichotic test) showed central auditory processing disorders. The evaluated lesion in the processing of temporal and verbal auditory information can be a significant factor contributing to additional overload of the neural activity and leading to chronic fatigue when performing daily activities in patients with CFS and post-COVID-19 complications.

Cochlear Function in Adults Exposed to Severe Acute Respiratory Syndrome Coronavirus 2

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a viral infection with a wide variety of symptoms, including fever, coughing, sneezing, fatigue, and a loss of taste and smell. Moreover, there are some recent studies that investigate the effects of SARS-CoV-2 on hearing and auditory performance. With this current study, we investigate the early effects of the coronavirus disease on hair cells in the cochlea.

METHODS

In the current study, there were 25 subjects (17 females, 8 males) who tested positive for polymerase chain reaction on nasopharyngeal swabs. They had reported normal auditory functions and no history of otology before SARS-CoV-2. To determine auditory functions, pure-tone audiometry, otoacoustic emissions (OAE) tests, and threshold equalizing noise (TEN) tests were used.

RESULTS

Although the hearing thresholds increased at higher frequencies, they were within normal limits according to four-frequency pure-tone averages. All participants had normal OAE, and there were no detected dead regions for any of the subjects. Even so, there were significant increases in hearing thresholds in TEN.

CONCLUSION

There is no cochlear dysfunction discovered by OAE and TEN in SARS-CoV-2-affected individuals. Nonetheless, the increase in hearing thresholds at higher frequencies, other than the pure-tone average frequencies detected by TEN, and the decrease in the presence of detected OAE could be related to deterioration in the basal part of the cochlea.

Sudden Sensorineural Hearing Loss in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

INTRODUCTION

Accumulating data indicate that patients with COVID-19 could be affected by sudden sensorineural hearing loss (SSNHL). The aim of the study was to analyze the epidemiological and clinical trend of SSNHL occurrence during the COVID-19 pandemic by applying a systematic review and meta-analysis approach.

METHODS

PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane databases were searched.

RESULTS

The seven included studies had adequate relevance to the topic and the quality was fair. The mean age at SSNHL onset ranged from 39.23 to 62.18 years during the pandemic year period (PYP); a meta-analysis of four studies comparing these data with those of previous periods in the same institutions found a younger age during the PYP (pooled mean -0.2848). The heterogeneity was high (76.1935%) and no frank asymmetry was observed in the funnel plot. The SARS-CoV-2 positivity rate of SSNHL patients ranged from 0% to 57.53%. Standard steroid treatments were applied without significant adverse effects. Comprehensively, hearing improvement was achieved for more than half of the cases. No studies reported long-term follow-up data.

CONCLUSIONS

Further prospective analyses on large series and a long-term follow up on COVID-related SSNHL cases are necessary to address the open questions regarding the causative link between COVID-19 infection and SSNHL.

Comparative Study of Audiovestibular Symptoms between Early and Late Variants of COVID-19

Audiovestibular symptoms during the acute phase of the corona virus disease 2019 (COVID-19), have been reported for earlier waves of the pandemic, while no studies investigated nor compared audiovestibular manifestations during subsequent waves of COVID-19. In the current study, we aimed to compare the occurrence of audiovestibular symptoms associated with COVID-19 between the alpha/beta, delta, and omicron variants. An online questionnaire was distributed to individuals with confirmed test results for COVID-19. We asked participants to report whether they experienced audiovestibular symptoms during the acute phase of the disease. The study included 939 participants; 120 un-infected controls and infected participants during alpha/beta (n = 301), delta (n = 102), and omicron (n = 416) predominance periods. Self-reported audiovestibular symptoms were found to be statistically significantly different between un-infected controls and COVID-19 infected individuals in all analyzed variants. Furthermore, our results showed no significant differences in audiovestibular symptoms among individuals infected during alpha/beta, delta, and omicron waves. Although individuals infected during the delta variant predominance period reported higher percentages of audiovestibular symptoms (ranging from 11.8% to 26.5% for auditory symptoms and from 12.7% to 34.3% for vestibular symptoms) than for the alpha/beta (ranging from 6.3% to 18.9% for auditory symptoms and 8.3% to 29.9% for vestibular symptoms) and omicron (ranging from 9.6% to 21.2% for auditory and 12.5 to 29.1% for vestibular symptoms) variants, this did not achieve statistical significance. With regards to auditory symptoms, the most commonly reported symptoms were aural fullness followed by hearing loss and tinnitus. With regards to vestibular symptoms, dizziness was the most commonly reported symptom followed by vertigo and unsteadiness. Logistic regression revealed that experiencing auditory symptoms were associated with other neurological symptoms, back and joint pain, and chest pain as COVID-19 symptoms. Vestibular symptoms were associated with anemia, gender, fatigue, headache, and breathing difficulties. In conclusion, our study shows that audiovestibular symptoms are common during the acute phase of early and late COVID-19 variants with no significant differences between them.

Audiovestibular and vaccination complications of COVID-19

Objectives

Since its first appearance in Wuhan December 2019, SARS-CoV2 virus received great attention due to its severe symptoms and high spread causing COVID-19 disease which spread all over the world like a pandemic. The causative virus is capable of human-to-human transmission via droplet and direct contact suggesting that upper respiratory tract is the main site to virus manifestations.

There is a great diversity in its clinical picture, although the severe respiratory and neurological symptoms are commonly present; however, other symptoms are present. Although otological manifestations are reported in many COVID-19 patients even in asymptomatic cases, they did not receive much attention compared with other critical manifestations. In this article, we paid our attention specifically to the otological manifestations of COVID-19 and their relevance either to the virus infection, treatment, or vaccination through literature review.

Conclusion

COVID-19 disease has a deleterious effect on the inner ear. This effect is not only due to SARS-Cov-2 infection, but it could be also due to the ototoxic drugs used for treatment. The COVID-19 vaccinations are found to be implicated in the otological symptoms in some cases.

Sudden Sensorineural Hearing Loss as a Rare Sequela After Complete Recovery From COVID-19 Infection: Case Series and Literature Review

Respiratory disease caused by a mutant coronavirus variant has spread rapidly worldwide. According to reports, the COVID-19 version propagated at the end of 2019 and originated in Wuhan, China. On January 30, 2022, the World Health Organization declared the outbreak a Public Health Emergency of International Concern, and on March 11, 2020, the outbreak has declared a pandemic. The COVID-19 infection might appear with no symptoms, very few symptoms, or extremely severe symptoms We are the first to identify sudden sensorineural hearing loss (SSNHL) as a side effect in COVID-19 patients who have fully recovered from the illness. Additionally, all reported cases of this presentation have an unexplained unilateral left ear involvement. This article reviews the literature and four cases of COVID-19 patients with SSNHL. We present four cases of COVID-19 positivity that were verified by PCR analysis of nasopharyngeal swabs. After fully recovering from the infection, all patients developed acute sensorineural hearing loss on the left side. A deterioration in the hearing ability among COVID-19 survivors makes it possible that the problem persists long after their recovery from infection. To support such a claim, additional in-depth research is required. The current study, in our opinion, will contribute to an increase in understanding about COVID-19, promote awareness, and alert healthcare professionals to take into account and discuss any symptoms.

Update on Findings about Sudden Sensorineural Hearing Loss and Insight into Its Pathogenesis

Sudden sensorineural hearing loss (SSNHL) is routinely encountered and is one of the most common emergent diseases in otolaryngology clinics. However, the etiology of SSNHL remains unclear. Due to the inaccessibility of the living human inner ear for biopsy, studies investigating the etiology of SSNHL have been performed by analyzing data obtained from examinations using peripheral blood or imaging. We updated the findings obtained from serological, magnetic resonance imaging, genetic, and viral examinations to reveal the etiology of SSNHL. Regarding viral examination, we focused on sensorineural hearing loss associated with coronavirus disease (COVID-19) because the number of correlated reports has been increasing after the outbreak. The updated findings revealed the following three possible mechanisms underlying the development of SSNHL: thrombosis and resulting vascular obstruction in the cochlea, asymptomatic viral infection and resulting damage to the cochlea, and cochlear inflammation and resulting damage to the cochlea. Thrombosis and viral infection are predominant, and cochlear inflammation can be secondarily induced through viral infection or even thrombosis. The findings about sensorineural hearing loss associated with COVID-19 supported the possibility that asymptomatic viral infection is one of the etiologies of SSNHL, and the virus can infect inner ear tissues and directly damage them.

Direct, indirect, post-infection damages induced by coronavirus in the human body: an overview

Background

Severe acute respiratory syndrome Coronavirus-2 invades the cells via ACE2 receptor and damages multiple organs of the human body. Understanding the pathological manifestation is mandatory to endure the rising post-infection sequel reported in patients with or without comorbidities.

Materials and methods

Our descriptive review emphasises the direct, indirect and post-infection damages due to COVID-19. We have performed an electronic database search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with selective inclusion and exclusion criteria.

Results

The included studies substantiated the extensive damages in the multiple organs due to direct and indirect consequences of COVID-19. After an apparent recovery, the prolonged presentation of the symptoms manifests as post-COVID that can be related with persisting viral antigens and dysregulated immune response.

Conclusion

A few of the symptoms of respiratory, cardiovascular, and neuropsychiatric systems that persist or reappear as post-COVID manifestations. Vaccination and preventive programs will effectively reduce the prevalence but, the post-COVID, a multisystem manifestation, will be a significant tribulation to the medical profession. However, the issue can be managed by implementing public health programs, rehabilitation services, and telemedicine virtual supports to raise awareness and reduce panic.

Hearing disorder following COVID ‐19 vaccination: A pharmacovigilance analysis using the Vaccine Adverse Event Reporting System

What is known and objective

Evidence on whether the coronavirus disease 2019 (COVID‐19) vaccination could cause hearing‐related adverse events is still conflicting. This study aims to access the association between COVID‐19 vaccine and hearing disorder.

Methods

The Vaccine Adverse Event Reporting System (VAERS) was queried between January 2020 to November 2021. The disproportionality pattern for hearing impairment of COVID‐19 vaccine was accessed by calculating the reporting odds ratio (ROR) and proportional reporting ratio (PRR). A further subgroup analysis based on the type of COVID‐19 vaccine and the doses administered was performed. In addition, the disproportionalities for hearing dysfunction between COVID‐19 and influenza vaccines were compared.

Results and discussion

A total of 14,956 reports of hearing‐related adverse events were identified with COVID‐19 vaccination and 151 with influenza vaccine during the analytic period in VAERS. The incidence of hearing disorder following COVID‐19 vaccination was 6.66 per 100,000. The results of disproportionality analysis revealed that the adverse events of hearing impairment, after administration of COVID‐19 vaccine, was significantly highly reported (ROR 2.38, 95% confidence interval [CI] 2.20–2.56; PRR: 2.35, χ² 537.58), for both mRNA (ROR 2.37, 95% CI 2.20–2.55; PRR 2.34, χ² 529.75) and virus vector vaccines (ROR 2.50, 95% CI 2.28–2.73; PRR 2.56, χ² 418.57). While the disproportional level for hearing dysfunction was quite lower in influenza vaccine (ROR 0.36, 95% CI 0.30–0.42; PRR 0.36, χ² 172.24).

What is new and conclusion

This study identified increased risk for hearing disorder following administration of both mRNA and virus vector COVID‐19 vaccines compared to influenza vaccination in real‐world settings.

Ear, nose, and throat manifestations of COVID-19 and its vaccines

Coronavirus disease 2019 (COVID-19) is a highly infectious disease and was designated a pandemic by the World Health Organization (WHO) on March 11, 2020. There are no classical manifestations of the disease. The most prevalent symptoms include fever, cough, dyspnea, myalgia and headache. The main route of transmission of the severe acute respiratory syndrome coronavirus-2 is through the upper respiratory tract. Therefore, it is not strange to find different ear, nose and throat (ENT) symptoms in individuals infected with this virus. Olfactory dysfunction is a common feature of COVID-19; either it is the only presenting symptom or it accompanies other manifestations of the disease. Other otolaryngological features such as sudden sensorineural hearing loss (SSNHL), dysphonia, nasal obstruction, sore throat, etc. are less frequent manifestations of COVID-19. These features, in addition, to being presented early in the disease process, certain long-standing symptoms like parosmia, dysphonia, and persistent deafness, are other characteristics of the disease. Geographical variation in otorhinolaryngological prevalence is another problem with this debilitating disease. Local and systemic adverse effects (local site injection pain, fever, myalgia, headache, and others) of the COVID-19 vaccines are more frequent than otolaryngological side effects (anosmia, hyposmia, Bell’s palsy, SSNHL, etc.). We aimed in this review to summarize the early and persistent ENT symptoms of COVID-19 or after the various COVID-19 vaccines.

Unilateral, permanent hearing loss following severe COVID-19 infection

Hearing loss following COVID-19 infection has been scarcely reported in the literature.

A previously well middle-aged man presented to the emergency department with breathlessness and cough 8 days after testing positive for COVID-19 in the community. The patient was treated in the intensive care unit due to respiratory failure. Following extubation and step down to ward-level care 2 months later, the patient reported sudden left-sided hearing loss and tinnitus. Ear examination was unremarkable and pure tone audiometry revealed profound left sensorineural hearing loss. MRI of the internal acoustic meatus did not show any cerebellopontine lesions. Intravenous steroid therapy as well as oral steroids were not successful in improvement of hearing.

A few cases of COVID-19-associated sensorineural hearing loss have been reported; the majority report irreversible loss. Awareness of this phenomenon and early referral for specialist review and audiological assessment to attempt salvage of hearing can reduce hearing disability.

Putative COVID-19 therapies imatinib, lopinavir, ritonavir, and ivermectin cause hair cell damage: A targeted screen in the zebrafish lateral line

The biomedical community is rapidly developing COVID-19 drugs to bring much-need therapies to market, with over 900 drugs and drug combinations currently in clinical trials. While this pace of drug development is necessary, the risk of producing therapies with significant side-effects is also increased. One likely side-effect of some COVID-19 drugs is hearing loss, yet hearing is not assessed during preclinical development or clinical trials. We used the zebrafish lateral line, an established model for drug-induced sensory hair cell damage, to assess the ototoxic potential of seven drugs in clinical trials for treatment of COVID-19. We found that ivermectin, lopinavir, imatinib, and ritonavir were significantly toxic to lateral line hair cells. By contrast, the approved COVID-19 therapies dexamethasone and remdesivir did not cause damage. We also did not observe damage from the antibiotic azithromycin. Neither lopinavir nor ritonavir altered the number of pre-synaptic ribbons per surviving hair cell, while there was an increase in ribbons following imatinib or ivermectin exposure. Damage from lopinavir, imatinib, and ivermectin was specific to hair cells, with no overall cytotoxicity noted following TUNEL labeling. Ritonavir may be generally cytotoxic, as determined by an increase in the number of TUNEL-positive non-hair cells following ritonavir exposure. Pharmacological inhibition of the mechanotransduction (MET) channel attenuated damage caused by lopinavir and ritonavir but did not alter imatinib or ivermectin toxicity. These results suggest that lopinavir and ritonavir may enter hair cells through the MET channel, similar to known ototoxins such as aminoglycoside antibiotics. Finally, we asked if ivermectin was ototoxic to rats in vivo. While ivermectin is not recommended by the FDA for treating COVID-19, many people have chosen to take ivermectin without a doctor’s guidance, often with serious side-effects. Rats received daily subcutaneous injections for 10 days with a clinically relevant ivermectin dose (0.2 mg/kg). In contrast to our zebrafish assays, ivermectin did not cause ototoxicity in rats. Our research suggests that some drugs in clinical trials for COVID-19 may be ototoxic. This work can help identify drugs with the fewest side-effects and determine which therapies warrant audiometric monitoring.

Sudden Sensorineural Hearing Loss after Third Dose Booster of COVID-19 Vaccine Administration

Coronavirus disease 2019 (COVID-19) was declared a pandemic due to its rapid spread worldwide, and its vaccination campaign is considered one of the most historic public hygiene measures in modern medicine. Sudden sensorineural hearing loss (SSHL) is a common emergency that affects patient’s quality of life and requires rapid treatment with steroids. The etiology could be viral or vascular even though in most cases it remains unknown (idiopathic SSHL). During the SARS-CoV-2 vaccination campaign, several rare but serious adverse events have been reported including thrombosis with thrombocytopenia syndrome, myocarditis, and Guillain-Barré Syndrome. ENT adverse events after vaccination were reported too, including cases of sudden sensorineural hearing loss (SSHL), vestibular neuronitis and audio vestibular disorders (such as tinnitus, dizziness, and vertigo). For the first time here, we reported two cases of SSHL after third administration of COVID-19 mRNA vaccine. Even if there is not clear evidence of an association between SSHL and vaccination, adverse effects should be kept in mind since viral infection could be the etiology of SSHL.

Cochleovestibular findings linked to COVID-19: A scoping review for clinical care planning in South Africa

Background

On 30 January 2020, the World Health Organization (WHO) officially declared an outbreak of the coronavirus disease 2019 (COVID-19) to be a global health emergency. Research has focused on the impact and response to life-threatening symptoms of COVID-19 across the lifespan; however, there is a need to investigate the effects of COVID-19 on the cochleovestibular system, as viral infections are known to impact this system. This is particularly important for contexts where resources are limited and prioritisation of resources requires strong risk versus benefit evaluations.

Objective

Therefore, the purpose of this scoping review was to investigate published evidence on the impact of COVID-19 on the cochleovestibular system across the lifespan in order to allow for strategic clinical care planning in South Africa, where capacity versus demand challenges exist.

Methods

Electronic bibliographic databases such as CINAHL, EBSCOHost, MEDLINE, ProQuest, PubMed, Scopus and ScienceDirect were searched for peer-reviewed publications between January 2020 and January 2022. These had to be published in English and related to the impact of COVID-19 on the cochleovestibular system, where the question was: ‘what evidence has been published on the impact of COVID-19 on the cochleovestibular system?’ Review selection and characterisation was performed by the researcher with an independent review by a colleague using pretested forms.

Results

Of a total of 24 studies that met the inclusion criteria, the current scoping review revealed limited conclusive published evidence linking COVID-19 to permanent hearing function symptoms. Current evidence supports the possibility of COVID-19, similar to other viral infections in adults, impacting the cochleovestibular system and causing tinnitus, vertigo and sudden sensorineural hearing loss (SSNHL), with the symptoms being generally temporary and resolving either partially or completely following therapy with steroids, with very inconclusive findings in the paediatric population.

Conclusion

These findings raise global implications for properly designed studies, which include longitudinal follow-up of cases across the lifespan, examining this link with some focus on establishing the pathophysiologic mechanisms at play as well. In the meanwhile, current findings raise the value of polymerase chain reaction (PCR) testing for all patients presenting with unexplained cochleovestibular symptoms during the pandemic, as these may be the only presenting symptoms indicating COVID-19, thus requiring careful treatment and management.

Persistent neurological manifestations in long COVID-19 syndrome: A systematic review and meta-analysis

Background

Several studies have reported prolonged symptoms especially neurological symptoms following acute infection in patients with COVID-19, known as long COVID-19. There are only few studies investigating this population and relatively less known, including nervous system involvement. A systematic review and meta-analysis of these studies are required to understanding the prevalence of persistent neurological manifestations after COVID-19.

Objective

To conduct a systematic review and meta-analysis on the persistent neurological manifestations in COVID-19 survivors.

Methods

Authors conducted a literature search through PubMed and MedRxiv from January 1st, 2020 to October 2021 according to PRISMA guideline. Furthermore, the authors added additional sources by reviewing related references. Studies presenting the neurologic features of long COVID-19 patients in their data were included. Case reports and case series also included in this review. The quality of the studies was assessed based on the Oxford Centre for Evidence-Based Medicine guidelines. Selected studies were included in the meta-analysis of proportion and heterogeneity test.

Findings

From 128 identified studies, 36 were eligible, with 9944 participants included. Most of the included studies had mean duration of follow-up after COVID-19 onset of less than 6 months. Fatigue was the most common (52.8%, 95%CI 19.9 – 84.4) symptoms of long COVID, followed by cognitive disorder (35.4%, 95%CI 2.1 – 81.7); paresthesia (33.3%, 95%CI 2.7 – 76.6); sleep disorder (32.9%, 95%CI 6.5 – 67.4); musculoskeletal pain (27.8%, 95%CI 12.7 – 46); and dizziness (26.4%, 95%CI 4.6 – 57.9).

Conclusion

Neurological manifestations are prevalent and persisting in patients with long COVID. The duration of the symptoms are vary among literatures. However, the frequency are mostly observed during the first six months after the illness onset.

SARS‐CoV ‐2 infection with bilateral intralabyrinthine hemorrhage

A 47‐year‐old woman presented with the complaint of sudden hearing loss associated with vertigo. Serological testing was positive for IgM and negative for IgG COVID‐19 antibodies, with no other associated factors. Magnetic resonance imaging of the brain showed bilateral intralabyrinthine hemorrhage.

This is a rare case of bilateral intralabylinthine hemorrhage after COVID‐19 infection. The mechanism is unclear, but clinicians should keep this case in mind when you see sudden hearing loss with vertigo, and early intervention should be considered.

Unilateral sudden sensorineural hearing loss in post-COVID-19 patients: Case report

Sudden sensorineural hearing loss (SSNHL) is an otologic emergency. Sensorineural hearing loss needs to be distinguished from conductive when patients present with sudden hearing loss at the primary care level. Prompt diagnosis of sensorineural hearing loss with pure tone audiometry and immediate treatment by an otolaryngologist can improve the hearing outcome. To date, few case reports exist about SSNHL among post-COVID-19 patients, and none were reported in Malaysia. Here, we present two cases of SSNHL in patients after COVID-19 infection. We wish to highlight the association of SSNHL following COVID-19 infection for timely referral towards better audiology outcomes. Permanent hearing loss will lead to another negative impact on the long-term quality of life of COVID-19 patients.

Audio-Vestibular Profile of COVID-19; Systematic Review and Meta-analysis

Introduction

After more than a year of the COVID-19 pandemic, audio-vestibular problems have been reported as consequences. Several limited case report studies with different methodologies were published. This study aimed to describe the impact of COVID-19 on the auditory-vestibular system and communication problems in subjects with hearing impairment.

Materials and Methods

The current systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. PubMed, Web of Science, and Google Scholar were searched to find relevant articles using combined keywords.

Results

Out of 26 final studies, 20 studies dealt with the effects of COVID-19 on the auditory and vestibular system, and six articles examined the COVID-19 effects on hearing-impaired people and patients. In these studies, dizziness (17.8%), tinnitus (8.1%), and vertigo (2.8%) were common symptoms. Most studies were case reports (42.30%), and in terms of quality, nine studies (34.61%) were in the suitable quality group.

Conclusions

COVID-19 might cause auditory-vestibular system problems by directly affecting the structures or functions of the inner ear or by weakening the immune system. The need for taking preventive measures during the COVID-19 pandemic has caused communication and social challenges, particularly for people with hearing loss.

Hearing loss and the COVID-19 pandemic

Objective

Hearing loss is an important public health problem. Its causes vary, including infections, noise, and aging. The first wave of the COVID-19 pandemic occurred in April 2020 in Japan. During the pandemic, people were urged to stay at home and drastically changed their lifestyles. This study aimed to examine hearing loss before and during the pandemic. The prevalence during the pandemic after April 2020 was compared for the period in 2019. Study subjects were those who received health checkups in both periods. Hearing loss was defined as a hearing threshold of > 30 dB at 1 kHz and > 40 dB at 4 kHz in either ear using pure-tone audiometry.

Results

A total of 2367 persons presented in both 2019 and 2020. The overall rates of hearing loss were 9.5% and 13.2% before and after the pandemic, respectively. After controlling for age, sex, current smoking, regular exercise and alcohol consumption, the rate of hearing loss showed a significant increase in 2020 (p =  < 0.0001). With age stratification, an increase was observed in the participants aged < 40 years (1.3% vs. 3.1%, p < 0.001) and 40–59 years (7.2% vs. 12.6%, p < 0.001). Further studies are needed to confirm the impact of the COVID-19 pandemic on hearing loss.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-06120-1.

Evaluation of the efferent auditory system in COVID-19 adult patients

BACKGROUND

The short- and long-term effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the medial olivocochlear reflex and outer hair cells in the cochlea remain largely unclear.

AIMS

The aim of this study was to investigate the efferent auditory system effects in adult patients with COVID-19.

MATERIALS AND METHODS

The study included 18-50 years old 44 volunteers: 26 individuals (52 ears) with COVID-19 in the study group and 18 healthy individuals (36 ears) in the control group. Otolaryngological examination, immitancemetric evaluation, distortion product otoacoustic emission (DPOAE), contralateral acoustic stimulation with DPOAE, audiometric evaluation, and high frequency audiometric evaluation were performed in all individuals participating in the study.

RESULTS

In our study, patients with COVID-19 had significantly lower DPOAE results with or without broadband noise at only 6 kHz frequency and contralateral suppression results at all frequencies compared to healthy individuals. A statistically significant difference was found between the study and control groups according to whether the participants had a response in the high frequency audiometry at 12 and 16 kHz frequencies.

CONCLUSIONS

COVID-19 affects many systems in the body. As a result of the findings obtained in the present study, it is shown that the auditory efferent system may also be affected.

Sensorineural Hearing Loss Post-COVID-19 Infection: An Update

The course of COVID-19 infection may be complicated by a variety of neurological manifestations. Since the inner ear is vulnerable to viruses, sensorineural hearing loss (SNHL) has been reported to occur following the SARS-CoV-2 infection, often resulting in long-term morbidity and worsening the quality of life. The interest in how the virus affects the inner ear has gradually increased since the pandemic’s spread, but little is still known about the SNHL potentially caused by SARS-CoV-2. The aim of this paper is to evaluate the possible association between SNHL and COVID-19 infection, through a systematic literature review. Currently available data suggest that SARS-CoV-2 may hamper cochlear function; however, available reports are still limited. Large cohort and prospective studies are necessary to evaluate the long-term effects of this viral infection in the inner ear.

COVID-19 and Sudden Sensorineural Hearing Loss: A Systematic Review

A growing body of evidence suggests that patients with the 2019 Coronavirus disease (COVID-19) have a risk of developing sudden sensorineural hearing loss (SSNHL). The pathogenesis of COVID-19-related SSNHL remains unclear. This systematic review examined whether COVID-19 causes an increased incidence of SSNHL and the clinical characteristics of patients with COVID-19-related SSNHL according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. SSNHL usually developed between a few days and 2 months after the diagnosis of COVID-19, and a proportion of patients developed it before the diagnosis of COVID-19. The literature is inconsistent regarding whether COVID-19 causes an increased incidence of SSNHL, and this matter remains unclear. This review included 23 patients with COVID-19-related SSNHL, all adult patients with an average age of 43.1 years. Of these patients, 60.9% had accompanying tinnitus symptoms. Glucocorticoids are the preferred medication to treat COVID-19-related SSNHL. Intratympanic administration may be considered to reduce the side effects of the drug. Hearing tests are suggested when hearing loss is suspected in COVID-19 individuals, and if SSNHL is detected, prompt and aggressive treatment is vital. Large-scale, multicenter research on the pathophysiology, treatment, and prognosis of COVID-19- related SSNHL should be conducted in the future.

Post-COVID-19 Impairment of the Senses of Smell, Taste, Hearing, and Balance

Background: Various symptoms have been associated with COVID-19, but little is known about the impacts of COVID-19 on the sensory system, risk factors, and the duration of symptoms. This study assesses olfactory, gustatory, hearing, and vestibular systems after COVID-19. Methods: This cross-sectional, single-center study involved 50 patients one to six months after COVID-19 and reports their patient records and the extent, onset, and duration of olfactory, gustatory, hearing, and balance disorders using questionnaires during and after COVID-19. Sensory symptoms were objectively studied using the following clinical tests after COVID-19 Sniffin’ Sticks, taste tests, tone/speech audiometry, and video head impulse test. Results: Post-COVID-19-patients were suffering from olfactory and gustatory impairment for up to six months. According to the Dizziness Handicap Inventory, balance disorders were less noticed: Overall, about 40% of the patients during COVID-19 and nearly all patients recovered within six months. After COVID-19, clinical tests revealed that 75% were suffering from hyposomnia/anosmia, and 20% of all patients reported mild hypogeusia for up to six months. Vestibular disorders and hearing impairment rarely/did not occur. Females were significantly more affected by sensory impairments than males. Conclusions: COVID-19 particularly caused olfactory and gustatory impairment; balance disorders were present too; vestibular and auditory symptoms were negligible.

Neuro-otological Symptoms: An Atypical Aspect of COVID-19 Disease

This study aimed to evaluate the various neuro-otological symptoms experienced by patients with COVID-19 disease. This is a retrospective study conducted from September 2020 to August 2021. Patients with positive RTPCR tests for COVID-19, aged between 18 and 60 years were included in the study. The patients were assessed for neuro-otological symptoms, the type, frequency, and character of these symptoms, their relation with age, gender and COVID-19 disease. Of the 286 patients, 64 (22.3%) had neuro-otological symptoms. The mean age of the patients was 36.3 ± 8.1 years. The frequency of neuro-otological symptoms was higher in females than males and was more frequent in the age group of 18–30 years as compared with other age groups. Of these 64 patients, 29 had vertigo (10.1%), 21 (7.3%) tinnitus, 16 (5.5%) experienced hearing loss. Like many viral diseases, apart from its typical prodromal symptoms, COVID-19 can also cause symptoms like tinnitus, hearing loss, and vertigo.

Otologic and vestibular symptoms in COVID-19: A scoping review

Background

Otologic and vestibular symptoms have been seen in patients confirmed to have COVID-19 disease. Further discussion of these symptoms may provide insight into short- and long-term management for these patients.

Objective

The aim of this review was to describe the otologic and vestibular symptoms that present in patients with COVID-19. The primary outcomes of this review were onset, duration and clinical outcomes of these symptoms.

Sources of Evidence

Pub Med, APAMed Central, Herdin, CINAHL, Scopus, Springer Link, ProQuest Coronavirus Research Database, and Google Scholar were searched for the articles to be included.

Eligibility Criteria

Studies included were those involving adult patients diagnosed with COVID-19 who experienced hearing loss, ear pain, ear discharge, otitis media, vertigo, or tinnitus. Studies were eligible for inclusion if there was a description of the otologic dysfunction, specifically onset, duration, or clinical outcomes.

Results

The majority of patients who experienced hearing loss (68%), tinnitus (88%), vertigo/dizziness (30%), ear pain (8%), and discharge (100%) did so within a month of experiencing the typical symptoms of COVID-19. A majority also experienced complete resolution of their symptoms within 2 weeks. Standard treatment for COVID-19 was usually provided but when specific diagnoses are made for these symptoms (e.g., sudden sensorineural hearing loss, otitis media, vestibular neuritis), they are treated in the same manner as one would for non-COVID-19 cases, in addition to the management for COVID-19. In certain cases, there may be a need for additional work-up to rule out other causes.

Conclusions

Otologic and vestibular symptoms were present in COVID-19 patients, majority as part of the systemic nature of the disease. The onset, duration, and course were consistent with the natural history of a systemic viral infection. COVID-19 should be considered in any patient with a new-onset hearing loss, tinnitus, or vertigo/dizziness, even in the absence of infectious or respiratory symptoms.