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Ricciardiello F, Pisani D, Viola P, Cristiano E, Scarpa A, Giannone A, Longo G, Russo G, Bocchetti M, Coppola C, Perrella M, Oliva F, Chiarella G. Sudden Sensorineural Hearing Loss in Mild COVID-19: Case Series and Analysis of the Literature. Audiol Res 2021; 11:313-326. [PMID: 34287226 PMCID: PMC8293051 DOI: 10.3390/audiolres11030029] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/06/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background: There is growing evidence of otoneurological involvement of SARS-CoV-2, such as tinnitus and balance disorders and smell and taste disorders, but HL in COVID-19 patients has still been marginally studied. Investigating the role of SARS-CoV-2 as an aetiological factor of Sudden Sensorineural Hearing Loss (SSNHL) may offer the opportunity to address treatment strategies to maximize clinical recovery and avoid side effects. Methods and results: For this purpose, we will present case studies of five patients who experienced SSNHL during COVID-19. Patients were selected from COVID-19 positive adult subjects with mild clinical presentation, admitted to the outpatient Ear Nose and Throat Department of Cardarelli Hospital due to the onset of SSNHL during the infection. All underwent a complete audio-vestibular investigation before and after SSNHL treatment protocol. Each patient is described with a detailed analysis. Conclusions: SSNHL could be an occasional symptom of COVID-19, even in mild manifestations of the disease. Our experience leads us to underline the value of promptly recognizing and addressing this and other uncommon symptoms, giving patients the opportunity to receive early treatment.
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Affiliation(s)
- Filippo Ricciardiello
- ENT Department, AORN Cardarelli, 80131 Napoli, Italy; (F.R.); (E.C.); (A.G.); (F.O.)
| | - Davide Pisani
- Unit of Audiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (G.C.)
- Correspondence: ; Tel.: +39-096-1364-7124
| | - Pasquale Viola
- Unit of Audiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (G.C.)
| | - Elisabetta Cristiano
- ENT Department, AORN Cardarelli, 80131 Napoli, Italy; (F.R.); (E.C.); (A.G.); (F.O.)
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy;
| | - Antonio Giannone
- ENT Department, AORN Cardarelli, 80131 Napoli, Italy; (F.R.); (E.C.); (A.G.); (F.O.)
| | | | - Giuseppe Russo
- Health Management AORN Cardarelli, 80131 Napoli, Italy; (G.R.); (C.C.)
| | - Marco Bocchetti
- Biogem Scarl, Molecular Oncology and Precision Medicine Laboratory, 83031 Irpino, Italy;
| | - Ciro Coppola
- Health Management AORN Cardarelli, 80131 Napoli, Italy; (G.R.); (C.C.)
| | - Marco Perrella
- Anesthesiology and Reanimation Department AORN Cardarelli, 80100 Napoli, Italy;
| | - Flavia Oliva
- ENT Department, AORN Cardarelli, 80131 Napoli, Italy; (F.R.); (E.C.); (A.G.); (F.O.)
| | - Giuseppe Chiarella
- Unit of Audiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (G.C.)
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Abstract
The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15–20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.
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Neri G, Filograna Pignatelli GR, Pacella A, Ortore R, Khasawneh L. Recurring paroxysmal positional vertigo: evaluation of the vascular factor. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2021; 41:77-83. [PMID: 33746226 PMCID: PMC7982760 DOI: 10.14639/0392-100x-n0502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/13/2020] [Indexed: 01/20/2023]
Abstract
To evaluate the effective incidence of vascular factor in the recurrence of benign paroxysmal positional vertigo (BPPV), we studied 50 subjects, 32 affected by idiopathic recurrent BPPV (study group) and 18 healthy subjects (control group). All subjects underwent complete otoneurological balance and haemodynamic evaluation by extracranial colour-coded duplex sonography (ECCS) of vertebral arteries (VA) with indication of arterial flow in ml/min, and retinal fluorangiography (FAG). The ECCS of 19 patients (59.3%) within the study group presented a reduction in vertebral arterial flow, exceeding the limits established by normative values (< 100 ml/min). In all cases, the same side was affected by BPPV, emphasised by vertebral hypoperfusion. The remaining 13 patients (40.6%) showed an arterial vertebral flow entirely within the normative values. The FAG excluded qualitative alterations of the cerebral microcirculation. The ECCS demonstrated that 59.3% of the study group showed a significant reduction in vertebral arterial flow ipsilateral to the semicircular canal affected by BPPV. This increased to 68.75% when the flow difference (D) between both the vertebral arteries were considered and reached 71.8% when vascular risk factors were evaluated. We conclude that reduced perfusion of the vestibular structures makes an already critical situation even more difficult, which can eventually develop into labyrinth suffering. The absence of fluorangiographic signs suggests that the labyrinthine neuroepithelium is much more sensitive to hypoperfusion than the retina. We hypothesise that this ischaemic situation could degenerate utricular macula, otolith detachment, leading to the development of recurrent BPPV. This risk situation for the labyrinth can also be revealed by the evaluation of three parameters: presence of vascular risk factors, reduction of vertebral flow < 100 ml/min and the difference in flow between the 2 vertebral arteries > 29 ml/min.
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Affiliation(s)
- Giampiero Neri
- Department of Neurosciences Imaging and Clinical Sciences, University Gabriele D’Annunzio of Chieti-Pescara, Italy
| | | | - Alessandro Pacella
- Department of Neurosciences Imaging and Clinical Sciences, University Gabriele D’Annunzio of Chieti-Pescara, Italy
| | - Rocco Ortore
- Department of Otolaryngology (ENT), IRCCS Hospital Home for the Relief of Suffering, San Giovanni Rotondo, Italy
| | - Laith Khasawneh
- Department of General and Special Surgery, Hashemite University of Jordan, Zarqa, Jordan
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