SARS-CoV-2 (COVID-19) and audio-vestibular disorders

Sudden sensorineural hearing loss: audiological profile during the COVID-19 pandemic

Introduction

Sudden sensorineural hearing loss (SSNHL) is an otological emergency that requires prompt recognition and intervention to prevent devastating impacts on people's lives. During the COVID-19 pandemic, sensory deprivations have been reported in patients positive for SARS-CoV-2 virus, including deleterious effects on the auditory pathway. This study aims to describe the audiological profile of individuals with SSNHL during the COVID-19 pandemic and to correlate hearing recovery in subgroups of individuals with or without COVID-19.

Methods

Prospective cohort including patients diagnosed with SSNHL evaluated in a tertiary care center between March 2020 and September 2022. Hearing loss was confirmed with pure-tone and speech audiometry, with Speech Recognition Threshold (SRT) and word recognition score (WRS). Audiometric testing was performed at the moment of diagnosis, then 7, 30 and 120 days after diagnosis. The average degree of hearing loss was assessed by calculating the 4-frequency pure tone average (4fPTA). The investigation of COVID-19 included RT-PCR technique for the SARS-CoV-2 virus and collection of information regarding disease severity. A statistical analysis was performed using an analysis of covariance (ANCOVA) model to compare the 4fPTA between the four groups (with and without a history of COVID-19, unilateral and bilateral cases) at the end of the follow-up period.

Results

Fifty-two patients with SSNHL were assessed, 40 (76.9%) with unilateral and 12 (23.1%) with bilateral hearing loss, totaling 64 ears included. Of those, 15 (28.8%) patients tested positive for SARS-CoV-2 and were symptomatic for COVID-19. Of all unilateral cases, 22.5% were seropositive and showed symptoms of COVID-19, a number that increased to 50% for bilateral cases. Comparing the COVID-19 positive groups, individuals with unilateral SSNHL went from 40 dB as their average 4fPTA at onset to 20 dB as their average 4fPTA after 120 days, whereas those with bilateral SSNHL went from an initial average of 60 dB to a final average of 66 dB. Although the 4fPTA value of individuals with unilateral SSNHL improved in 7 days, the mean values showed no significant difference between positive and negative groups. There was a higher incidence of bilateral simultaneous SSNHL in patients who had not been vaccinated against COVID-19 and who presented with symptoms of severe COVID-19.

Conclusion

Infection with SARS-CoV-2 resulted in more severe SSNHL, in bilateral SSNHL, and in poorer recovery from SSNHL in bilateral cases. Bilateral SSNHL was seen more frequently in patients who had not received vaccination against COVID-19.

Evaluating the impact of COVID-19 on vertigo and hearing impairment: A post-recovery analysis

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has manifested with respiratory symptoms and a spectrum of extra-pulmonary complications. Emerging evidence suggests potential impacts on the auditory and vestibular systems, but the extent and nature of these effects in recovered individuals remain unclear. This study aimed to investigate the prevalence and severity of vertigo and hearing impairment in individuals who have recovered from COVID-19 and to identify potential risk factors associated with these sensory symptoms. A cohort of 250 recovered COVID-19 patients was assessed. Standardized questionnaires, including the Dizziness Handicap Inventory and the Vertigo Symptom Scale, were used to evaluate vertigo. Hearing assessment was conducted using pure-tone audiometry, speech audiometry, tympanometry, and oto-acoustic emissions testing. Logistic regression analysis was performed to assess the association between COVID-19 severity and the occurrence of sensory symptoms, controlling for confounding variables such as age and comorbidities. Of the participants, 10% reported vertigo, varying severity. Hearing assessments revealed that most participants had normal hearing, with an average speech discrimination score of 94.6. Logistic regression analysis indicated a significant association between severe COVID-19 and an increased likelihood of vertigo (OR 2.11, 95% CI 1.02-4.35, P = .043) and hearing impairment (OR 3.29, 95% CI 1.60-6.78, P = .002). This study suggests a significant association between COVID-19 severity and vertigo and hearing impairment prevalence. The findings underscore the importance of sensory symptom assessment in the post-recovery phase of COVID-19, highlighting the need for comprehensive healthcare approaches to manage long-term sequelae.

COVID-19 vaccination-related tinnitus is associated with pre-vaccination metabolic disorders

Cases of tinnitus have been reported following administration of COVID-19 vaccines. The aim of this study was to characterize COVID-19 vaccination-related tinnitus to assess whether there is a causal relationship, and to examine potential risk factors for COVID-19 vaccination-related tinnitus. We analyzed a survey on 398 cases of COVID-19 vaccination-related tinnitus, and 699,839 COVID-19 vaccine-related reports in the Vaccine Adverse Effect Reporting System (VAERS) database that was retrieved on 4 December 2021. We found that following COVID-19 vaccination, 1) tinnitus report frequencies for Pfizer, Moderna and Janssen vaccines in VAERS are 47, 51 and 70 cases per million full vaccination; 2) the symptom onset was often rapid; 3) more women than men reported tinnitus and the sex difference increased with age; 4) for 2-dose vaccines, the frequency of tinnitus was higher following the first dose than the second dose; 5) for 2-dose vaccines, the chance of worsening tinnitus symptoms after second dose was approximately 50%; 6) tinnitus was correlated with other neurological and psychiatric symptoms; 7) pre-existing metabolic syndromes were correlated with the severity of the reported tinnitus. These findings suggest that COVID-19 vaccination increases the risk of tinnitus, and metabolic disorders is a risk factor for COVID-19 vaccination-related tinnitus.

Evaluation of the effects of Covid-19 on cochleovestibular system with audiovestibular tests

PURPOSE

The purpose of the present study was to investigate the effects of COVID-19 on audiovestibular system with Transiently Evoked Distortion Otoacoustic Emissions (TOAE), Distortion Product Otoacoustic Emissions (DPOAE), video head impulse test (vHIT) and caloric test.

METHODS

Audiovestibular findings of 24 patients with moderate/severe COVID-19 and 24 healthy controls were compared using pure tone audiometry, tympanometry, TOAE, DPOAE, caloric test, and vHIT.

RESULTS

On audiometry, the pure tone averages of the COVID-19 patients were higher than the controls (P = .038). The TEOAE amplitudes at 4000 and 5000 Hz (P = .006 and P < .01), and DPOAE amplitudes at 3000, 6000, and 8000 Hz (P < .001, P = .003 and P < .001) were significantly lower in COVID-19 patients compared to the controls. On vestibular tests, there was no significant difference between the caloric test results of the patients and the controls (P > .05). On vHIT testing, amplitudes of right semicircular canal was found to be significantly lower in COVID-19 group compared to the control group (P = .008).

CONCLUSION

COVID-19 may affect inner ear functions causing a subtle damage in the outer hair cells and lateral semicircular canals. It must be kept in mind that COVID-19 may cause cochleovestibular problems.

Advances in acupuncture treatment for tinnitus

Tinnitus is the abnormal perception of sound in the absence of a corresponding external acoustic stimulus, which seriously affects the patients' quality of life, physical and mental health, and the safety of life. There is almost no effective cure for tinnitus, primarily due to its complicated etiopathogenesis and unclear mechanisms. As a major and ancient physical therapy in Traditional Chinese Medicine, acupuncture has been widely used in tinnitus because of its simple operation, rapid effect, and low cost. This paper reviews the relevant literature on the treatment of different kinds of tinnitus by acupuncture, and summarizes the therapeutic efficacy and mechanism of acupuncture on tinnitus, which is expected to provide new ideas and research directions for the study of tinnitus treatment by acupuncture. Tinnitus is the abnormal perception of sound in the absence of a corresponding external acoustic stimulus, which seriously affects the patients' quality of life, physical and mental health, and the safety of life. There is almost no effective cure for tinnitus, primarily due to its complicated etiopathogenesis and unclear mechanisms. As a major and ancient physical therapy in Traditional Chinese Medicine, acupuncture has been widely used in tinnitus because of its simple operation, rapid effect, and low cost. This paper reviews the relevant literature on the treatment of different kinds of tinnitus by acupuncture, and summarizes the therapeutic efficacy and mechanism of acupuncture on tinnitus, which is expected to provide new ideas and research directions for the study of tinnitus treatment by acupuncture.

Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey

BACKGROUND

Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population.

OBJECTIVE

Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms.

METHODS

A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection-related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus.

RESULTS

Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection.

CONCLUSIONS

In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post-COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume.

Detection of SARS-CoV-2 virus in middle ear effusions and its association with otitis media with effusion

A large-scale outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) occurred in Shanghai, China, in early December 2022. To study the incidence and characteristics of otitis media with effusion (OME) complicating SARS-CoV-2, we collected 267 middle ear effusion (MEE) samples and 172 nasopharyngeal (NP) swabs from patients. The SARS-CoV-2 virus was detected by RT-PCR targeting. The SARS-CoV-2 virus, angiotensin-converting enzyme 2 (ACE2), and transmembrane serine protease 2 (TMPRSS2) expression in human samples was examined via immunofluorescence. During the COVID-19 epidemic in 2022, the incidence of OME (3%) significantly increased compared to the same period from 2020 to 2022. Ear symptoms in patients with SARS-CoV-2 complicated by OME generally appeared late, even after a negative NP swab, an average of 9.33 ± 6.272 days after COVID-19 infection. The SARS-CoV-2 virus was detected in MEE, which had a higher viral load than NP swabs. The insertion rate of tympanostomy tubes was not significantly higher than in OME patients in 2019-2022. Virus migration led to high viral loads in MEE despite negative NP swabs, indicating that OME lagged behind respiratory infections but had a favorable prognosis. Furthermore, middle ear tissue from adult humans coexpressed the ACE2 receptor for the SARS-CoV-2 virus and the TMPRSS2 cofactors required for virus entry.

Drug-induced hearing loss: Listening to the latest advances

Sensorineural hearing loss (SNHL) is the most common type of hearing loss. Causes include degenerative changes in the sensory hair cells, their synapses and/or the cochlear nerve. As human inner ear hair cells have no capacity for regeneration, their destruction is irreversible and leads to permanent hearing loss. SNHL can be genetically inherited or acquired through ageing, exposure to noise or ototoxic drugs. Ototoxicity generally refers to damage to the structures and functions of the inner ear following exposure to specific drugs. Ototoxicity can be multifactorial, causing damage to cochlear hair cells or cells with homeostatic functions that modulate cochlear hair cell function. Clinical strategies to limit ototoxicity include identifying patients at risk, monitoring drug concentrations, performing serial hearing assessments and switching to less ototoxic therapy. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the PubMed® database. The search terms "ototoxicity", "hearing loss" and "drugs" were combined. We included studies published between September 2013 and June 2023, and focused on medicines and drugs used in hospitals. The review highlighted a number of articles reporting the main drug classes potentially involved: namely, immunosuppressants, antimalarials, vaccines, antibiotics, antineoplastic agents, diuretics, nonsteroidal anti-inflammatory drugs and analgesics. The presumed ototoxic mechanisms were described, together with the therapeutic and preventive options developed over the last ten years.

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.

Cochlear Implantation in Patients with Bilateral Sudden Sensorineural Hearing Loss after COVID-19 Infection

COVID-19 infection is associated with a variety of neurological manifestations. Since the inner ear is vulnerable to viruses, sensorineural hearing loss (SNHL) has been reported to occur following SARS-CoV-2 infection. We present here two cases of profound SNHL following SARS-CoV-2 infection. Pure-tone audiograms confirmed profound SNHL. The tympanogram and Auditory Brainstem Responses showed no abnormal symptoms. MRIs and CTs identified some changes but no significant anatomical nor physiological manifestations explaining the obvious cause for hearing loss. High doses of oral corticosteroids with additional conservative therapy were given with no therapeutic response, and therefore, cochlear implant surgery was performed. One case was bilaterally treated, and the other one received an implantation on one side. Both surgeries were carried out without intra- nor postoperative complications. Interestingly, in both cases, advanced fibrotic tissue was found during surgery. Both cases reported successful rehabilitation and are satisfied with their new sound perception following cochlear implantation.

Smartphone-based evaluation of static balance and mobility in long-lasting COVID-19 patients

Background

SARS-CoV-2 infection can lead to a variety of persistent sequelae, collectively known as long COVID-19. Deficits in postural balance have been reported in patients several months after COVID-19 infection. The purpose of this study was to evaluate the static balance and balance of individuals with long COVID-19 using inertial sensors in smartphones.

Methods

A total of 73 participants were included in this study, of which 41 had long COVID-19 and 32 served as controls. All participants in the long COVID-19 group reported physical complaints for at least 7 months after SARS-CoV-2 infection. Participants were evaluated using a built-in inertial sensor of a smartphone attached to the low back, which recorded inertial signals during a static balance and mobility task (timed up and go test). The parameters of static balance and mobility obtained from both groups were compared.

Results

The groups were matched for age and BMI. Of the 41 participants in the long COVID-19 group, 22 reported balance impairment and 33 had impaired balance in the Sharpened Romberg test. Static balance assessment revealed that the long COVID-19 group had greater postural instability with both eyes open and closed than the control group. In the TUG test, the long COVID-19 group showed greater acceleration during the sit-to-stand transition compared to the control group.

Conclusion

The smartphone was feasible to identify losses in the balance motor control and mobility of patients with long-lasting symptomatic COVID-19 even after several months or years. Attention to the balance impairment experienced by these patients could help prevent falls and improve their quality of life, and the use of the smartphone can expand this monitoring for a broader population.

Number of initial symptoms of SARS-CoV-2 infection is associated with the risk of otological symptoms: a retrospective study

BACKGROUND

The characteristics of otological symptoms in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are lacking. Almost no research has been conducted to explore the emergence of otological symptoms after coronavirus disease 2019 infection. The aims of this study were to investigate the prevalence and specific clinical characteristics of and risk factors for otological symptoms among patients with SARS-CoV-2 infection.

METHODS

We included two groups to investigate the prevalence and clinical characteristics of otological symptoms among patients with SARS-CoV-2 infection. The first sample (S1) was drawn retrospectively from four communities via questionnaires, and the second sample (S2) from an outpatient clinic.

RESULTS

A total of 189 participants were included in S1 (124 women [65.6%]; mean [standard deviation (SD)] age, 33.66 [13.56] years), and 47 in S2 (25 women [53.2%]; mean [SD] age, 45.28 [14.64] years). The most prevalent otological symptoms in S1 were dizziness (15.9%), tinnitus (7.9%), aural fullness (6.9%), otalgia (5.3%), hearing loss (1.6%), and otopyorrhoea (1.1%). Moreover, for each additional typical symptom of SARS-CoV-2 infection, the risk (odds ratio) of otological symptoms increased by 1.33 (95% confidence interval: 1.10-1.61, p = 0.003). The prevalence of aural fullness was higher in the unvaccinated group than that in the group receiving two or three vaccinations (p = 0.018).

CONCLUSIONS

Various otological symptoms may occur in patients with SARS-CoV-2 infection. The number of typical symptoms of SARS-CoV-2 infection is positively associated with the probability of otological symptoms. However, vaccination may reduce the probability of certain otological symptoms.

Predictors of Dizziness and Hearing Disorders in People with Long COVID

Background and Objectives: Individuals report persistent symptoms after becoming infected by SARS-CoV-2 (COVID-19) that last for >4 weeks (long-COVID syndrome). Dizziness and hearing loss have been reported among long-COVID symptoms. However, little is known about the potential predictors of dizziness and hearing loss in individuals with long COVID. This study aimed to explore the presence and correlates of dizziness and hearing loss in a sample of people with long-COVID syndrome. Materials and Methods: Individuals aged 18 years and older who were infected with COVID-19 at least 8 weeks prior to the start of the study were included if they were not diagnosed with dizziness or hearing loss before getting COVID-19. Demographics and COVID-19-related information were collected. Participants completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence (ABC) scale, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), and Medical Outcomes Study Short Form 12 (SF-12). Finally, hearing was assessed using pure-tone audiometry (PTA) in a subsample. Results: Two hundred and nine individuals (66% female) with a mean (SD) age of 27 (9) participated in the study. Perceived dizziness and hearing loss were reported in 26 and 15.3% of the sample, respectively. Logistic regression was conducted to identify potential predictors of dizziness and hearing loss separately. After controlling for age and severity of dizziness, female sex and high fatigue severity were associated with an increased likelihood of reporting dizziness (R2 = 31%). The severity of dizziness and neurological symptoms during the acute stage of COVID-19 were associated with an increased likelihood of reporting hearing loss (R2 = 10.4%) after controlling for age. Conclusions: Dizziness and hearing loss present in long COVID and can be disabling. Females with high levels of fatigue should be questioned about persistent dizziness. Hearing loss should be considered in individuals with neurological symptoms and severe dizziness as a consequence of long COVID.

TCM "medicine and food homology" in the management of post-COVID disorders

Background

The World Health Organization declared that COVID-19 is no longer a public health emergency of global concern on May 5, 2023. Post-COVID disorders are, however, becoming more common. Hence, there lies a growing need to develop safe and effective treatment measures to manage post-COVID disorders. Investigating the use of TCM medicinal foods in the long-term therapy of post-COVID illnesses may be beneficial given contemporary research's emphasis on the development of medicinal foods.

Scope and approach

The use of medicinal foods for the long-term treatment of post-COVID disorders is highlighted in this review. Following a discussion of the history of the TCM "Medicine and Food Homology" theory, the pathophysiological effects of post-COVID disorders will be briefly reviewed. An analysis of TCM medicinal foods and their functions in treating post-COVID disorders will then be provided before offering some insight into potential directions for future research and application.

Key findings and discussion

TCM medicinal foods can manage different aspects of post-COVID disorders. The use of medicinal foods in the long-term management of post-COVID illnesses may be a safe and efficient therapy choice because they are typically milder in nature than chronic drug use. These findings may also be applied in the long-term post-disease treatment of similar respiratory disorders.

The Pathogenesis of Cytomegalovirus and Other Viruses Associated with Hearing Loss: Recent Updates

Virus infection is one of the most common etiologies of hearing loss. Hearing loss associated with viral infection can be unilateral or bilateral, mild or severe, sudden or progressive, and permanent or recoverable. Many viruses cause hearing loss in adults and children; however, the pathogenesis of hearing loss caused by viral infection is not fully understood. This review describes cytomegalovirus, the most common virus causing hearing loss, and other reported hearing loss-related viruses. We hope to provide a detailed description of pathogenic characteristics and research progress on pathology, hearing phenotypes, possible associated mechanisms, treatment, and prevention measures. This review aims to provide diagnostic and treatment assistance to clinical workers.

Natural history of long-COVID in a nationwide, population cohort study

Previous studies on the natural history of long-COVID have been few and selective. Without comparison groups, disease progression cannot be differentiated from symptoms originating from other causes. The Long-COVID in Scotland Study (Long-CISS) is a Scotland-wide, general population cohort of adults who had laboratory-confirmed SARS-CoV-2 infection matched to PCR-negative adults. Serial, self-completed, online questionnaires collected information on pre-existing health conditions and current health six, 12 and 18 months after index test. Of those with previous symptomatic infection, 35% reported persistent incomplete/no recovery, 12% improvement and 12% deterioration. At six and 12 months, one or more symptom was reported by 71.5% and 70.7% respectively of those previously infected, compared with 53.5% and 56.5% of those never infected. Altered taste, smell and confusion improved over time compared to the never infected group and adjusted for confounders. Conversely, late onset dry and productive cough, and hearing problems were more likely following SARS-CoV-2 infection.

Could vertigo be a post-COVID-19 sequela or presenting symptom?

Background

It has been postulated that COVID-19 has a substantial neuro-otological impact such as vertigo or dizziness that is rarely evaluated. The purpose of this research is to study the occurrence of vertigo (whether as presenting symptom or a sequela) and its etiological characteristics in patients with covid 19 infection and close contact. It is a cross-sectional study (convenient sample) conducted on patients that had a previous history of covid 19 infection and another group of contact individuals who presented with the sensation of vertigo. All the included participants underwent full neurological and otological examination, nasopharyngeal swab PCR to confirm COVID-19 infection and video nystgmograghy (VNG).

Results

it was included 44 participants, where 7 (15.9%) of the participants were post-COVID-19 patients and 37 (84.1%) were close contacts of COVID patients. It was found that 6(85.7%) of post-COVID-19 patients had vestibular neuritis (VN), and 1(14.3%) patient had Benign Paroxysmal Positional Vertigo (BPPV). 9(23%) of those in close contact had positive PCR for COVID infection, 6(66.7%) of them had VN, and the other 3 (33.3%) had BPPV.

Conclusion

Vertigo could be a possible complication or a presenting symptom in patients with COVID patients that is mainly attributed to peripheral vestibular dysfunction.

Auditory Screening in Newborns after Maternal SARS-CoV-2 Infection: An Overview

BACKGROUND AND AIM

Several viruses have previously been reported to be responsible for congenital hearing loss; therefore, since the beginning of the SARS-CoV-2 infection pandemic, various reports have investigated a possible link. The aim of this review is to assess the possible link between maternal COVID-19 infection and congenital hearing loss.

METHODS

This systematic review was performed using PRISMA criteria, searching Medline and Embase databases from March 2020 to February 2023. A total of 924 candidate papers were identified; however, considering the specific selection criteria, only nine were selected for additional analysis.

RESULTS

The overall number of children born from mothers infected with COVID-19 during pregnancy identified through this review was 1687. The confirmed cases of hearing loss were 0.7% (12/1688); a description of its nature (sensorineural vs. conductive) is missing in the selected studies, and the follow-up period is variable across the analyzed papers. Surprisingly, a large proportion of false positives were recorded at the first stage of screening, which resulted normal at the re-test.

CONCLUSIONS

Currently, a correlation between congenital hearing loss and SARS-CoV-2 infection cannot be definitively established. Further studies are desirable to provide additional evidence on this topic.

Hearing loss and COVID-19: an umbrella review

INTRODUCTION

COVID-19 can result in an extensive range of extrapulmonary, and neurological signs and symptoms such as olfactory and/or taste dysfunction, and otologic symptoms. The aim of this study was to investigate the hearing loss manifestation from COVID-19.

METHODS

The goal of this umbrella review was to examine hearing loss associated with COVID-19 disease. English literature published until October 15, 2022 in online databases including PubMed, Scopus, Web of Science, and Embase was considered for this purpose. Eligibility of the articles for subsequent data extraction was evaluated in a two-step selection process with consideration to an inclusion/exclusion criterion. This review followed the PRISMA protocol and the Amstar-2 checklist for quality assessment.

RESULTS

A total of four treatment strategies were used by different studies which included oral corticosteroids, intratympanic corticosteroids, combined oral and intratympanic corticosteroids, and hyperbaric oxygen therapy. Five studies investigated corticosteroid use in the forms of oral or intratympanic injection; four studies reported (complete or partial) hearing improvements after steroid treatment, while one study stated no significant improvement in hearing function. One study reported that oral corticosteroid monotherapy alone was not effective, while vestibular symptoms were ameliorated by a combination of oral prednisone, intratympanic dexamethasone injection, and hydroxychloroquine.

CONCLUSION

The findings suggest that despite being one of the rare complications of COVID-19, hearing loss can impact a patient's quality of life. The most common type reported was sensorineural hearing loss, which can be diagnosed with variable techniques.

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.

The short-term effect of COVID-19 on the cochleovestibular system in pediatric patients

OBJECTIVES

The audio-vestibular equivalent of neurological symptoms secondary to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been discussed; however, it has not been fully clarified. Although it has been reported that the vestibulocochlear system is affected in adult coronavirus disease-2019 (COVID-19) patients, there is no study in the literature in which the pediatric patient group with COVID-19 was evaluated comprehensively with auditory and vestibular tests. In this study, the short-term damage caused by SARS-CoV-2 in the vestibulocochlear system in pediatric patients was examined.

METHODS

This study aimed to evaluate the vestibulocochlear system of pediatric patients (aged 9-15 years) with a recent history of COVID-19. The study included 35 individuals with a recent history of COVID-19 and 35 age-gender-matched healthy individuals (control group). Pure tone audiometry, suppressed otoacoustic emission (OAE), video head impulse test (VHIT), and cervical and ocular vestibular evoked myogenic potentials (c/o-VEMP) tests were administered to all participants following their otoscopic examinations, and the obtained data were compared between the two groups.

RESULTS

When the data obtained with pure tone audiometry were compared, statistically significant differences were found between the groups at four different frequencies (1000, 2000, 4000, and 8000 Hz) in favor of the control group. There was a statistically significant difference between the groups in the signal-to-noise ratio (SNR) values obtained before noise at 2800 Hz and before and after noise at 4000 Hz. VHIT lateral gain, LARP gain, and RALP gain were statistically significantly lower in the COVID-19 group than in the control group (p < 0.05). VHIT lateral asymmetry parameter was measured higher in the COVID-19 group than in the control group, and this difference was statistically significant (p < 0.05). In the VHIT test, the asymmetry parameter was significantly higher in the COVID-19 group (p < 0.05). In the o-VEMP test, n10 latency, p15 latency, n10-p15 interlatency, n10-p15 interpeak amplitude, and asymmetry parameters were measured, and no statistically significant difference was found between the COVID-19 group and the control group (p > 0.05).

CONCLUSION

Evidence was obtained that the cochleovestibular system was damaged in pediatric patients in the early post-COVID-19 period.

[Olfactory, gustatory and auditory disorders associated with COVID-19. A systematic review of their distribution and pathogenesis]

The presented systematic review contains basic information about the frequency, characteristic features of the course and pathogenesis of olfactory, gustatory and auditory disorders that occur with COVID-19, with which an otorhinolaryngologist meets in his practice. These disorders are often the first, and sometimes the only, manifestations of the underlying disease, which determines their role in early diagnosis and timely detection of the underlying disease. The article includes original articles, clinical case reports and literary reviews.

Vestibular disorders in patients after COVID-19 infection

Introduction

The COVID-19 clinical symptoms are primarily related to the respiratory system but may also be involved in many others, including the nervous system. Recently, vertigo or dizziness has been described as one of the clinical manifestations and possible complications of COVID-19.

Materials and methods

This clinical study was designed to describe the otorhinolaryngological evaluation and videonystagmographic (VNG) findings in patients with an antecedent of COVID-19 infection in the last 6 months. In this study, we sought to investigate the presence of persistent vestibular damage in healed COVID-19 patients and to determine the origin of vertigo by conducting a comprehensive vestibular examination. To evaluate the association precisely, an otoneurological assessement was conducted on all participants. The study group included 58 patients aged 23–75 years with vertigo, who were diagnosed with COVID-19 infection 6 months before the examination. Each participant was submitted to an evaluation consisting of anamnesis, otorhinolaryngological evaluation, and VNG.

Results

Spontaneous nystagmus with closed eyes was reported in 8 patients (13.8%). Positional nystagmus was observed in 15 patients (24.1%). Asymmetrical optokinetic nystagmus was observed in 18 patients (31%). A distorted record in the tracking pendulum test was present in 23 patients (39.7%). Square waves were observed in 34 COVID-19 patients (58.6%). Unilateral weakness (UW) was observed in 23 subjects (39.7%); among those with UW, 22 patients (95.7%) also demonstrated directional preponderance contralateral to the UW. Another 16 patients (27.6%) presented only directional advantage. The post-caloric recruitment was present in 38% patients.

Conclusion

Patients who had been diagnosed with COVID-19 seem to be more likely to suffer from vertigo/dizziness and to compensate more slowly. COVID-19 infection may cause inner ear damage and lead to vestibular dysfunction. The role of the central nervous system in the onset of equilibrium disorders should be considered. The presence of vertigo of central origin may indicate the neurotropic effect of SARS-CoV-2 following COVID-19. Imbalance may be the only symptom of COVID-19 and may also be a late complication of the disease due to post-infectious inflammation of the nervous tissue. Comprehensive studies are needed to investigate whether COVID-19 can cause long-term vestibular deficits.

The impact of COVID-19 on speech-language and hearing professions in low- and middle-income countries: Challenges and opportunities explored

BACKGROUND

 Since the advent of the coronavirus disease 2019 (COVID-19), the speech-language and hearing (SLH) professions globally have been confronted with novel and unexpected challenges.

OBJECTIVE

 The aim of this article was to explore the impact of COVID-19 on SLH professions in low- and middle-income countries (LMICs) as presented in the Special Issue of the South African Journal of Communication Disorders in the year 2022.

METHOD

 Divergent from the standard editorial writing style, this editorial adopted a research approach where a qualitative, descriptive scoping review design was conducted to meet the objectives of the study. Three specific objectives were targeted: (1) exploring the challenges to SLH research, teaching and practice; (2) establishing evidence-based solutions available for these challenges that can be used to improve the professions' response in the post-pandemic era; and (3) determining the areas that require further investigation, alternative solutions and innovation for improved readiness for future pandemics. A total of 21 manuscripts were reviewed that covered three predetermined themes - research, teaching and practice - that were constructed through a deductive approach as part of the call for papers for the special issue. These manuscripts were from academics, researchers and clinicians from various institutions in LMICs. The review is presented using thematic analysis.

RESULTS

 The review raised important challenges, presented under various subthemes, to the three key themes. These challenges reflect on the impact of COVID-19 on the SLH professions in terms of research, teaching, service provision and ethical challenges, as well as its impact on speech language, hearing, swallowing and balance functions. The review also advanced solutions and future directions during and beyond COVID-19.

CONCLUSION

 These findings raise global implications for research, teaching and practice that are not only relevant to the SLH professions.

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.

Prevalence of symptoms in 1512 COVID-19 patients: have dizziness and vertigo been underestimated thus far?

The relationship between SARS-CoV-2 infection and dizziness is still unclear. The aim of this study is to assess the prevalence and characteristics of dizziness and vertigo among patients with mild-to-moderate COVID-19. Patients discharged from the emergency rooms with a confirmed SARS-CoV-2 diagnosis were assisted by daily telephone calls until nasopharyngeal swab negativization, and specific symptoms concerning balance disorders were investigated through targeted questions posed by experienced physicians. The study included 1512 subjects (765 females, 747 males), with a median age of 51 ± 18.4 years. New-onset dizziness was reported by 251 (16.6%) patients, among whom 110 (43.8%) complained of lightheadedness, 70 (27.9%) of disequilibrium, 41 (16.3%) of presyncope, and 30 (12%) of vertigo. This study analyzed in detail the prevalence and pathophysiological mechanisms of the different types of balance disorders in a large sample, and the results suggest that dizziness should be included among the main symptoms of COVID-19 because one-sixth of patients reported this symptom, with females being significantly more affected than males (20.3 vs 12.9%, P < 0.001). Most cases of dizziness were attributable to lightheadedness, which was probably exacerbated by psychophysical stress following acute infection and mandatory quarantine. Vertigo should not be underestimated because it might underlie serious vestibular disorders, and disequilibrium in elderly individuals should be monitored due to the possible risk of falls.

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.

In pursuit of increasing the application of tele-audiology in South Africa: COVID-19 puts on the alert for patient site facilitator training

BACKGROUND

 The coronavirus disease 2019 (COVID-19) presented and highlighted new and unanticipated challenges to the provision of clinical services, raising an urgency for the application of different models of service delivery, including tele-audiology. In many tele-audiology encounters, a site facilitator is needed at the patient site to help with the hands-on aspects of procedures, and the implications of this requirement are significant for the resource-constrained African context.

OBJECTIVES

 The aim of this scoping review was to investigate published evidence on training provided to patient site facilitators (PSFs) for tele-audiology application to guide the South African audiology community in tele-audiology application initiatives.

METHOD

 Electronic bibliographic databases including Science Direct, PubMed, Scopus MEDLINE and ProQuest were searched to identify peer-reviewed publications, published in English, between 2017 and 2021 related to training of PSFs. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were followed during the screening process as well as for illustrating the process.

RESULTS

 Findings are discussed under four key themes: (1) type of tele-audiology and the implications thereof, (2) length of training and its implications, (3) diversity in the range of PSFs used and its implications for the training, and (4) heterogeneity in the training.

CONCLUSION

 The findings highlight important considerations for tele-audiology application within the African context, specifically decision-making around who can serve in the role of PSFs, as well as content and nature of training required, with implications for policy and regulations as well as human resource strategy. These findings are important for the COVID-19 pandemic era and beyond.

Acute Unilateral Peripheral Vestibulopathy After COVID-19 Vaccination: Initial Experience in a Tertiary Neurotology Center

Objective

The aim of the present study was to identify patients who developed acute unilateral peripheral vestibulopathy (AUPVP) after COVID-19 vaccination.

Methods

For this single-center, retrospective study, we screened the medical records of our tertiary interdisciplinary neurotology center for patients who had presented with AUPVP within 30 days after COVID-19 vaccination (study period: 1 June−31 December 2021). The initial diagnosis of AUPVP was based on a comprehensive bedside neurotological examination. Laboratory vestibular testing (video head impulse test, cervical and ocular vestibular evoked myogenic potentials, dynamic visual acuity, subjective visual vertical, video-oculography, caloric testing) was performed 1–5 months later.

Results

Twenty-six patients were diagnosed with AUPVP within the study period. Of those, n = 8 (31%) had developed acute vestibular symptoms within 30 days after COVID-19 vaccination (mean interval: 11.9 days, SD: 4.8, range: 6–20) and were thus included in the study. The mean age of the patients (two females, six males) was 46 years (SD: 11.7). Seven patients had received the Moderna mRNA vaccine and one the Pfizer/BioNTech mRNA vaccine. All patients displayed a horizontal(-torsional) spontaneous nystagmus toward the unaffected ear and a pathological clinical head impulse test toward the affected ear on initial clinical examination. Receptor-specific laboratory vestibular testing performed 1–5 months later revealed recovery of vestibular function in two patients, and heterogeneous lesion patterns of vestibular endorgans in the remaining six patients.

Discussion and Conclusions

The present study should raise clinicians' awareness for AUPVP after COVID-19 vaccination. The relatively high fraction of such cases among our AUPVP patients may be due to a certain selection bias at a tertiary neurotology center. Patients presenting with acute vestibular symptoms should be questioned about their vaccination status and the date of the last vaccination dose. Furthermore, cases of AUPVP occurring shortly after a COVID-19 vaccination should be reported to the health authorities to help determining a possible causal relationship.

Imaging of the head and neck during the COVID19 pandemic

There is a wide spectrum of clinical manifestation of COVID-19 in the head and neck, but often these do not have an imaging correlate. This review will highlight the most common imaging features of COVID-19 in the head and neck that can be seen on routine head and neck CT and MRI. In addition, situations where a more dedicated imaging protocol is required will be highlighted. Finally, as mass vaccination efforts are underway worldwide, post vaccination imaging can often complicate cancer surveillance imaging. Post vaccination imaging features and recommendations will be discussed.

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.

Neurocognitive Profile of the Post-COVID Condition in Adults in Catalonia-A Mixed Method Prospective Cohort and Nested Case-Control Study: Study Protocol

The diagnosis of the post-COVID condition is usually achieved by excluding other diseases; however, cognitive changes are often found in the post-COVID disorder. Therefore, monitoring and treating the recovery from the post-COVID condition is necessary to establish biomarkers to guide the diagnosis of symptoms, including cognitive impairment. Our study employs a prospected cohort and nested case-control design with mixed methods, including statistical analyses, interviews, and focus groups. Our main aim is to identify biomarkers (functional and structural neural changes, inflammatory and immune status, vascular and vestibular signs and symptoms) easily applied in primary care to detect cognitive changes in post-COVID cases. The results will open up a new line of research to inform diagnostic and therapeutic decisions with special considerations for cognitive impairment in the post-COVID condition.

Adverse Audio-Vestibular Effects of Drugs and Vaccines Used in the Treatment and Prevention of COVID-19: A Review

(1) Background: The purpose of this article is to review pharmacological treatments for COVID-19 (currently approved by the EMA (European Medical Agency) and FDA (Food and Drug Administration)) and highlight their potential audio-vestibular side-effects as an ototoxic adverse reaction. (2) Methods: Review of the available literature in the scientific databases PubMed, ResearchGate, Scopus, and ScienceDirect, and in summaries of product data sheets. (3) Results: In accordance with EBM (evidence-based medicine) the treatment of COVID-19 by using lopinavir/ritonavir, chloroquine and hydroxychloroquine, azithromycin, favipiravir, amantadine, oseltamivir, and ivermectin is no longer recommended for patients suffering from COVID-19 due to a lack of clinical data, publications, and recommendations. There were 39 publications and 15 summaries of product characteristics (as other sources of data) which were also used in this analysis. Adverse events could be permanent or disappear over time. Following treatment for COVID-19, the most frequent adverse audio-vestibular reactions reported in clinical trials and publications in the area of audiology and otorhinolaryngology were: dizziness, blurry vision with dizziness, nasopharyngitis, dysgeusia, and tinnitus. As far as vaccines are concerned, dizziness as an ototoxic effect was uncommon and occurs only in hypersensitive people who experience anaphylactic shock. (4) Conclusions: The ototoxicity of the drugs discussed here does not have as severe symptoms as the drugs used in the treatment of COVID-19 in 2020 (e.g., hydroxychloroquine), and relates mainly to disorders of the vestibulocochlear system. However, there is still a need to monitor ototoxic side-effects because of potential interactions with other ototoxic drugs. Many of the drugs approved by EMA and FDA are new, and not every side-effect is known.

ENT symptoms in acute COVID-19: a narrative review

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterised by a wide spectrum of disease severity ranging from asymptomatic or oligosymptomatic cases to severe and life-threatening forms. As this new coronavirus is a respiratory virus, it is not surprising that many symptoms caused by SARS-CoV-2 infection are related to the involvement of the upper respiratory tract. In addition the most pathognomonic of symptoms, i.e. the alteration of smell, nasal obstruction, sore throat and cough have been consistently described as early symptoms of the disease. However, for other ENT symptoms, such as oral lesions and audio-vestibular changes, a causal relation is far from proven. The rapid and extensive spread of COVID-19 makes it difficult to demonstrate a causative link between several ENT symptoms and SARS-CoV-2 infection and it is reasonable to assume that at least in some cases this link is actually coincidental in some cases. Moreover, following the phenomenon of the race to publish, there has been an uncontrolled release of poor-quality articles showing the most disparate associations mainly based on a temporal association between SARS-CoV-2 infection and symptoms of various types including those of the ENT area. In this narrative review of the literature, we will critically describe the ENT symptoms of COVID-19.

The Impact of COVID-19 Confinement on Tinnitus and Hearing Loss in Older Adults: Data From the LOST in Lombardia Study

Background

Although a direct relationship between tinnitus or hearing difficulties and COVID-19 has been suggested, current literature provides inconsistent results, and no research has been undertaken in older adults.

Methods

In November 2020, we conducted the LOST in Lombardia survey, a telephone-based cross-sectional study on a sample of 4,400 individuals representative of the general population aged ≥65 years from Lombardy region, Northern Italy. Individuals with diagnosed tinnitus and/or hearing loss were asked whether their conditions had improved or deteriorated in 2020 compared to 2019.

Results

Overall, 8.1% of older adults reported a diagnosis of tinnitus and 10.5% of hearing loss. In 2020 compared to 2019, among individuals with tinnitus, those with increasing severity (5.0%) were similar to those decreasing it (5.3%). Among individuals with hearing loss, more people reported an increase (13.6%) than a decrease (3.2%) in their disease severity. No individual with a diagnosis in 2020 of tinnitus (n = 6) or hearing loss (n = 13) had COVID-19. The incidence of tinnitus was lower in 2020 (rate: 14.8 per 10,000 person-years) than in previous years (rate in 1990–2019: 36.0 per 10,000 person-years; p = 0.026). There was no change in the incidence of hearing loss (p = 0.134).

Conclusions

In this large representative sample of older adults, on average neither COVID-19 confinement nor SARS-CoV-2 infection appeared to increase the severity or incidence of tinnitus. The increased severity of hearing difficulties may totally or partially be explained by physiologic deterioration of the condition, or by a misperception due to the use of face-masks.

The effect of the severity of COVID-19 on the sequelae of the audiovestibular system

Objectives: The neurotropic and neuroinvasive properties of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have been described. It remains unknown how SARS-CoV-2 affects the audiovestibular system when it causes mild or severe disease. In this study, the sequelae effect of SARS-CoV-2 on the audiovestibular systems of different patient groups was investigated using objective and subjective test batteries. Methods: In this present study, we evaluated vestibulocochlear functions of patients who previously had Coronavirus Disease-2019 (COVID-19) with pure tone audiometry, ocular vestibular-evoked myogenic potential (o-VEMP), and cervical vestibular-evoked myogenic potential (c-VEMP) tests to identify possible sequelae by comparing them with the control group. Results: We found that the amplitude of p13-n23 was lower in both groups of patients than in the control group (p < 0.001). In the results of the left ear c-VEMP, the amplitude of p13-n23 was statistically different between the outpatient, inpatient, and control groups. The amplitude of p13-n23 was lower in both groups of patients than in the control group (p < 0.001). In the evaluation of the o-VEMP in the left ear, we observed a statistically significant difference in the latency of n10 (p = 0.006) and the amplitude of n10-p15 (p < 0.001) between the groups. The n10 latency was prolonged in both groups of patients compared to the control group and there was no statistically significant difference between groups of patients. Furthermore, the amplitude of n10-p15 was lower in both groups of patients compared to the control group and there were no statistically demonstrable differences between the groups of patients. Conclusions: In conclusion, our results suggest that SARS-CoV-2 may affect the vestibulocochlear system. But we could not find a direct relationship according to the severity of the disease.

Neurological consequences of COVID-19 and brain related pathogenic mechanisms: A new challenge for neuroscience

Due to the infection by the SARS-CoV-2 virus (COVID-19) there were also reported neurological symptoms, being the most frequent and best cited those that affect the cerebrovascular, sensorial, cognitive and motor functions, together with the neurological diffuse symptoms as for examples headache or dizziness. Besides, some of them behave high risk of mortality. Consequently, it is crucial to elucidate the mechanisms of action in brain of SARS-CoV-2 virus in order to create new therapeutic targets to fight against this new disease. Since now the mechanisms of arrival to the brain seems to be related with the following processes: blood brain barrier (BBB) disruption together with nervous or axonal transport of the virus by the trigeminal nerve, the vagus nerve, or the brain-gut-axis. Being two the mechanisms of brain affectation most cited: a direct affectation of the virus in the brain through neuroinvasion and an indirect mechanism of action due to the effects of the systemic infection. Both processes include the triggering of inflammation, hypoxia and the increased likelihood of secondary infections. This topic supposes a major novel challenge for neuroscience. Therefore, the aim of this review is to provide summarized information about the neurological symptomatology and the brain pathogenic mechanisms involved and reported in COVID-19.

Sudden hearing loss and vestibular disorders during and before COVID-19 pandemic: An audiology tertiary referral centre experience

PURPOSE

During the Coronavirus disease 2019 (COVID-19) pandemic a reduction in the diagnosis of many otorhinolaryngological and audiological disorders has been widely reported. The main aim of this investigation was to evaluate the impact of COVID-19 outbreak on the incidence of acute hearing and vestibular disorders.

MATERIALS AND METHODS

A retrospective analysis was performed of all patients evaluated in an audiology tertiary referral centre for acute cochleo-vestibular impairment between March 1st 2020 and February 28th 2021 (Pandemic Year Period, PYP). Results were compared to patients presenting with the same disorders during two previous periods (March 1st 2019 to February 29th 2020 and March 1st 2018 to February 28th 2019; First Precedent Year Period, FPYP and Second Precedent Year Period, SPYP, respectively).

RESULTS

The annual incidence of total acute audio-vestibular disorders (number of annual diagnoses divided by total number of annual audiological evaluations) was 1.52% during the PYP, 1.31% in FPYP and 1.20% in SPYP. Comparison between the pandemic period and previous periods did not show a significant difference (p > 0.05). The overall incidence of SSNHL and combined acute cochlear-vestibular involvement was significantly higher during the PYP compared to the previous periods (p = 0.022).

CONCLUSIONS

There were no differences in the absolute number of acute audio-vestibular disorders during the pandemic compared to previous periods. Although not significant, the SSNHL during the pandemic appeared worse in terms of pure-tone average with a higher incidence of associated vestibular involvement. Further studies are needed to clarify the role of SARS-CoV-2 on audio-vestibular disorders incidence and pathophysiology.

Multi-professional Neurorehabilitation after Covid-19 Infection Should Include Assessment of Visual Function

•

Visual function should be considered when reviewing the rehabilitation needs of patients after COVID-19.

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The association between vision-related issues and coexisting symptoms with an effect on body function and activity and/or participation highlights the need for multiprofessional rehabilitation assessment and intervention after COVID-19.

Objective

To report vision-related symptoms and neuro-visual clinical signs in patients approximately 4 months after discharge from hospitalization after COVID-19 infection. To report on coexisting functional and activity limitations.

Design

The study is part of an ambidirectional population-based cohort study.

Setting

An outpatient setting in a hospital environment.

Participants

Patients from a population-based cohort study including all patients with laboratory-confirmed COVID-19 admitted to hospital during a 3-month period in a health care region in Sweden. Among patients who, based on a standardized telephone interview, were identified as having persisting rehabilitation needs 4 months after discharge (n=185), several (n=57) reported vision-related symptoms. All 57 patients were invited to a neuro-visual examination. Six patients declined, 6 were unavailable, and 3 did not fulfil the inclusion criteria. Thus, 42 patients were included in the analysis (N=42).

Interventions

Not applicable.

Main Outcome Measures

Vision-related symptoms, neuro-visual function, and coexisting impairments affecting activities of daily life and participation.

Results

A total of 31% of patients with rehabilitation needs after COVID-19 reported vision-related symptoms. Reading-related issues (73.8%), blurry vision (69.0%), and light sensitivity (66.7%) were the most common symptoms. Patients with reading-related issues showed a higher level of eye strain (P<.001). Neuro-visual deficits were found in 83.3% of the patients, mainly concerning eye teaming (23.1%-66.7%) and eye movement (28.6%-30.8%) functions. Patients with vision-related symptoms reported fatigue and 18 other coexisting symptoms to a greater extent (P≤.0001 to .049).

Conclusions

Neuro-visual symptoms and signs should be considered when assessing rehabilitation needs after COVID-19. The association between vision-related issues and coexisting symptoms with an effect on body function and activity and/or participation underlines the need for multiprofessional rehabilitation assessment and intervention.

New onset tinnitus in the absence of hearing changes following COVID-19 infection

BACKGROUND

A variety of neurosensory symptoms including tinnitus have been associated with COVID-19 infection. While most cases of tinnitus are associated with hearing loss, here we report a case of severe tinnitus following COVID-19 infection with normal thresholds through 8000 Hz.

CASE REPORT

A 49-year-old male presented with new onset severe tinnitus following COVID-19 infection. Tinnitus was bilateral, constant and nonpulsatile. Audiometric evaluation revealed normal threshold through 8000 Hz, with mild hearing loss at 16,000 Hz. Conservative measures including masking strategies failed to mitigate symptoms. A trial of gabapentin 300 mg twice per day improved tinnitus with no notable side effects.

CONCLUSION

This patient may represent a subpopulation of patients who suffer from severe tinnitus following COVID-19 infection in the setting of largely normal hearing. The pathophysiology may be distinct from the more common hearing loss associated tinnitus and perhaps neuromodulators may play a larger role in mitigating tinnitus in this patient subset.

In Search of a Neurotologic Profile in COVID-19 - A Study in Health Care Workers

Introduction COVID-19 is an emerging disease and the neurotologic symptoms are still not well understood. Furthermore, the development of a neurotological profile and its associated factors can help the clinician in the diagnosis and treatment of this disease. The objective is to determine the neurotologic manifestations experienced by COVID-19 positive health care workers and their associated factors. Methods A symptoms survey was administered to health care workers who were positive to COVID-19 from September to October 2020. An informed consent form was digitally signed and Google Forms software was used for the survey. Frequencies and percentages were used for categorical variables, and associated clinical features were reported with odds ratios. Results We included 209 COVID-19 positive health care workers, 55.5% (n = 116) were women, and 44.5% (n = 93) were men. Fifty-three percent of patients were 20 to 30 years old and 56.4% had at least one comorbidity. The prevalence of neurotological manifestations was 18.6% (n = 39/209), the most frequent symptoms were vertigo (61.5%, n = 24/39), tinnitus (43.5%, n = 17/39), imbalance (43.5%, n = 17/39), and one case of facial paralysis (2.5%, n = 1/39). Neurotological manifestations were associated predominantly with asthenia (p = 0.021), loss of smell (p = 0.002) and taste dysfunction (p = 0.002). Conclusion The most common neurotological manifestations were vertigo, tinnitus and imbalance. Clinical features associated with a neurotologic profile were asthenia, hyposmia and dysgeusia.

Labyrinthite post-vaccinale anti-COVID19 révélatrice d’une GPA

Introduction

Dans le contexte de la pandémie à SARS-CoV-2, des manifestations audio-vestibulaires post-infection à Covid-19 ont été rapportées [1]. Depuis l’apparition des vaccins, quelques cas d’atteinte de l’oreille interne survenus dans les 30 jours suivants la vaccination par vaccin à ARNm [2] sont également décrits. Nous présentons ici le cas unique d’une labyrinthite révélant une vascularite nécrosante à ANCA imputable au vaccin ChAdOx1 nCoV-19.

Observation

Une patiente de 67 ans, sans antécédent ORL connu, en rémission d’un cancer du sein BRCA2-muté, a présenté fin mars 2021 une otite moyenne aiguë compliquée en avril d’une labyrinthite bilatérale. Elle avait reçu une injection de vaccin ChAdOx1 nCoV-19 le 6 mars 2021. 3 lignes d’antibiotiques ont été administrés avant que le diagnostic de labyrinthite ne soit posé. L’otoscopie mettait en évidence des tympans inflammatoires et l’audiogramme une surdité mixte bilatérale. L’IRM des conduits auditifs internes montrait un épaississement non nodulaire mais rehaussé de la paroi latérale gauche du cavum le long de la fossette de Rosenmüller et du trajet tubaire associé à un comblement des pyramides pétreuses droite et gauche. Les biopsies profondes de l’oreille droite montraient une inflammation subaiguë sans granulome. Les analyses microbiologiques étaient stériles.

Devant l’apparition d’arthralgies inflammatoires des poignets et genoux et un amaigrissement de 3 kg, une maladie de système était suspectée. Elle était apyrétique et ne présentait pas d’autre signe ORL, ni de manifestations ophtalmologique, respiratoire ou neurologique. On observait une anémie inflammatoire (CRP à 39,6 mg/l) sans autre cytopénie, sans anomalie de la fonction rénale (dont protéinurie ou hématurie) ni des tests hépatiques. Les sérologies VIH, syphilis, borréliose étaient négatives. Les ANCA-PR3 étaient rendus positifs à un taux de 18 UI/ml et on trouvait un anticoagulant circulant de type lupique sans autre anti phospholipide. Les AAN étaient négatifs et l’exploration du complément normale. L’IRM cérébrale montrait quelques hypersignaux non spécifiques de la substance blanche supratentorielle. L’analyse du LCR ne décrivait pas de profil inflammatoire et les PCR virales VZV et HSV intrathécales étaient indétectables. Le scanner thoraco-abdomino-pelvien objectivait des micronodules pulmonaires. Le traitement a consisté en un assaut de corticoïdes IV relayé d’une corticothérapie orale à 1 mg/kg/j de prednisone suivi d’une décroissance progressive.

La patiente rapporte une disparition des otalgies et une amélioration de l’audition dès les premiers jours de traitement parallèlement à la normalisation du syndrome inflammatoire. L’hydrops tympanique a disparu et l’amélioration fonctionnelle a été documentée par l’audiogramme.

Discussion

La labyrinthite associée aux vascularites à ANCA est bien établie même s’il s’agit d’une manifestation peu fréquente dans le cadre de l’expression ORL de la granulomatose avec polyangéite. Le lien entre pathologie infectieuse et vascularite nécrosante systémique est souvent évoqué mais sans preuve directe [3]. Des réactions dysimmunitaires et inflammatoires ont été rapportées à la suite d’infections notamment virale ; et la pandémie COVID-19 a permis de rouvrir le débat sur le rôle immunogène de l’ARN virale. Avec plus de 3 milliards de personnes vaccinées pour le SARS-CoV2, ces manifestations dysimmunitaires constituent un pourcentage très faible d’effets indésirables qui semblent s’exprimer dans des conditions prédisposantes ou dans des populations particulières. Des cas de labyrinthite et de vascularites à ANCA ont été rapportées en lien avec une infection à Covid19. La pharmacovigilance rapporte 6 autres cas de labyrinthite en France et 373 dans le monde imputable à un vaccin anti-SARS-CoV2. On en compte un en France parmi les 118 rapportés dans le monde avec le vaccin ChAdOx1 nCoV-19. À notre connaissance, cette observation est la première à témoigner de l’association entre labyrinthite et vascularite à ANCA imputable au vaccin anti-SARS-CoV2.

Conclusion

La labyrinthite associée aux vascularites à ANCA-PR3 imputable au vaccin ChAdOx1 nCoV-19 est une manifestation exceptionnelle. Cette atteinte uniquement ORL a été de bon pronostic et semble corticosensible à l’image des vascularites nécrosantes à ANCA localisée à la sphère ORL.

Labyrinthitis: A Rare Consequence of COVID-19 Infection

Since the declaration of coronavirus disease 2019 (COVID-19) as a pandemic, it remains a widespread infection with a major impact on global resources and health infrastructure. The hallmark of COVID-19 continues to be the well-documented effects it has on the respiratory system. With the passage of time, the involvement of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in other systems has become more apparent, with the increased incidence of thromboembolic events, cardiac involvement as well as gastrointestinal and neurological symptoms secondary to the infection. Our case report demonstrates a presentation of vertigo, hearing loss, tinnitus, and aural fullness. Our patient was diagnosed as positive for COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) nine days prior to developing these symptoms. Her COVID-19 infection was otherwise relatively mild, for which she did not seek any medical intervention. A careful assessment ruled out cerebrovascular causes and led us to the diagnosis of SARS-CoV-2-induced labyrinthitis. Our patient was successfully treated as an outpatient without unnecessary investigations and responded well to standard therapy for viral labyrinthitis as per National Health Service (NHS) guidelines. She eventually reported having made a full recovery within three weeks of the initial encounter. Audio-vestibular consequences of COVID-19 are less reported compared to other symptoms of neurological involvement, such as gustatory or olfactory dysfunction, which have become key indicators aiding in the diagnosis of the infection. Among these disorders, the commonly reported presentation is that of vestibular neuronitis. Our case report demonstrates that labyrinthitis is also among the neurological manifestations to be considered as a result of COVID-19, which can be safely managed in the community with the same strategies as those employed for other viral triggers. It also reveals the need for further research into the effects that COVID-19 may have on the audio-vestibular system.