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

Respiratory illness brought on by a mutant coronavirus variant has unfold quickly worldwide. According to stories, the COVID-19 model propagated on the finish 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 [1]. The COVID-19 an infection would possibly seem with no signs, only a few signs, or extraordinarily extreme signs [2,3].

According to COVID-19’s latent interval, the signs might manifest 2-14 days after publicity [4]. Patients with COVID-19 generally expertise fever, coughing, exhaustion, gastrointestinal misery, and a lack of odor sensibility [5]. The aged and people with comorbidities are susceptible to illness and have unfavorable outcomes [6]. Patients with COVID-19 illness expertise varied outcomes; some totally get better from an infection with no need remedy, whereas others develop acute respiratory misery that necessitates admission to the intensive care unit [7].

Viral infections can lead to unilateral or bilateral listening to loss, ranging in severity from minor to profound [8]. The literature describes some pathophysiology for listening to loss, together with secondary to host inflammatory response and direct viral interior ear damage [9]. Typically, the listening to loss introduced on by viral an infection is sensorineural, whereas varied forms of listening to loss have been linked to sure viruses [10]. However, nasopharyngeal or throat swabs present that some COVID-19 sufferers have optimistic viral RNA although they’re asymptomatic [11]. It remains to be unknown if COVID-19 can have an effect on the auditory system, although many viruses have the potential to take action [11].

Sudden listening to impairment could be sensorineural or conducive. The latter situation is the sudden sensorineural listening to loss (SSNHL). SSNHL sufferers sometimes don’t have any identified trigger; nonetheless, malignancies of the cerebellopontine angle, vascular ailments, autoimmune issues, or viral infections have been implicated in some situations. More than 30 dB SNHL on greater than three frequencies concurrently for longer than three days meet the necessities to be thought of SSNHL [12]. However, scientific work and educational analysis take listening to loss ranges decrease than 30 dB into consideration [12]. SSNHL administration suggestions intention to search out and tackle any underlying causes. Steroid remedy might help in regaining listening to capability [12]. If the systemic technique will not be employed or for salvage remedy, steroids could be administered intra-tympanic or systemically.

We are the primary to determine SSNHL as a facet impact in COVID-19 sufferers who’ve totally recovered from the sickness. Additionally, all reported circumstances of this presentation have an unexplained unilateral left ear involvement. This article opinions the literature and 4 circumstances of COVID-19 sufferers with SSNHL.

We current 4 circumstances of COVID-19 positivity that have been verified by PCR evaluation of nasopharyngeal swabs. After totally recovering from the an infection, all victims developed acute sensorineural listening to loss on the left facet (Table 1).

Case 1

A 43-year-old male affected person will not be identified to have any continual sickness. The affected person needed to get a nasopharyngeal swab since they’d been near the COVID-19-positive affected person. PCR evaluation of the swab confirmed a optimistic consequence. He skilled chest ache, a cough, and a high-grade temperature whereas remoted at house. After whole therapeutic and the cessation of the signs talked about above, he skilled intermittent tinnitus in his left ear for a month. When he abruptly misplaced listening to on his left facet for a day, the affected person went to the physician. There was no historical past of current higher respiratory tract infections, fever, ear ache, or discharge. The affected person denied having ever had a continual ear situation, had ear surgical procedure, or used ototoxic medication. Systemic oral steroids (Prednisolone) have been administered to the affected person for one week at a dosage equal to 1 mg/kg of physique weight earlier than being progressively weaned off over the next week. Tinnitus and listening to loss remained unchanged.

The affected person then introduced his issues to the otology clinic. The examination of the throat, nostril, and ears revealed nothing distinctive. The Weber take a look at was lateralized to the correct ear utilizing a tuning fork with a frequency of 512 Hz, and the Rinne take a look at was optimistic in each ears. In each ears, tympanometry was sort A. The left ear’s sensorineural listening to loss was found by pure tone audiometry to be reasonable at low frequencies and gentle at excessive frequencies. On the opposite ear, the listening to thresholds have been inside regular ranges. After receiving two intratympanic injections of dexamethasone at a dose of 10 mg/mL separated by three days, the scenario improved. The tinnitus vanished, and the affected person’s left ear’s listening to totally returned to regular thresholds.

Case 2

A 40-year-old male affected person will not be identified to have any continual sickness. He skilled lethargy and fever, and a nasopharyngeal swab revealed a COVID-19 an infection. The affected person was instructed to remain in seclusion at house until his situation bought higher. He skilled fast left-side listening to loss with tinnitus and aural fullness two months after totally recovering from this an infection. No prior historical past of fever, ear ache, or an higher respiratory sickness in the course of the previous few weeks. The man denied having ever had continual ear situations, had ear surgical procedure, or taken ototoxic medication. The affected person had systemic oral steroid remedy (Prednisolone) for 5 days at a dose of 60 mg every day, adopted by a taper of 10 mg every day for an extra 5 days, however his listening to sense didn’t enhance. He arrived on the otology clinic complaining of those signs. Examining the ear, nostril, and throat revealed no irregular findings. The outcomes of the Weber take a look at have been lateralized to the correct ear, whereas the Rinne take a look at was optimistic in each ears. Tympanometry indicated bilateral sort A. Pure tone audiometry indicated regular listening to thresholds on the correct facet and mild-moderate sensorineural listening to impairment on the left. A 4 mg/mL intratympanic dexamethasone injection was out there as a type of remedy (three injections with three-day intervals between them). The affected person’s left ear recovered listening to to regular thresholds, whereas tinnitus and auditory fullness improved.

Case 3

A forty-four-year-old feminine affected person has no historical past of any continual illness. She is a physician specializing in obstetrics and gynecology and has shut relationships with some COVID-19-positive victims. The affected person underwent a nasopharyngeal swab for COVID-19 after complaining of complications, adjustments in style and odor, and a lack of listening to. After a optimistic pattern, the affected person was instructed to remain house in isolation till full restoration. She skilled sudden listening to loss on her left facet for 2 months. There was no historical past of fever, tinnitus, auditory fullness, ear discharge, or ear ache. The affected person had no historical past of ototoxic drug use, continual ear situations, or ear surgical procedure. She acquired remedy with a systemic oral steroid (Prednisolone), 60 mg orally every day for 5 days, adopted by a 10-mg every day lower over the next 5 days.

After that, she reported to the otology clinic that her left ear’s listening to had diminished. Complete ear, nostril, and throat exams revealed nothing uncommon. The Weber take a look at was lateralized to the correct ear, and Rinne’s take a look at was optimistic in each ears. Tympanometry was used to guage the listening to, and it discovered that each ears have been sort A. Except for a dip to 30 dB on 4k Hz, pure tone audiometry revealed regular listening to thresholds on the correct facet and gentle to reasonable sensorineural listening to impairment on the left facet. One intratympanic dexamethasone injection (10 mg/mL) was given to the affected person. She reported vital enchancment, and her left ear’s listening to thresholds had returned to regular ranges earlier than the an infection.

Case 4

A 35-year-old male affected person is thought to have hypertension, polycythemia vera, and obstructive sleep apnea. While returning to Saudi Arabia in the course of the COVID-19 epidemic, the affected person had a nasopharyngeal swab carried out. Despite the affected person’s denial of any signs on the time of the swab, the swab was detected as optimistic for COVID-19 by PCR. Without experiencing any COVID-19-related signs, the affected person completed a two-week isolation interval. He skilled a sudden listening to loss in his left ear for 2 days after two weeks of isolation. The affected person rejected the presence of any further otologic signs, a historical past of continual ear situations, previous ear surgical procedure, or utilization of ototoxic medication.

During the analysis, the Rinne take a look at was optimistic in each ears, and a tuning fork set to 512 Hz was used to lateralize the Weber take a look at to the correct ear. Tympanometry indicated sort A in each ears. Pure tone audiometry confirmed regular listening to thresholds on the correct facet and mild-moderate sensorineural listening to loss on the left facet. The affected person was given the choice of receiving an intra-tympanic dexamethasone injection resulting from his hypertension. At intervals of three days, sufferers acquired three 4 mg/mL injections. After the process, his left ear’s listening to ranges have been restored to regular.

Encephalitis, meningitis, demyelination, and Guillain-Barre syndrome are a number of of the neurologic signs linked to COVID-19 which were reported [13]. Additionally, extra circumstances of style and odor abnormalities have been noticed, elevating the chance that the COVID-19 virus has a direct neuropathic impact [13]. Potential neuropathic impacts on the vestibule-cochlear system may additionally happen [14]. A examine examined the outer hair cells of asymptomatic COVID-19 victims. The management group confirmed elevated high-frequency, pure-tone thresholds whereas transient evoked otoacoustic discharges have been remarkably diminished in COVID-19 sufferers.

However, updated, no particular remedy has been found but, and understanding of this virus can be restricted. Being conscious of the signs of COVID-19 will help in establishing an early analysis and restrict the illness’s unfold [15]. The ear, nostril, and throat (ENT) signs have been noticed in some COVID-19 victims, particularly youthful ladies [16]. In common, the signs of COVID-19 victims might contain fever, cough, fatigue, gastrointestinal upset, and lack of odor [17]. The impact of COVID-19 is a fascinating situation in audiology. An autopsic examine of the center ear and mastoid carried out on three cadavers of COVID-19-positive sufferers confirmed that two out of three sufferers had optimistic COVID-19 on the center ear swab. This discovering warrants a possible COVID-19 invading the center ear, and the potential of interior ear invasion can’t be dominated out. A full precaution is important in center ear surgical procedure because the virus might unfold to the well being care suppliers [18].

In the present investigation, we think about SSNHL as a late sequela of the COVID-19 virus. According to the literature examine, solely a small variety of folks with COVID-19 sickness developed SSNHL (Table 2). After totally recovering from the illness and its well-known repercussions, none of those sufferers skilled SSNHL. The first preliminary case of COVID-19 illness was reported in a senior feminine affected person in Thailand, and there was no enchancment in her listening to [19]. Sensorineural listening to loss in each ears in a affected person hospitalized within the intensive care unit (ICU) with extreme respiratory COVID-19 an infection [20]. The affected person was given two ototoxic medication within the ICU. However, not all of the sufferers within the present sequence got them. A case of SSNHL was identified in a COVID-19 affected person in Turkey by Kilic et al. [21]. The affected person had an entire listening to decision on day 11 with out steroid administration, although the listening to was assessed by cellphone because the affected person was in isolation. Another case reported in Egypt was a male affected person with a optimistic COVID-19 take a look at. On day 3, the affected person complained of left-side listening to loss. The audiometric take a look at revealed vital SSNHL. The affected person didn’t utterly get better his listening to regardless of receiving the intratympanic steroidal injection. An grownup affected person with COVID-19 was just lately hospitalized within the ICU and required 30-day intubation in a case reported within the UK [22]. The affected person reported left-side listening to loss and tinnitus every week after being extubated. Despite receiving intratympanic steroid injections and oral steroids, the affected person’s PTA indicated left-side SHL [23].

All 4 circumstances on this case sequence are left-sided SSNHLs that developed after full restoration from COVID-19 an infection. The severity of the listening to loss ranged from gentle to extreme, and there was no clear gender predominance. Two out of 4 circumstances had different otological signs. There isn’t any clarification within the literature for why the left ear was bothered in each case reported on this sequence. The remedy with intratympanic dexamethasone injections produced excellent ends in all 4 described circumstances. Dexamethasone was utilized in 4 or 10 mcg/mL concentrations, relying on what was out there. Less frequent injections of upper concentrations of dexamethasone have been wanted to deal with the sufferers. There have been no unwanted effects from dexamethasone injections administered intratympanically.

A deterioration within the listening to means amongst COVID-19 survivors makes it potential that the issue persists lengthy after their restoration from an infection. To help such a declare, further in-depth analysis is required. The present examine, in our opinion, will contribute to a rise in understanding about COVID-19, promote consciousness, and alert healthcare professionals to take into consideration and talk about any signs.