ABSTRACT
Background: Several viral infections may lead to hearing loss. It>s still unknown whether COVID-19 has effects on the auditory system or not. In this regard, to evaluate the possibility of sudden sensorineural hearing loss due to COVID-19, this study aimed to report sudden sensorineural hearing loss (SSNHL) in patients with COVID-19 in Iran. Case Report: The patient was a 7-year-old girl diagnosed with COVID-19 and sensorineural hearing loss. An audiogram revealed normal hearing in the right ear and severe sensorineural hearing loss in the left ear. The tympanometry test result was bilateral type A. The treatment started with prednisolone (1 mg/kg/d). The audiogram of follow-up pure-tone audiometry did not reveal any improvement. Conclusion(s): SSNHL appears to be a possible complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. COVID-19 infection could have deleterious effects on cochlear hair cells and eight nerve functions. Therefore, audiological monitoring should be initiated in patients presenting with COVID-19.Copyright © 2023 The Author(s);Published by Kerman University of Medical Sciences.
ABSTRACT
Lateral skull base paragangliomas (glomus tumors) are rare skull base tumors arising from neuroendocrine cells. These benign tumors can be locally aggressive with potential for intracranial extension and significant morbidity as they compromise cranial nerve structures. Treatment is highly patient dependent. Herein, we present a case of recurrent glomus vagale paraganglioma requiring a multidisciplinary transjugular and transcervical approach for complete resection. A 64-year-old male was referred to the neurotology clinic in 2019 for a left skull base tumor causing progressive dysphonia and dysphagia. Exam revealed left true vocal fold weakness and no other abnormalities. Hearing was normal on the left. Magnetic resonance imaging (MRI) revealed a large hyperintense lesion of the left jugular foramen with intracranial cerebellopontine angle extension and normal flow through the sigmoid sinus and jugular vein. The patient elected for surgical removal and near-total resection was achieved via retrosigmoid craniotomy. A small portion was intentionally left in the jugular foramen to preserve the intact eleventh cranial nerve, internal jugular vein, and sigmoid sinus. Surgical pathology confirmed glomus paraganglioma. Postoperative radiation was strongly recommended, but the patient was lost to follow-up due to the COVID-19 pandemic. The patient re-presented in late 2021 with worsened dysphonia and dysphagia. Exam confirmed left true vocal fold immobility consistent with vagal nerve paralysis and a new finding of left tongue weakness consistent with hypoglossal nerve injury. MRI revealed recurrence of the lesion to dimensions larger than original presentation and complete occlusion of the sigmoid-jugular system. Hearing and facial nerve function remained fully intact, thus a transjugular approach with hearing preservation and complete surgical resection was utilized. After combined retrosigmoid and transcervical incision, the transjugular approach was utilized to resect the sigmoid sinus, the tumor of the jugular foramen, and the intracranial extension. The ear canal and facial nerve canal were preserved. The sigmoid sinus was ligated with surgical clips and the jugular vein was ligated with suture thread. Intracranially, the hypoglossal nerve was identified and preserved, and the vagus nerve was seen eroded by tumor. Pathology confirmed recurrent paraganglioma. Postoperatively, the patient recovered well but continues to endorse persistent dysphonia. His treatment plan includes radiation and thyroplasty. Multiple surgical approaches for the treatment of skull base paragangliomas have been reported including infratemporal types A to D, among others. This report identifies a rare case of recurrent paraganglioma which necessitated removal via transjugular approach. While uncommon in skull base surgery, this approach allowed identification and preservation of important neck and skull base structures (e.g., facial nerve, ear canal, spinal accessory nerve) while achieving complete gross resection. Radiation techniques have become popular alternatives for treatment of glomus tumors of the skull base due to high levels of surgery-related adverse events. Thus, skull base surgeons should be aware of the utility of the transjugular surgical technique for patients with intact hearing and facial nerve function who seek removal of intracranial jugular foramen tumors.
ABSTRACT
Introduction: Although some studies have recently reported an association between coronavirus disease 2019 (COVID-19) vaccination and Bell's palsy (BP), a clear causal relationship has not been elucidated. Moreover, the clinical characteristics of BP after COVID-19 vaccination have not yet been studied. In the present study, we investigated the risk and clinical characteristics of BP following COVID-19 vaccination. Method(s): This retrospective chart review study had two parts. Part 1 evaluated the association between COVID-19 vaccination and BP by comparing the overall number of patients first diagnosed with BP during the pre-COVID-19 vaccination period (March 2018 to February 2019, March 2019 to February 2020 and March 2020 to February 2021) and the COVID-19 mass vaccination period (March 2021 to February 2022). Part 2 compared clinical characteristics between vaccine-related (time interval between vaccination and BP onset <42) and unrelated patients (time interval >=42 days or non-vaccination) with only newly diagnosed BP patients during the COVID-19 vaccination period. Result(s): Part 1 of this study found a higher occurrence of BP in the COVID-19 mass vaccination period compared to the previous 3 pre-vaccination years. In the part 2 study, we identified 13 patients who developed BP within 42 days of COVID-19 vaccination during the study period. All patients except one developed BP after receiving mRNA-based COVID-19 vaccines. Most cases (9/13;69.2%) occurred after the second or third vaccination dose. Thirteen patients with COVID-19 vaccine-related BP were younger (43.92 +/- 13.14 vs 54.32 +/- 16.01;p = 0.033) and more frequently accompanied by taste changes (58.8% vs 10.9%;p=0.002) compared to 52 cases of vaccine-unrelated BP. Compared with vaccine-unrelated BP, patients with vaccine-related BP had a greater likelihood of good recovery of facial nerve function (100% vs 78%) with a faster time to recovery (p = 0.042). Conclusion(s): This study suggests that COVID-19 vaccines, especially mRNA-based ones, may be associated with BP with distinctive clinical characteristics, which occur more frequently in young individuals, are frequently accompanied by taste changes, and have a fast and good recovery. Copyright © 2022