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Objectives: Since its first appearance in Wuhan December 2019, SARS-CoV2 virus received great attention due to its severe symptoms and high spread causing COVID-19 disease which spread all over the world like a pandemic. The causative virus is capable of human-to-human transmission via droplet and direct contact suggesting that upper respiratory tract is the main site to virus manifestations. There is a great diversity in its clinical picture, although the severe respiratory and neurological symptoms are commonly present;however, other symptoms are present. Although otological manifestations are reported in many COVID-19 patients even in asymptomatic cases, they did not receive much attention compared with other critical manifestations. In this article, we paid our attention specifically to the otological manifestations of COVID-19 and their relevance either to the virus infection, treatment, or vaccination through literature review. Conclusion(s): COVID-19 disease has a deleterious effect on the inner ear. This effect is not only due to SARS-Cov-2 infection, but it could be also due to the ototoxic drugs used for treatment. The COVID-19 vaccinations are found to be implicated in the otological symptoms in some cases.Copyright © 2022, The Author(s).
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Background: COVID-19 is the new version of the old coronavirus known since 1960, which caused the Middle East respiratory syndrome (MERS-CoV) in 2012 and the severe acute respiratory syndrome (SARS) in 2003. Symptoms included fever and cough, diarrhea and vomiting, and neurological symptoms like anosmia. Method(s): One hundred twenty-eight patients diagnosed as COVID-19 with audio-vestibular complaints were subjected to audio-vestibular assessment and were included in the study. Result(s): In our study on COVID-19 patients who reported audio-vestibular complaints, hearing loss was found in 43.8% of patients in comparison to vertigo that represented 40.6% of cases. The most common type was sensorineural hearing loss representing 29.7% of patients and which was unilateral and sudden in 35.7% of them. Less commonly conductive hearing loss (CHL) was found in 14.1% of cases the most common form was bilateral mild to moderate CHL (83.3%) due to bilateral middle ear effusion. Among cases with vertigo, the most common etiology was benign paroxysmal positional vertigo (BPPV) (42.5%) then uncompensated vestibular neuritis (VN) (31.5%), and lastly, combined BPPV with VN (25%) of cases. Less frequently we found tinnitus in (13.3%) which was bilateral in (64.7%), labyrinthitis (5.5%), and acute VN 5.5%). The significant increase in the number of audiovestibular complaining cases that were observed in the course of the recurrent waves' peaks pushed us to study the relationship between the pandemic and the audiovestibular system. The effect of COVID on AV systems is well noticed and management would be mandatory.Copyright © 2022, The Author(s).
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Introduction: Reports of vestibular syndrome have been associated with COVID vaccination in the recent literature. In this study, we aimed to evaluate the association between COVID-19 vaccines and vestibular disorders using Vigibase®, the WHO pharmacovigilance database. Material and methods: On January 5th, 2022, we extracted in a deduplicated dataset of VigiBase® reports of vestibular disorders for tozinameran (Pfizer®), elasomeran (Moderna®), Ad26.COV2.S (Janssen®) and ChadOx1nCov-19 (Astra-Zeneca®), using MedDRA preferred terms neuronitis vestibular, acute vestibular syndrome, vestibular disorder and the low level term vestibular vertigo. Seriousness was analyzed and reported odds ratio (ROR) were calculated. We also reviewed the management of COVID-vaccine associated vestibular disorders reported in Caen Regional Pharmacovigilance Center. Results: In Vigibase®, 226 reports of vestibular disorders were found for ChadOx1nCov-19, 40 for Ad26.COV2.S, 254 for elasomeran and 1,050 for tozinameran. The ROR were respectively 2.5 (2.2-2.8), 2.5 (1.8-3.2), 3.6 (3.2-4.0) and 7.0 (6.6-7.4). Reports were considered serious in 74.3% for ChadOx1nCov-19, 70.0% for Ad26.COV2.S, 60.6% for elasomeran and 56.01% for tozinameran. Finally, we collected 13 reports of COVID-19 vaccines associated vestibular disorders in our pharmacovigilance center. Concerning the management of those vestibular disorders, 4 patients received antiemetics, 1 received betahistine, 7 received acetylleucine, 2 received corticoids and 6 had vestibular physiotherapy sessions. After 1 month of follow-up, only one patient had recovered. Discussion/Conclusion: The Vigibase® analysis showed a statistically significant association between the 4 COVID-19 vaccines under study and vestibular disorders. Short-term anticholinergics, antiemetics, antihistamines or benzodiazepines, and a corticosteroid burst with rapid taper as well as vestibular rehabilitation are usually recommended treatments. In our case series we noticed the long duration of the symptoms despite the treatments received and the heterogeneity of the adopted therapeutic strategy. Physicians should be aware and careful of the potential association of COVID-19 vaccines and vestibular disorders. Management guidelines are needed given the wide exposure to COVID-19 vaccines.
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Introduction Symptoms and severity of SARS-CoV-2 infection vary greatly. Dizziness is a frequently reported symptom of SARS-CoV-2 viral infection. However, the extent to which this symptom is a result of the effect of SARS-CoV-2 on the vestibular system remains unclear. Material & methods In the present single-centre study, 50 patients with a previous SARS-CoV-2 infection underwent a vestibular assessment consisting of dizziness handicap inventory to assess dizziness during and after infection, clinical examination, video head impulse test and subjective visual vertical test (SVV). When SVV was abnormal, vestibular evoked myogenic potentials were performed. In addition, 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 was performed. Results During and after the SARS-CoV-2 infection, women were significantly more likely to suffer from dizziness than men. A significantly reduced semicircular canal or otolith function was not observed in either women or men. Acute SARS-CoV-2 infection was diagnosed in three patients who presented to with acute vestibular syndrome. One of the patients exhibited acute peripheral unilateral vestibulopathy upon diagnosis. A different patient was diagnosed with vestibular migraine and another with a posterior inferior cerebellar artery infarct. Conclusion Past SARS-CoV-2 infection does not usually lead to a hypofunction of the vestibular organs. However, individual patients with acute infection have been reported to show symptoms of acute vestibular syndrome. Although the underlying pathomechanism has not yet been elucidated, SARS-CoV-2-induced neuropathy or ischemia should be considered in the differential diagnosis.
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Currently, patients who attribute their complaints and disorders to the past COVID-19 are turning to a neurologist for a consultation. One should consider dangerous complications of COVID-19 such as stroke, including cerebral venous thrombosis, autoimmune encephalitis and myelitis, posterior reversible encephalopathy syndrome, Guillain-Barre' syndrome. Disorders of consciousness, disorders of smell and taste, headache and dizziness are significantly more often present in the acute period of COVID-19. Long-term persistence of complaints and disorders after COVID-19 is regarded as post-COVID syndrome (PCS). Neurological complaints and disorders in a patient who has had COVID-19 are often caused by the development or exacerbation of a comorbid disease, including primary headache, musculoskeletal pain in the neck and back, various vestibular disorders, Alzheimer's disease, anxiety and depressive disorders. Unfortunately, in real clinical practice, these diseases are often not diagnosed, patients are observed with a diagnosis of PCS, and it is not taken into account that the basis for diagnosing PCS is the exclusion of other diseases that can explain complaints and disorders in a patient who has suffered from COVID-19.
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Objective: NA Introduction: Vertigo is an unusual presentation of COVID infection about which there have been only a few case reports focusing on peripheral vestibular dysfunctions. Accumulation of clinical experiences is needed to improve our knowledge and clinical practice. We report a recent encounter with predominant and persistent vestibular symptoms from COVID-19 infection. Design/Methods: NA Case Presentation: A 31 y/o otherwise healthy male suffered rapidly onset severe non-positional vertigo, disequilibrium, and nystagmus associated with nausea and vomiting, which were followed in a few hours with high fever, diarrhea, and generalized fatigue. He and his wife were then both tested positive for SARS CoV-2 by PCR. He denied having other common COVID-19 symptoms. All his systemic symptoms resolved in 2 weeks after treatments. However, he remained having persistent severe and subjectively progressive vertigo and disequilibrium upon the first office encounter 2 months later. Symptoms were enhanced by head pitching and were reduced by maintaining head stationary in supine position with eyes closed. Examination was unremarkable except the findings of slight left-sided peripheral vestibular weakness and mild deviation with Fukuda stepping. Further vestibular studies showed normal water caloric irrigation, impaired vertical gaze holding, abnormal subjective visual vertical testing, and delayed bilateral vestibular evoked myogenic potentials. COVID-19 infection-related peripheral and central vestibular complications were suspected. The patient was referred to vestibular rehabilitation. Discussion: COVID-19 virus is known to cause acute and long-term injuries of peripheral and central nervous systems. Although uncommon, COVID-19 infection can present with acute vestibular symptoms. Like the other reports, our case showed no profound peripheral vestibular losses after recovery from acute COVID-19 infection. However, his debilitating vestibular discomforts have persisted long after the recovery. Our observations suggest that the mechanisms for COVID-19-related vestibular dysfunctions are more complicated and may involve both peripheral and central vestibular systems.
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Objective: To explore the underlying reasons of dizziness experienced by patients after having the COVID-19 infections or vaccinations. Background: At our dizziness center, we saw a spike of dizziness consults after patients were diagnosed with COVID-19 infections or received COVID-19 vaccinations. The symptoms included dizziness, vertigo, and imbalance. This study aims to examine if the infection, vaccination, or antibodies from such could be the reason for the dizziness complaints or if other factors explain patients' dizziness. Design/Methods: Patients were identified using a combination of retrospective chart review to identify patients with diagnoses of dizziness, COVID-19, and COVID-19 vaccinations from our database, coupled with referrals from ongoing clinical consultations who we believed to exhibit dizziness symptoms related to their COVID-19 infections or vaccinations within four weeks of dizziness onset. Patients all had brain MRI and extensive vestibular testing, including: VNG, Rotary Chair, audiograms, and consultation with an experienced neuro-otologist. Results: Of the 40 patients examined, 20 began experiencing dizziness after testing positive for COVID-19 and 20 reported dizziness after receiving the vaccines. All patients had brain MRI, but no MRI findings indicated inflammatory changes from infections or antibody reactions. Only five of 40 patients had abnormal VNG indications of uncompensated peripheral vestibulopathy which could be related to virus infections or antibody reactions. Thirty out of 40 patients had histories of anxiety, depression, other mood disorders, or family histories of mood disorders. Based on the clinical history and examinations, along with MRI findings and comprehensive vestibular testing, 75% of the 40 patients had diagnoses of persistent perceptual positional vertigo (PPPV), which was most likely related to patients' underlying anxiety, depression, or mood disorders. Conclusions: We believe that the COVID-19 infections or vaccinations may trigger PPPV as stressors, but mostly not due to the virus infections or its antibody reactions.