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1.
Stroke Vasc Neurol ; 7(2): 172-175, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1832555

ABSTRACT

BACKGROUND: Acute vestibular syndrome (AVS) features continuous dizziness and may result from a benign inner ear disorder or stroke. The head impulse-nystagmus-test of skew (HINTS) bedside assessment is more sensitive than brain MRI in identifying stroke as the cause of AVS within the first 24 hours. Clinicians' perspectives of the test in UK secondary care remains unknown. Here, we explore front-line clinicians' perspectives of use of the HINTS for the diagnosis of AVS. METHODS: Clinicians from two large UK hospitals who assess AVS patients completed a short online survey, newly designed with closed and open questions. RESULTS: Almost half of 73 total responders reported limited (n=33), or no experience (n=19), reflected in low rates of use of HINTS (n=31). While recognising the potential utility of HINTS, many reported concerns about subjectivity, need for specialist skills and poor patient compliance. No clinicians reported high levels of confidence in performing HINTS, with 98% identifying training needs. A lack of formalised training was associated with onward specialist referrals and neuroimaging (p=0.044). CONCLUSIONS: Although the low sample size in this study limits the generalisability of findings to wider sites, our preliminary data identified barriers to the application of the HINTS in AVS patients and training needs to improve rapid, cost-effective and accurate clinical diagnosis of stroke presenting with vertigo.


Subject(s)
Nystagmus, Pathologic , Stroke , Acute Disease , Head Impulse Test , Humans , Nausea , Nystagmus, Pathologic/complications , Nystagmus, Pathologic/diagnosis , Stroke/diagnosis , United Kingdom , Vertigo/diagnosis , Vertigo/etiology , Vomiting
2.
J Pak Med Assoc ; 72(2): 354-356, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1761742

ABSTRACT

In the present era of the coronavirus 2019 (COVID-19) pandemic, it has been observed that the severe acute respiratory syndrome, coronavirus 2 (SARS-CoV-2) infection does not only affect the respiratory tract, but also triggers various neurological symptoms in one-third of patients. The most prominent of such symptoms is anosmia, which is independent of rhinologic symptoms such as nasal obstruction, discharge, and pain that cannot be otherwise explained. Vestibular neuronitis ranks third among the causes of peripheral vestibular vertigo, characterized by nausea, vomiting, and dizziness that develops within minutes or hours. Although the etiopathogenesis remains poorly known, neuronitis is generally considered to be attributable to the viral or post-viral inflammation of the vestibular branch of the eighth cranial nerve. This report presents a case of vestibular neuronitis, which is likely to be a manifestation of acute vestibular neuronitis associated with COVID-19.


Subject(s)
COVID-19 , Vestibular Neuronitis , Adult , COVID-19/complications , Dizziness/etiology , Humans , Male , SARS-CoV-2 , Vertigo/diagnosis , Vertigo/etiology , Vestibular Neuronitis/complications , Vestibular Neuronitis/diagnosis
3.
ACS Chem Neurosci ; 12(23): 4368-4370, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1517590

ABSTRACT

COVID-19 has been shown to affect the ear and has led to hearing deficits, tinnitus, and vertigo. Very little is known regarding the mechanisms and targets of SARS-CoV-2 that cause the above symptoms. Anatomical extensions from the areas of viral loads to the middle ear appear to enable the SARS-CoV-2 to cause either an inflammatory response or a direct effect on the lining epithelium leading to temporary hearing and equilibrium-related symptoms in COVID-19. Herein the anatomical continuity from the areas of viral loads to the middle and internal ear is debated to uncover the possible covert routes used by SARS-CoV-2 to affect the hearing and equilibrium in COVID-19.


Subject(s)
COVID-19 , Tinnitus , Hearing , Humans , SARS-CoV-2 , Tinnitus/etiology , Vertigo/etiology
4.
Med Pr ; 72(3): 321-325, 2021 Jun 30.
Article in Polish | MEDLINE | ID: covidwho-1413233

ABSTRACT

In 2019, COVID-19, the disease caused by the SARS-CoV-2 virus, evolved into a pandemic which is still going on. The basic clinical symptoms of the SARS-CoV-2 infection are: fever, dry cough, fatigue, muscle pain, respiratory problems, and the loss of smell or taste. Other symptoms, including those related to hearing and balance organs (hearing loss, tinnitus, dizziness), are reported less frequently by patients. They are especially rarely reported as the first symptoms of this infection. In order to answer the question of whether SARS-CoV-2 can cause hearing and balance damage, the authors reviewed the literature sources from 2019-2020 included in EMBASE and PubMed, entering the following words: "hearing loss," "COVID-19," "coronavirus," "sensorineural hearing loss," "vertigo," and "dizziness." Ultimately, 9 studies on the possible relationship between hearing impairment and SARS-CoV-2, and 4 studies on the possible relationship between damage to the balance and SARS-CoV-2, were qualified for the study. The results of the analysis suggest a possible relationship between COVID-19 and hearing loss, with no evidence of a similar relationship between this virus and the balance system. The possible existence of such a relationship should be especially remembered by hospital emergency room doctors, otolaryngologists and audiologists, especially as regards the possibility of a sudden sensironeural hearing loss as the first symptom of COVID-19. This also applies to doctors of other specialties. The authors indicate the need for further, intensive and multifaceted research on this issue. Med Pr. 2021;72(3):321-5.


Subject(s)
COVID-19/complications , Hearing Disorders/etiology , Hearing , Postural Balance , Vestibular Diseases/etiology , Adult , COVID-19/epidemiology , COVID-19/physiopathology , Female , Hearing Loss/etiology , Humans , Male , Middle Aged , Tinnitus/etiology , Vertigo/etiology , Young Adult
5.
Auris Nasus Larynx ; 49(2): 291-298, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1401171

ABSTRACT

OBJECTIVE: To answer the question whether balance related systems have been affected in adults who recovered from Covid-19 disease. This is the first case-control study to assess balance objectively and quantitatively in Covid-19 disease. METHODS: Thirty-seven patients who recovered from Covid-19 disease and 30 healthy controls were compared using Dizziness Handicap Inventory (DHI), Computerized Dynamic Posturography (CDP), Vestibular Evoked Myogenic Potentials(VEMP) and Video Head Impulse Test (v-HIT). RESULTS: On CDP, the composite and visual general scores of the patients were significantly lower than controls (p<0.01). The v-HIT gains of the patients significantly decreased in the vertical semicircular canals compared to controls (p<0.01).There was a significant difference between the patients and controls regarding the absence of o-VEMPs (p<0.01) while the amplitudes and latencies were similar between the groups (p>0.05). Decreased P1/N1 amplitudes and elongated N1 latencies were found on c-VEMP testing (p<0.05). Anosmia, taste disorder and gender were not associated with subjective and objective test results (p>0.05). CONCLUSION: The Covid-19 disease can cause dizziness rather that incapacitating vertigo. Dizziness can be seen in almost one-fifth of the adult covid19 out-patients, which may be due to involvement of vestibular and visual systems,ortheir central connections. The squeals created in the balance related systems may be irreversible as they have persisted after the recovery of the patients. It is also plausible to anticipate more severe condition in the older patients who were treated in the intensive care units. In the long term follow up of the survivors, the need for balance rehabilitation programs should be remembered in order to minimize risks of falling down.


Subject(s)
COVID-19 , Vestibular Evoked Myogenic Potentials , Adult , Case-Control Studies , Dizziness/etiology , Humans , Postural Balance/physiology , Vertigo/etiology , Vestibular Evoked Myogenic Potentials/physiology
6.
Med Pr ; 72(3): 321-325, 2021 Jun 30.
Article in Polish | MEDLINE | ID: covidwho-1175785

ABSTRACT

In 2019, COVID-19, the disease caused by the SARS-CoV-2 virus, evolved into a pandemic which is still going on. The basic clinical symptoms of the SARS-CoV-2 infection are: fever, dry cough, fatigue, muscle pain, respiratory problems, and the loss of smell or taste. Other symptoms, including those related to hearing and balance organs (hearing loss, tinnitus, dizziness), are reported less frequently by patients. They are especially rarely reported as the first symptoms of this infection. In order to answer the question of whether SARS-CoV-2 can cause hearing and balance damage, the authors reviewed the literature sources from 2019-2020 included in EMBASE and PubMed, entering the following words: "hearing loss," "COVID-19," "coronavirus," "sensorineural hearing loss," "vertigo," and "dizziness." Ultimately, 9 studies on the possible relationship between hearing impairment and SARS-CoV-2, and 4 studies on the possible relationship between damage to the balance and SARS-CoV-2, were qualified for the study. The results of the analysis suggest a possible relationship between COVID-19 and hearing loss, with no evidence of a similar relationship between this virus and the balance system. The possible existence of such a relationship should be especially remembered by hospital emergency room doctors, otolaryngologists and audiologists, especially as regards the possibility of a sudden sensironeural hearing loss as the first symptom of COVID-19. This also applies to doctors of other specialties. The authors indicate the need for further, intensive and multifaceted research on this issue. Med Pr. 2021;72(3):321-5.


Subject(s)
COVID-19/complications , Hearing Disorders/etiology , Hearing , Postural Balance , Vestibular Diseases/etiology , Adult , COVID-19/epidemiology , COVID-19/physiopathology , Female , Hearing Loss/etiology , Humans , Male , Middle Aged , Tinnitus/etiology , Vertigo/etiology , Young Adult
7.
J Vestib Res ; 31(5): 381-387, 2021.
Article in English | MEDLINE | ID: covidwho-1081662

ABSTRACT

BACKGROUND: since the beginning of COVID-19 outbreak a growing number of symptoms and deficits associated with the new pathology have emerged, among them cochlear damage in otherwise asymptomatic COVID-19 patients has been described. OBJECTIVE: to investigate general and audiovestibular symptoms and sequelae in healed patients, and to seek for any sign of residual or permanent hearing or vestibular loss. METHODS: we reviewed the data coming from 48 Covid-19 patients whose nasopharyngeal swabs have turned negative, all employed at our facility, that opted in for a free screening of audiovestibular symptoms offered by our hospital after the aforementioned report was published. The screening included a tonal pure tone audiometry, a vHIT and SHIMP test, as well as a survey including known symptoms and audiovestibular symptoms. RESULTS: general symptoms as reported by our patients largely reflect what reported by others in the literature. 4 (8.3%) patients reported hearing loss, 2 (4.2%) tinnitus, 4 dizziness (8.3%), 1 spinning vertigo (2%), 1 dynamic imbalance (2%), 3 static imbalance (6.3%). Most audiovestibular symptoms have regressed. Thresholds at pure tone audiometry and vHIT gain were within normality range in all post-Covid-19 patients. CONCLUSIONS: even if some patients suffer from audiovestibular symptoms, these are mostly transitory and there is no clear evidence of clinically relevant persistent cochlear or vestibular damage after recovery.


Subject(s)
COVID-19 , Hearing Loss, Sensorineural , Audiometry, Pure-Tone , Humans , SARS-CoV-2 , Vertigo/diagnosis , Vertigo/etiology
8.
BMJ Case Rep ; 14(1)2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1020901

ABSTRACT

A 19-year-old man was admitted with a 2-week history of continuous cough along with a day history of acute onset unsteadiness and hiccups. Given the current pandemic, he was initially suspected to have COVID-19, however he tested negative on two occasions. Subsequent brain magnetic resonance imaging (MRI)confirmed a small left acute and subacute lateral medullary infarction with chest X-ray suggesting aspiration pneumonia with right lower lobe collapse. This is a distinctive case of posterior circulation stroke presenting with a new continuous cough in this era of COVID-19 pandemic. We anticipate based on MRI findings that his persistent cough was likely due to silent aspiration from dysphagia because of the subacute medullary infarction. It is therefore imperative that healthcare workers evaluate people who present with new continuous cough thoroughly to exclude any other sinister pathology. We should also be familiar with the possible presentations of posterior circulation stroke in this pandemic era.


Subject(s)
COVID-19/diagnosis , Cough/physiopathology , Hiccup/physiopathology , Lateral Medullary Syndrome/diagnostic imaging , Pneumonia, Aspiration/diagnostic imaging , Sensation Disorders/physiopathology , Vertigo/physiopathology , Cough/etiology , Diagnosis, Differential , Diffusion Magnetic Resonance Imaging , Hiccup/etiology , Humans , Lateral Medullary Syndrome/complications , Lateral Medullary Syndrome/physiopathology , Magnetic Resonance Imaging , Male , Pneumonia, Aspiration/etiology , Postural Balance , SARS-CoV-2 , Sensation Disorders/etiology , Vertigo/etiology , Young Adult
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