Audio-vestibular system injury in coronavirus disease 2019

ABSTRACT

Coronavirus disease 2019 is a pandemic disease, which commonly presents with fatigue, loss of smell, fever and ground-glass opacities on diagnostic imaging of the lungs. After the first few months of the pandemic, we noticed a tendency for audio-vestibular complaints on out-patient visits post-hospitalization for COVID-19. Objective. The aim of this study was to study the prevalence of audio-vestibular complaints in COVID-19. Materials and methods. This study included 57 patients with audio-vestibular complaints during and after hospitalization for COVID-19 at University Hospital Kaspela in Plovdiv, Bulgaria. The patients underwent both auditory and vestibular tests, as well as a computed tomography of the cranial brain. Results. The ratio of males to females was 1,351, with most belonging to the age group of 51 to 70 years (63,2%). All 57 patients had sudden hearing loss - unilateral in 36 (63,2%) and bilateral in 21 (36,8%), while 17 patients (29.8%) additionally had subjective tinnitus. Forty-eight patients (84,2%) had vestibular complaints - general dizziness in 46 (95,8%) and rotatory vertigo in two (4,2%). Two patients had spontaneous nystagmus (3,5%), 43 (75,4%) - saccades, and 25 (43,9%) - smooth pursuit and gaze disturbances. Romberg with closed eyes was positive in two patients (3,5%), and Fukuda lateralized to the healthy ear also in two patients (3,5%). Dix-Hallpike was positive in one patient (1,8%). The video head-impulse test was positive in two patients (3,5%). Vascular encephalopathy was found on computed tomography in 33 patients (57,9%). Conclusions. Coronavirus disease 2019 may be associated with vestibulocochlear nerve damage, and in most cases, it is an isolated injury to the auditory nerve. Complaints of dizziness are most likely due to vascular changes in the central nervous system.