Auditory and Vestibular Findings in Brazilian Adults Affected by COVID-19: An Exploratory Study

Abstract

<b><i>Introduction:</i></b> The aim of the study was to describe auditory and vestibular findings in Brazilian adults after COVID-19 in a municipality from the outskirts of the São Paulo state. <b><i>Methods:</i></b> This was a transversal and exploratory study comprising sixteen participants infected by the SARS-CoV-2 virus, confirmed through RT-PCR detection, aged 20 to 55 years. Subjects underwent anamnesis, vestibular and auditory testing. Fisher’s exact test was used to evaluate medication use, chemical and physical exposure, and occupational risk and McNemar test was used to compare auditory and vestibular symptoms pre- and post-COVID-19. <b><i>Results:</i></b> Most patients were women (75%) and had been exposed to the virus over 90 days before testing (50%). 18.8% used hydroxychloroquine, 68.8% used ivermectin, and 87.5% used azithromycin to treat COVID-19. Auditory complaints were reported by 31.2% and vestibular by 18.7%. There was no statistical difference before and after the disease. Other reported symptomatology was hair loss, pain, fatigue, memory loss, difficulty to concentrate, and headache. Auditory findings were relevant in contralateral acoustic reflex, in the distortion-product otoacoustic emissions, and in the brainstem auditory evoked potential, characterizing a neurosensorial compromise. 43.74% of patients had altered vectonystagmography. When comparing both ears, no statistical relevance was found; however, when results were crossed with medication use and exposures, there was statistical relevance in the amplitude of the V wave for medications and absolute latency of the V wave to exposure to physical agents. <b><i>Discussion/Conclusion:</i></b> This study demonstrated auditory and vestibular findings of neurosensorial nature, considering hearing and of a peripheral vestibulopathy. As it is a study of transversal nature, it is not possible to extend results to general population; yet it may be a finding to future studies.

Increased Incidence of Vestibular Disorders in Patients With SARS-CoV-2

“…The data we present demonstrate that individuals testing positive for COVID-19 are over twice as likely to develop vestibular symptoms compared to the general population. Although our data estimates the overall prevalence of vestibular disorder amongst these patients at between 1% and 3%, other studies have estimated the self-reported numbers to reach as high as over 40% ( 7 , 14 , 15 ). One must also consider individuals whose vestibular symptoms remain undiagnosed, those who did not seek medical attention for their vestibular symptoms during our observation window, and those who were never tested and diagnosed with COVID-19.…”

“…However, other head and neck symptoms related to COVID-19, particularly of the cochleovestibular system, also necessitate our attention, as up to 58% of patients affected by COVID-19 reported vestibular symptoms and 9% reported auditory symptoms upon initial diagnosis ( 6 ). These symptoms have also been found to affect women disproportionately ( 7 ). Jeong et al have demonstrated a mechanism of viral entry into the cells of the cochleovestibular end organs via the angiotensin-converting enzyme 2 receptor pathway, providing further insight into the impact it has on hearing loss, tinnitus, and vertigo ( 8 – 10 ).…”