Acute Unilateral Peripheral Vestibulopathy After COVID-19 Vaccination: Initial Experience in a Tertiary Neurotology Center

Abstract

ObjectiveThe aim of the present study was to identify patients who developed acute unilateral peripheral vestibulopathy (AUPVP) after COVID-19 vaccination.MethodsFor this single-center, retrospective study, we screened the medical records of our tertiary interdisciplinary neurotology center for patients who had presented with AUPVP within 30 days after COVID-19 vaccination (study period: 1 June−31 December 2021). The initial diagnosis of AUPVP was based on a comprehensive bedside neurotological examination. Laboratory vestibular testing (video head impulse test, cervical and ocular vestibular evoked myogenic potentials, dynamic visual acuity, subjective visual vertical, video-oculography, caloric testing) was performed 1–5 months later.ResultsTwenty-six patients were diagnosed with AUPVP within the study period. Of those, n = 8 (31%) had developed acute vestibular symptoms within 30 days after COVID-19 vaccination (mean interval: 11.9 days, SD: 4.8, range: 6–20) and were thus included in the study. The mean age of the patients (two females, six males) was 46 years (SD: 11.7). Seven patients had received the Moderna mRNA vaccine and one the Pfizer/BioNTech mRNA vaccine. All patients displayed a horizontal(-torsional) spontaneous nystagmus toward the unaffected ear and a pathological clinical head impulse test toward the affected ear on initial clinical examination. Receptor-specific laboratory vestibular testing performed 1–5 months later revealed recovery of vestibular function in two patients, and heterogeneous lesion patterns of vestibular endorgans in the remaining six patients.Discussion and ConclusionsThe present study should raise clinicians' awareness for AUPVP after COVID-19 vaccination. The relatively high fraction of such cases among our AUPVP patients may be due to a certain selection bias at a tertiary neurotology center. Patients presenting with acute vestibular symptoms should be questioned about their vaccination status and the date of the last vaccination dose. Furthermore, cases of AUPVP occurring shortly after a COVID-19 vaccination should be reported to the health authorities to help determining a possible causal relationship.

Vestibular syndromes after COVID‐19 vaccination: A prospective cohort study

“…Due to the suspected immunological cause, with reactivation of herpes simplex virus (HSV) type II from the vestibular ganglion [ 28 ], acute UVP following vaccination appears to be an interesting subgroup. A recent study by Schmid et al found eight patients in a 6‐month period who had developed a UVP in timely conjunction with COVID‐19 vaccination [ 14 ]; in our patient subcohort, only three patients suffered from a UVP after their vaccination (within a 4‐week interval), which was less frequent than in the prepandemic control cohort. Although we cannot exclude that the inflammatory response to COVID‐19 vaccination may contribute to the evolution of a vestibular neuritis by reactivation of HSV II in single cases, a specific clustering above likelihood of spontaneous incidence was not observed.…”

“…However, its proportion corresponds to the usual frequency at our [14]; in our patient subcohort, only three patients suffered from a UVP after their vaccination (within a 4-week interval), which was less frequent than in the prepandemic control cohort. Although we cannot exclude that the inflammatory response to COVID-19 vaccination may contribute to the evolution of a vestibular neuritis by reactivation of HSV II in single cases, a specific clustering above likelihood of spontaneous incidence was not observed.…”

“…However, in the great majority of patients, the specific diagnoses and central nervous system involvement remained unclear due to the limited neuro‐ophthalmological and neurophysiological diagnostic setup. Another recent study described eight patients who had developed a UVP within 30 days after COVID‐19 vaccination [ 14 ]. However, it remained unclear whether UVP incidence after COVID‐19 vaccination was higher than in the prepandemic years.…”

The effects of COVID-19 on the vestibular system

“…Olfactory dysfunction 15 (30) Gustatory dysfunction 21 ( considered their infection as "mild", and 36 patients (72%) reported olfactory and gustatory symptoms. The other patient who received inpatient or ICU treatment described their infection as "severe".…”

Is Vestibular Neuropathy Rather a Neuritis?

“…Further research is needed to clarify if LD and other neurotropic infections are one of the causes of VN. Since the COVID-19 pandemic, there are also reports about VN after COVID-19 infection and after vaccination [28] and the reports about its neurotropic potential accumulate. Therefore it is essential to test patients with acute onset of peripheral vestibular neuropathy also for COVID-19.…”