Assessment of balance after recovery from Covid-19 disease

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.

Vestibular Rehabilitation in Isolated Otolith Dysfunction After Covid-19: A Case Report

“…This finding is in line with a study by Jafarzadeh in which the home-based vestibular rehabilitation improved vestibular dysfunction in 3 patients with vestibular neuritis after COVID-19 infection [9]. Also, the obtained result of the current study is in line with a previous study in which the cervical and ocular VEMP results of a patient with isolated otolith disorder showed recovery [16]. Although the exact cellular or neuronal pathways of otolith recovery are unknown, it seems that vestibular rehabilitation has benefits even for isolated otolith dysfunction and leads to the general improvement of balance function.…”

“…The clinical significance of balance disorders in SARS-CoV-2 infection has been reported in a study using computerized dynamic posturography (CDP) and the vestibular evoked myogenic potential (VEMPs). The study showed that COVID-19 could involve the peripheral and or central vestibular system leading to abnormal findings in CDP and VEMPs, which may occur even after the patient's recovery from infection [16].…”

Impact of mild COVID-19 on balance function in young adults, a prospective observational study

“…Indeed, as anticipated, our findings show balance impairments in young Polish adults who have recovered from mild COVID-19. This may be linked to the involvement of systems responsible for postural stability, as suggested by Yılmaz et al, who investigated a group of subjects on average 10 years older than our sample 18 .…”

“…Falls can be dangerous, as they often lead to disability 16 or even death, especially in the elderly 13 , 15 . Given the risk of damage to the CNS due to SARS-CoV-2 infection, it has been suggested that a balance assessment should be performed in COVID-19 survivors, representing different age groups and severity levels of COVID-19 17 , 18 .…”

“…However, balance evaluations in those affected by COVID-19 have mainly been performed using subjective rather than objective methods. To the best of our knowledge, at this point in the world literature there are few studies assessing postural stability in adults and young adults who recovered from COVID-19 17 – 21 and there is only one research report, from Istanbul, related to measurement of balance after recovery from COVID-19 performed using objective assessment methods 18 . Furthermore, in Poland no studies related to this issue have been reported so far, consequently it seemed reasonable to undertake research investigating the incidence of this impairment in a group of young adults who have suffered from COVID-19.…”