Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss

Abstract

This study aimed to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients presenting with only sudden sensorineural hearing loss (SSHNL) during the COVID-19 pandemic. Methods: The study included five male patients who presented with the sole complaint of unilateral SSNHL to the otolaryngology outpatient clinic between 03-12 April 2020. The patients were referred to the infectious diseases clinic to be evaluated for SARS-CoV-2 by real time polymerase chain reaction (RT-PCR) testing. Results: RT-PCR testing for SARS-CoV-2 was positive in one of the patients and negative in the other four patients. A positive response to COVID-19-specific treatment in the SARS-CoV-2 positive SSNHL patient was noted. Conclusion: It should be remembered that non-specific symptoms such as SSNHL could be the only sign with which to recognize a COVID-19 case. Awareness of such a non-specific presentation of COVID-19 patients is crucial during this pandemic period for preventing infectious spread through isolation and early initiation of COVID-19 targeted treatment.

Coronavirus disease 2019 and sudden sensorineural hearing loss

“…A number of mechanisms have been implicated: neuritis caused by viral involvement of the cochlear nerves, cochleitis due to viral involvement of the cochlea and peri-lymphatic tissues, and the stress response resulting in the cross-reaction of the inner-ear antigens to viral infections. 4 There are only three other case reports to our knowledge that have reported sudden SNHL in Covid-19 positive patients. [3][4][5] Immune-mediated inflammation likely plays a significant role given that severe cases of Covid-19 have been associated with dysregulation of the immune system.…”

“…4 There are only three other case reports to our knowledge that have reported sudden SNHL in Covid-19 positive patients. [3][4][5] Immune-mediated inflammation likely plays a significant role given that severe cases of Covid-19 have been associated with dysregulation of the immune system. In these severe cases, an increased neutrophil-to-lymphocyte ratio and elevated inflammatory cytokines such as interleukin 6 have been observed.…”

“…Initially, there were reports that steroids may delay viral clearance and increase infection severity. 4,7,8 Kilic et al reported on five cases of sudden SNHL during the coronavirus pandemic. 4 The one patient who was Covid-19 positive was treated with oral hydroxychloroquine, while the remaining four In addition, two commentaries published in Lancet journals in February and March 2020, respectively, reported that corticosteroids should not be used for the treatment of Covid-19 as they have no mortality benefit, they delay clearance of viral RNA and they have serious side effects.…”

“…4,7,8 Kilic et al reported on five cases of sudden SNHL during the coronavirus pandemic. 4 The one patient who was Covid-19 positive was treated with oral hydroxychloroquine, while the remaining four In addition, two commentaries published in Lancet journals in February and March 2020, respectively, reported that corticosteroids should not be used for the treatment of Covid-19 as they have no mortality benefit, they delay clearance of viral RNA and they have serious side effects. 8,9 However, this assumption was based on the findings of previous studies indicating that steroids increase mortality in patients with influenza and other viruses.…”

Can COVID-19 cause sudden sensorineural hearing loss?

“…We thank to Pietro D L et al for their comments on our recently published article (Kilic et al, 2020). In previous studies, viral infections have been reported to have an important role in the etiology of sudden sensorineural hearing loss (SSNHL) (Cohen et al, 2014).…”