Abstract

Introduction

The first case of Covid-19 was reported in China in December 2019. SARS-CoV-2 ,cause of Covid 19, is a virus that has the ability to be transmitted from person to person in direct contact or through droplets. The spread of the virus to the rest of China and the world was rapid. 2-14 days after the exposure to the virus, a variety of clinical features can be seen. The most common symptoms are muscle pain, fever, cough, shortness of breath, sore throat, headache, and taste and smell disorders. Age and immunocompromisation are important factors that increase susceptibility of severe infection, that might result in acute respiratory distress syndrome, organ failure, and death [1].

Sensorineural hearing loss(SNHL)  is frequently seen in ear, nose and throat clinics.

Its pathophysiology is still unknown. However, viral infections are held responsible.SNHL is often attributed to different viral-related immune-mediated  pathologies and can be a result of cellular stress response and vascular occlusion [2]. It has also been shown to cause intralabyrinth bleeding [3].

In two cross-sectional studies investigating the relationship between COVID-19 and SSNHL, first one found an increase in SSNHL cases during the pandemic period while a decrease was found in the second study [4,5]. The connection between COVID-19 and SNHL is not yet fully understood. In this article, the case of overlooked SNHL related with Covid 19 is presented.

Case Report

A 66 year-old female patient was admitted to our clinic with hearing loss in her left ear after leaving intensive care. The patient did not have any background of vertigo, ear pain, dizziness or trauma. She  was treated in the intensive care unit with the diagnosis of Covid 19. There was no history of any other disease or drug use. Otorhinolaryngologic examination was normal. Weber test was lateralized to the right and rhinne test was negative on the left. In pure tone audiometric examination, 53 db SNHL was detected in the left ear.

Figure 1 left sensorineural hearing loss

The tympanogram was normal.

Antineutrophil cytoplasmic antibody, anti-cardiolipin antibody, antinuclear antibody, and rheumatoid factor were negative. Immunoglobulin range, angiotensin converting enzyme count and complement C3 and C4 values were normal. Inner ear magnetic resonance imaging was normal. After IV 250 mg Prednisolone, she was managed with 1 mg / kg oral prednisolone. The patient who did not improve in his audiometric follow-up did not accept the intratympanic steroid recommendation. A clear etiology was not found for SNHL, but it has been suggested that may be related to covid 19. Informed consent was obtained.

Discussion

The first reported case of Covid 19-associated SNHL was in April 2020 by Sriwijitalai and Wiwanitkit in an elderly female from Thailand [6]. Later, Degen and colleagues detected total in right and severe in left ear SNHL during COVID-19 in a healthy 60-year-old male case. They applied cochlear implant to this case, which they stated that acute hearing loss occurred as a result of the spread of the meninges inflammation triggered by the virus to the cochlea [7]. On the other hand, severe sudden SNHL may develop during asymptomatic Covid 19 [8]. As can be seen in our case, the common feature for all of them is their moderate to severe sudden SNHL. Because of late detection, cases show a poor prognosis [6-8].

After case reports, studies were conducted to understand the relationship between COVID-19 and SNHL. Polymerase chain reaction  applied by Kılıç et all. for Covid 19 to 5 cases who were admitted to their clinics with sudden SNHL. One of these cases was tested positive for SARS-CoV-2  and sudden SNHL was the only symptom the case had [9]. Cochlear involvement in asymptomatic COVID 19 cases was objectively demonstrated by otoacoustic emission measurements [10].

Investigation of hearing loss in patients with SARS-CoV-2 infection and more importantly, patients that are recovered from SARS-CoV-2 infection, is too important since the infection can lead to permanent hearing loss.

Conclusion

In conclusion, SNHL, a clinical symptom of SARS-CoV-2 infection, is emphasized with this case report. Permanent hearing loss decreases the patients’ quality of life and as can be deduced from this report, early intervention in viral hearing loss can eliminate this possibility. Therefore, early detection is imperative.

References