The reversible tinnitus and cochleopathy followed first-dose AstraZeneca COVID-19 vaccination

Abstract

This case report aimed to remind the clinicians of the possibility of potential cochleopathy after the administration of the COVID-19 vaccine and to recommend immediate steroid treatment. Because this adverse event was reversible and recoverable, we still strongly recommend the continuation of the administration of the COVID-19 vaccine. Mr A is a 37-year-old man who had a past history of glaucoma and had been regularly treated with latanoprost and brimonidine eyedrops. He did not have any previous problems associated with tinnitus. He underwent pure tone audiometry (PTA) on 18 April 2021 as part of his regular health exams, and the results were within the normal range (Figure 1A). He received the first dose of the AstraZeneca COVID-19 vaccine at 11 am on 30 April 2021 without any local infection/complication. The pre-injection evaluation revealed no evidence for pre-existing infections. However, he started to have intermittent, right ear, high-pitch tinnitus from 4 pm into the night on 30 April 2021 with tinnitus handicap inventory (THI) score as 28. At midnight on April 30th, a high fever with chills and myalgia developed, with a poor response to 500 mg acetaminophen. Therefore, he visited the emergency department, wherein the laboratory data, including CBC/DC, Cre/GPT, PT/aPTT/fibrinogen/D-dimer, creatine kinase, and blood culture, were normal. The intermittent, right ear, high-pitch tinnitus progressed into continuous high-pitch tinnitus and disturbed the normal hearing of the patient. In addition, low-pitch right ear tinnitus also appeared intermittently. Moreover, the THI score increased to 46. He received an otolaryngologic inspection, which revealed no abnormal findings. The subsequent audiometry test at 1 pm on 1 May 2021 revealed normal findings in the PTA (Figure 1A), but a high short increment sensitivity index (SiSi) was observed (Figure 1B). Under the impression of acute inflammatory cochleopathy, he was treated with one dose of 10 mg intravenous dexamethasone and a 3-day oral 5 mg prednisolone three times per day. His fever and myalgia quickly subsided. In addition, the right ear high-pitch and low-pitch tinnitus completely subsided on 3 May 2021. The subsequent audiometry demonstrated that the patient had recovered well by 5 pm 3 May 2021 (Figure 1A and B), with the THI score returning to 0. The COVID-19 real-time polymerase chain reaction (RT-PCR) detection assay revealed negative findings throughout the entire course of treatment. The figures depicted Mr A’s pure tone audiometry on April 18th, May 1st and May 3rd (A); the figures depicted his short increment sensitivity index test (SiSi test) on May 1st (the worst day) and May 3rd (symptoms subsided) (B). This is the first-case report addressing the time-associated relationship between new-onset tinnitus and the first-dose injection of the AstraZeneca COVID-19 vaccine. The potential adverse events of micro-thromboembolism by COVID-19 vaccine would be less likely because steroids do not have any anti-thromboembolism effects. In addition, Mr A’s PTA was normal throughout the entire course which did not fulfill the definition of sudden sensorineural hearing loss.1 The pandemic of COVID-19 has been preliminarily found to be associated with an increased incidence of tinnitus.2 In our case, the treatment rationale may be similar to the treatment rationale by Rahimi.3 In the case report by Rahimi, the authors provided high dosage intratympanic corticosteroid injections to induce immunosuppression to treat a 60-year-old woman with sudden hearing loss and acute onset tinnitus following her COVID-19 infection. When considering our case, there was no infectious evidence to refute Mr A’s COVID-19 status, and his COVID-19 RT-PCR results revealed a negative finding. Therefore, tinnitus symptoms and impaired SiSi would be less likely to be associated with an actual COVID-19 attack. This case report aimed to recommend immediate steroid treatment for the management of patients of new-onset tinnitus/cochleopathy after the COVID-19 vaccination. Furthermore, due to the fact that the adverse event of new-onset tinnitus was reversible and recoverable, we still strongly recommend the continuation of the administration of the AstraZeneca COVID-19 vaccine, based on its merits and demerits. The current case report had been edited by Elsevier Language Editing Services on 11 May 2021 (Serial number: LE-211726-88899CF904E8). The current case report had been approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No.: A202105107). Conflict of interest. None declared.

Topics & Concepts