COVID -19 and sudden sensorineural hearing loss, a case report

Abstract

The Coronavirus disease-2019“COVID-19” pandemic is caused by novel Corona Virus-2019 (nCoV-19). The outbreak was identified in Wuhan, China, in December 2019 [1]. The World Health Organization has declared the outbreak a Public Health Emergency of International Concern on 30 January and a pandemic on March 11, 2020 [2]. As of may 1, 2020, more than 3.5 million cases of COVID-19 have been reported in over 187 countries and territories, resulting in more than 250,000 deaths [3]. The clinical symptoms of this disease may appear 2–14 days after exposure (based on the incubation period of COVID-19 virus). These symptoms include fever, sore throat, cough, myalgia and some patients had gastrointestinal infection symptoms [4]. The elderly people with comorbidity are more susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS). Neurological symptoms such as sudden loss of smell and taste also was reported in a significant number of COVID-19 patient [[1], [2], [3], [4], [5]]. Sudden sensorineural hearing loss (SSNHL) is defined as sensorineural hearing loss of 30 dB or greater in at least three consecutive frequencies occurring over 72 hours. Some viral infections can cause SSNHL that can be congenital or acquired, unilateral or bilateral. Viral infections has been proposed as a cause of SSNHL through damage of inner ear structures or by precipitating inflammatory responses which then cause this damage [4,6]. Case report A written informed consent has been obtained from the study participant. On April 11 a 52-year-old male physician declared close contact with a confirmed COVID-19 case. He was isolated and nasopharyngeal swab for nCoV-19 PCR was obtained. On April 15 PCR result was obtained and it was positive for nCoV-19. 3 days later he was referred to ENT clinic because he complained of sudden onset left-sided hearing loss that was preceded by gradually worsening tinnitus. The patient has no ear pain, discharge, dizziness nor vertigo. He had no history of head trauma or ototoxic medications during isolation. Otoscopic examination revealed bilateral normal external auditory canals and tympanic membranes. Tunning for tests demonstrated bilateral positive Renne test while Webber test lateralized to right side. There was no other focal neurological deficit. The patient was discharged on April 26 after two negative respiratory swabs. Audiometry was done that revealed right normal hearing level and left severe sensorineural hearing loss (Fig. 1 ) with bilateral type A impedance audiometry. Open in a separate window Fig. 1 Diagnostic pure tone audiometry.

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