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Kondo K, Honda K, Goshima K, Inoue N, Shinjo D, Tsutsumi T, Fushimi K. Otologic disease trends in Japan post-COVID-19 outbreak: A retrospective time-series analysis. Auris Nasus Larynx 2024; 51:525-530. [PMID: 38522357 DOI: 10.1016/j.anl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/17/2023] [Accepted: 01/12/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To evaluate the potential impact of coronavirus disease 2019 (COVID-19) and vaccinations on otologic diseases, including facial nerve paralysis (including Ramsay Hunt syndrome), vestibular neuritis, sudden sensorineural hearing loss, and Meniere's disease. METHODS In this retrospective study, we conducted a time-series analysis employing a causal impact algorithm on a large-scale inpatient database in Japan. We compared the actual number of hospitalized patients with otologic diseases to two predictions: one without any covariates and another with a covariate accounting for the reduction in the number of hospitalized patients due to lockdown measures. Additionally, we performed Granger causality tests to ensure the robustness of our findings. RESULTS No significant increase was noted in the number of hospitalized patients with otologic diseases following the onset of the COVID-19 pandemic in the causal impact analysis. Similarly, no notable surge was observed in hospitalizations for these diseases following the introduction of the COVID-19 vaccine. The Granger causality tests results aligned with the causal impact analysis findings. CONCLUSION Our findings indicate that COVID-19 and vaccinations had minimal discernible effects on hospitalization of patients with otologic diseases, suggesting that otologic diseases may not be significantly impacted by COVID-19 and vaccinations, which could have implications for public health policies and the allocation of healthcare resources during a pandemic. Further research and monitoring of long-term effects are warranted to validate these findings and guide healthcare decision-making.
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Affiliation(s)
- Keisuke Kondo
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, , S1651/S1568 M&D Tower, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138519, Japan; Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Honda
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Goshima
- Faculty of International Social Sciences, Division of International Social Sciences, Yokohama National University, Kanagawa, Japan
| | - Norihiko Inoue
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, , S1651/S1568 M&D Tower, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138519, Japan; Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | - Daisuke Shinjo
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, , S1651/S1568 M&D Tower, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138519, Japan.
| | - Takeshi Tsutsumi
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, , S1651/S1568 M&D Tower, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138519, Japan
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2
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Ammar H, Le Beller C, Bouccara D, Malinvaud D, Jouffroy R, Lillo-Le Louet A. Vestibular disorders following BNT162b2 mRNA COVID-19 vaccination: A retrospective case series. Fundam Clin Pharmacol 2024; 38:192-204. [PMID: 37473782 DOI: 10.1111/fcp.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/18/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND There are few publications regarding manifestations of vestibular disorders (VDs) following BNT162b2 mRNA COVID-19 vaccination. PURPOSE We describe cases of VD potentially related to BNT162b2 vaccination and calculate its reporting rate, in order to enlarge knowledge about this adverse effect. METHODS A retrospective analysis of cases of VD following BNT162b2 vaccination reported to the pharmacovigilance centre of Georges-Pompidou European Hospital (France), in 2021 was performed. In order to identify these cases from the pharmacovigilance database containing all our registered cases, we used the Standardised MedDRA Query (SMQ) 'vestibular disorders'. Then we analysed cases with vestibular symptoms, based on the association of typical manifestations. The reporting rate was calculated based on the number of VD cases and the number of vaccinated patients. RESULTS Among 6608 cases reported to our centre related to COVID-19 vaccines during 2021, 34 VDs associated with BNT162b2 administration were included. They were mainly reported in females (79%), 62% occurred after the first dose and 32% were serious. Symptoms had completely resolved in 13 cases (38%). Vertigo was the most common symptom followed by balance disorders. Three patients received second dose without reappearance of VD. The final diagnosis was reported in 10 patients (six cases of vestibular neuritis, two cases of central VD, two cases of benign paroxysmal positional vertigo). The regional reporting rate was 26 [95% CI: 17-34] cases of VD per 1 million persons vaccinated. CONCLUSION Although the relationship between vaccination and VD cannot be established, clinicians should be aware of this rare adverse effect.
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Affiliation(s)
- Helmi Ammar
- Pharmacovigilance Regional Centre, Hôpital Européen Georges Pompidou, AP-HP-Université Paris Cité, Paris, France
| | - Christine Le Beller
- Pharmacovigilance Regional Centre, Hôpital Européen Georges Pompidou, AP-HP-Université Paris Cité, Paris, France
| | - Didier Bouccara
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, Paris, France
- Unité CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition Group, Université Paris Cité, Paris, France
| | - David Malinvaud
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, Paris, France
- Unité CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition Group, Université Paris Cité, Paris, France
| | - Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique Hôpitaux Paris and Paris Saclay University, Paris, France
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport - EA7329, INSEP - Paris University, Paris, France
- Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM - Paris Saclay University, Paris, France
- EA 7525 Université des Antilles, Fort de France, France
| | - Agnès Lillo-Le Louet
- Pharmacovigilance Regional Centre, Hôpital Européen Georges Pompidou, AP-HP-Université Paris Cité, Paris, France
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3
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Srichawla BS, Quast J, Pacut P, Sivakumar S, Garcia-Dominguez MA, Belgrad J, Panda A, Carbone S, Sanders DT, Min E, Hayes NT, Bose A, Lee V, Ghasemi M. COVID-19 in the intensive care unit: Unmasking the critical factors impacting patient survival. J Investig Med 2023; 71:907-916. [PMID: 37485922 DOI: 10.1177/10815589231191813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
In the midst of the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world have been pushed to their limits as they grapple with the effects of the severe acute respiratory syndrome coronavirus 2 virus. Identifying prognostic factors that influence mortality in COVID-19 patients admitted to the ICU could offer valuable insights for clinicians seeking to prevent disease progression. A retrospective analysis was conducted on COVID-19 patients admitted to the ICU between January and September 2020. The analysis considered patient demographics, comorbidities, neurological and non-neurological symptoms, as well as laboratory markers. The multivariate logistic regression analysis aims to uncover associations between these factors and patient outcomes. Of the 387 patients included in this study, nearly half (48.5%) of the ICU patients succumbed to COVID-19. Factors that contributed to increased mortality included being 60 years of age or older, impaired consciousness, lung disease, elevated international normalized ratio (INR), and elevated blood urea nitrogen (BUN) levels. Surprisingly, symptoms such as dizziness/lightheadedness, myalgia, and headache were associated with a higher likelihood of survival. In addition, elevated D-dimer and aspartate aminotransferase (AST) levels, as well as lymphopenia, were more commonly observed in deceased patients. The study concluded that those who died in the ICU tended to be older, white, and burdened with more comorbidities and impaired consciousness. With the intriguing link between specific symptoms and survival, further research is essential to uncover the underlying pathophysiological mechanisms that influence ICU patient outcomes in the context of COVID-19.
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Affiliation(s)
| | - Jared Quast
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Peter Pacut
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | - Jillian Belgrad
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ashwin Panda
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sara Carbone
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Delia T Sanders
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Eli Min
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nicole T Hayes
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Abigail Bose
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Vanessa Lee
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mehdi Ghasemi
- University of Massachusetts Chan Medical School, Worcester, MA, USA
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4
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Aedo-Sánchez C, Gutiérrez G, Aguilar-Vidal E. COVID-19 and Vestibular Symptoms and Assessment: A Review. Audiol Neurootol 2023; 29:81-87. [PMID: 37703853 DOI: 10.1159/000533448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The current pandemic of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality primarily associated with respiratory failure. However, it has also been reported that COVID-19 can evolve into a nervous system infection. The direct and indirect mechanisms of damage associated with SARS-CoV-2 neuropathogenesis could affect our sensory functionality, including hearing and balance. SUMMARY In order to investigate a possible association between SARS-CoV-2 viral infection and possible damage to the vestibular system, this review describes the main findings related to diagnosing and evaluating otoneurological pathologies. KEY MESSAGES The clinical evidence shows that SARS-CoV-2 causes acute damage to the vestibular system that would not leave significant sequelae. Recovery is similar to vestibular pathologies such as vestibular neuronitis and benign paroxysmal positional vertigo. Further basic science, clinical, and translational research is needed to verify and understand the short- and long-term effects of COVID-19 on vestibular function.
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Affiliation(s)
- Cristian Aedo-Sánchez
- Departamento Tecnología Médica, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Escuela de Tecnología Médica, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gabriela Gutiérrez
- Escuela de Tecnología Médica, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Enzo Aguilar-Vidal
- Departamento Tecnología Médica, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Escuela de Tecnología Médica, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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5
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Deb N, Roy P, Biswakarma A, Mary T, Mahajan S, Khan J, Shah A. Neurological Manifestations of Coronavirus Disease 2019 and Monkeypox in Pediatric Patients and Their Management: A State-of-the-Art Systematic Review. Pediatr Neurol 2023; 146:65-78. [PMID: 37441883 PMCID: PMC10195769 DOI: 10.1016/j.pediatrneurol.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/13/2023] [Accepted: 05/13/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND There is an increasing number of cases being reported of neurological manifestations of Coronavirus disease 2019 (COVID-19) infection and monkeypox, both during the course of the infection and as a presenting symptom. We aim to review the neurological manifestations of COVID-19 and monkeypox in pediatric patients and their management. METHODS We conducted a systematic review that included cohort studies and case series or reports involving a pediatric population of patients with a confirmed COVID-19 or monkeypox infection and their neurological manifestations. We searched the following electronic databases: PubMed, EMBASE, and Scopus. RESULTS From 1136 articles identified, 127 studies were included. Headache, stroke, Guillain-Barré syndrome, seizure, nerve palsies, and multisystem inflammatory syndrome in children were the most common neurological symptoms caused by COVID-19, whereas encephalitis was commonly seen in patients with monkeypox. Rare neurological manifestations of COVID-19 included cerebral venous sinus thrombosis, plexopathies, demyelinating disorders, encephalitis, etc., and rare neurological manifestations of monkeypox included headache. CONCLUSIONS Our review highlights the importance of investigating possible neurological manifestations and closely monitoring these patients to develop a better understanding of the treatment strategies that can be adopted.
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Affiliation(s)
- Novonil Deb
- North Bengal Medical College and Hospital, West Bengal, India
| | - Poulami Roy
- North Bengal Medical College and Hospital, West Bengal, India.
| | | | - Therese Mary
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangaluru, Karnataka, India
| | - Sanah Mahajan
- Government Medical College, Jammu, Jammu and Kashmir, India
| | - Javeria Khan
- Veer Narmad South Gujarat University, Surat, Gujarat, India
| | - Aatam Shah
- Veer Narmad South Gujarat University, Surat, Gujarat, India
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6
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Devaragudi S, Gupta M. Vertigo in the Setting of COVID-19 Infection: A Case Report. Cureus 2023; 15:e34708. [PMID: 36909078 PMCID: PMC9995741 DOI: 10.7759/cureus.34708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Extensive research has been conducted on the pathophysiological sequelae of the SARS-CoV-2 virus. Newer symptoms pertaining to cardiovascular, gastrointestinal, and neurological systems, apart from the recognized respiratory system, are constantly being reported. We report a case of a 22-year-old female with a seven-day history of COVID-19 who presented to the emergency department with an acute vertigo attack associated with nausea and vomiting for three hours. Physical examination and audiometry showed no neurological and auditory deficits; she was diagnosed with vestibular neuritis. The patient was managed with betahistine hydrochloride and an antihistamine. There was a complete resolution of symptoms after seven days. There have been reports of new-onset vertigo associated with SARS-CoV-2 infection, but more well-designed studies are needed to establish an association between COVID-19 and vertigo.
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Affiliation(s)
- Sanjana Devaragudi
- Department of General Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, IND
| | - Mohit Gupta
- Department of General Medicine, Sharda Hospital, Greater Noida, IND
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7
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Casabianca M, Caula C, Titomanlio L, Lenglart L. Neurological consequences of SARS-CoV-2 infections in the pediatric population. Front Pediatr 2023; 11:1123348. [PMID: 36865695 PMCID: PMC9973732 DOI: 10.3389/fped.2023.1123348] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
COVID-19 in the pediatric population is mostly asymptomatic. However, 1 out of 5 children presents non-specific neurologic symptoms such as headache, weakness, or myalgia. Furthermore, rarer forms of neurological diseases are increasingly being described in association to a SARS-CoV-2 infection. Encephalitis, stroke, cranial nerves impairment, Guillain-Barré syndrome or acute transverse myelitis have been reported and account for around 1% of pediatric COVID-19 cases. Some of these pathologies may occur during or after the SARS-CoV-2 infection. The pathophysiological mechanisms range from direct invasion of the central nervous system (CNS) by SARS-CoV-2 itself to postinfectious immune-mediated CNS inflammation. In most cases, patients presenting neurological pathologies related to SARS-CoV-2 infection are at greater risk of life-threatening complications and should be closely monitored. Further studies are needed to acknowledge the potential long-term neurodevelopmental consequences of the infection.
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Affiliation(s)
- Manon Casabianca
- Pediatric Emergency Department, APHP - Hopital Robert Debré, Paris Cité University, Paris, France
| | - Caroline Caula
- Pediatric Emergency Department, APHP - Hopital Robert Debré, Paris Cité University, Paris, France
| | - Luigi Titomanlio
- Pediatric Emergency Department, APHP - Hopital Robert Debré, Paris Cité University, Paris, France.,Pediatric Migraine and Neurovascular Diseases Unit, APHP - Hopital Robert Debré, Paris Cité University, Paris, France.,DHU Protect, INSERM U1141, Paris Cité University, Paris, France
| | - Léa Lenglart
- Pediatric Emergency Department, APHP - Hopital Robert Debré, Paris Cité University, Paris, France
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8
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Aldè M, Barozzi S, Di Berardino F, Zuccotti G, Consonni D, Ambrosetti U, Socci M, Bertoli S, Battezzati A, Foppiani A, Zanetti D, Pignataro L, Cantarella G. Prevalence of symptoms in 1512 COVID-19 patients: have dizziness and vertigo been underestimated thus far? Intern Emerg Med 2022; 17:1343-1353. [PMID: 35098491 PMCID: PMC8801188 DOI: 10.1007/s11739-022-02930-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/12/2022] [Indexed: 12/16/2022]
Abstract
The relationship between SARS-CoV-2 infection and dizziness is still unclear. The aim of this study is to assess the prevalence and characteristics of dizziness and vertigo among patients with mild-to-moderate COVID-19. Patients discharged from the emergency rooms with a confirmed SARS-CoV-2 diagnosis were assisted by daily telephone calls until nasopharyngeal swab negativization, and specific symptoms concerning balance disorders were investigated through targeted questions posed by experienced physicians. The study included 1512 subjects (765 females, 747 males), with a median age of 51 ± 18.4 years. New-onset dizziness was reported by 251 (16.6%) patients, among whom 110 (43.8%) complained of lightheadedness, 70 (27.9%) of disequilibrium, 41 (16.3%) of presyncope, and 30 (12%) of vertigo. This study analyzed in detail the prevalence and pathophysiological mechanisms of the different types of balance disorders in a large sample, and the results suggest that dizziness should be included among the main symptoms of COVID-19 because one-sixth of patients reported this symptom, with females being significantly more affected than males (20.3 vs 12.9%, P < 0.001). Most cases of dizziness were attributable to lightheadedness, which was probably exacerbated by psychophysical stress following acute infection and mandatory quarantine. Vertigo should not be underestimated because it might underlie serious vestibular disorders, and disequilibrium in elderly individuals should be monitored due to the possible risk of falls.
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Affiliation(s)
- Mirko Aldè
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- grid.414818.00000 0004 1757 8749Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy
| | - Stefania Barozzi
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Di Berardino
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- grid.414818.00000 0004 1757 8749Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Children’s Hospital “Vittore Buzzi”, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli, Milan, Italy
- grid.4708.b0000 0004 1757 2822“L. Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Dario Consonni
- grid.414818.00000 0004 1757 8749Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Umberto Ambrosetti
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marina Socci
- grid.414818.00000 0004 1757 8749Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy
| | - Simona Bertoli
- grid.4708.b0000 0004 1757 2822Department of Food Environmental and Nutritional Sciences (DeFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Milan, Italy
- grid.414603.4Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases , IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Italian Auxologic Institute (IAI), Milan, Italy
| | - Alberto Battezzati
- grid.4708.b0000 0004 1757 2822Department of Food Environmental and Nutritional Sciences (DeFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Milan, Italy
| | - Andrea Foppiani
- grid.4708.b0000 0004 1757 2822Department of Food Environmental and Nutritional Sciences (DeFENS), International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Milan, Italy
| | - Diego Zanetti
- grid.414818.00000 0004 1757 8749Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy
| | - Lorenzo Pignataro
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- grid.414818.00000 0004 1757 8749Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Cantarella
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- grid.414818.00000 0004 1757 8749Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Postacute Laryngeal Injuries and Dysfunctions in COVID-19 Patients: A Scoping Review. J Clin Med 2022; 11:jcm11143989. [PMID: 35887754 PMCID: PMC9318309 DOI: 10.3390/jcm11143989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 01/08/2023] Open
Abstract
Objective: To investigate post-acute laryngeal injuries and dysfunctions (PLID) in coronavirus disease 2019 (COVID-19) patients. Methods: Three independent investigators performed a systematic review of the literature studying PLID in patients with a history of COVID-19. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Epidemiological, clinical, hospitalization features, laryngeal diseases, and voice outcomes were extracted from the included papers. Results: Eight papers met our inclusion criteria (393 patients) corresponding to five uncontrolled prospective and three retrospective studies. The most prevalent PLID were vocal fold dysmotility (65%), vocal fold edema (35%), muscle tension dysphonia (21%), and laryngopharyngeal reflux (24%). Posterior glottic stenosis (12%), granuloma (14%), and posterior glottic diastasis (12%) were the most common injuries. Most patients with PLID were obese and had a history of intensive care unit hospitalization, and orotracheal intubation. The delay between the discharge and the laryngology office consultation ranged from 51 to 122 days. The mean duration of intubation ranged from 10 to 34 days. Seventy-eight (49%) intubated patients were in the prone position. The proportion of patients requiring surgical treatment ranged from 39% to 70% (mean = 48%). There was an important heterogeneity between studies about inclusion, exclusion criteria, and outcomes. Conclusions: COVID-19 appeared to be associated with PLID, especially in patients with a history of intubation. However, future controlled studies are needed to evaluate if intubated COVID-19 patients reported more frequently PLID than patients who were intubated for other conditions.
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10
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Orinx C, Mat Q, Tainmont S, Cabaraux P, Duterme JP. Moving from H.I.N.T.S. to H.I.N.T.S. PLUS in the Management of Acute Vestibular Syndrome. EAR, NOSE & THROAT JOURNAL 2022:1455613221088702. [PMID: 35546789 DOI: 10.1177/01455613221088702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cindy Orinx
- Department of Otorhinolaryngology, 82159C.H.U. Charleroi, Charleroi, Belgium
| | - Quentin Mat
- Department of Otorhinolaryngology, 82159C.H.U. Charleroi, Charleroi, Belgium
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium
| | - Sophie Tainmont
- Department of Otorhinolaryngology, 82159C.H.U. Charleroi, Charleroi, Belgium
| | - Pierre Cabaraux
- Department of Neurology, 82159C.H.U. Charleroi, Charleroi, Belgium
| | - Jean-Pierre Duterme
- Department of Otorhinolaryngology, 82159C.H.U. Charleroi, Charleroi, Belgium
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11
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Kamogashira T, Funayama H, Asakura S, Ishimoto S. Vestibular Neuritis Following COVID-19 Vaccination: A Retrospective Study. Cureus 2022; 14:e24277. [PMID: 35602793 PMCID: PMC9119312 DOI: 10.7759/cureus.24277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To determine if the COVID-19 vaccine can cause vestibular neuritis (VN). Design Retrospective study. Setting Vertigo outpatient clinic of the Department of Otolaryngology JR Tokyo General Hospital. Participants: 378 patients who presented at the Vertigo clinic between July 2018 and March 2022 Results 23 out of 378 cases were diagnosed with vestibular neuritis. There was a significant seasonal bias of the onset of VN in 2021-3Q compared to other seasons. All 7 patients diagnosed with VN whose onset was 2021-3Q and 2021-4Q had received the BNT162b2 (Pfizer-BioNTech) vaccine within the previous 3 months and one patient diagnosed with VN whose onset was 2022-1Q had a history of COVID-19 infection six months earlier. Conclusions VN should be recognized as one of the side-effects of the BNT162b2 COVID-19 vaccination.
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Affiliation(s)
- Teru Kamogashira
- Department of Otolaryngology, JR Tokyo General Hospital, Tokyo, JPN.,Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, JPN
| | - Hideaki Funayama
- Department of Clinical Examination, JR Tokyo General Hospital, Tokyo, JPN
| | - Shinnosuke Asakura
- Department of Clinical Examination, JR Tokyo General Hospital, Tokyo, JPN
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Kaliyappan K, Chen YC, Krishnan Muthaiah VP. Vestibular Cochlear Manifestations in COVID-19 Cases. Front Neurol 2022; 13:850337. [PMID: 35370886 PMCID: PMC8971520 DOI: 10.3389/fneur.2022.850337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/15/2022] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a high transmissible infectious disease that primarily impacts the respiratory system and leads to death as it worsens. Ever since the World Health Organization declared the disease as a global pandemic, the pathophysiology, clinical manifestations, and disease prognosis has been discussed in various literature. In addition to impaired respiratory health, the symptoms also indicated the involvement of the cardiovascular and neurological system after SARS-CoV-2 infection. Despite the pulmonary, cardiovascular, and neurological complications, many reports also revealed the prevalence of vestibulocochlear symptoms like dizziness, vertigo, vestibular neuritis, sudden sensorineural hearing loss, and tinnitus. Though many clinical reports and scientific reviews reported the vestibular and cochlear impairments associated with coronavirus disease 2019 (COVID-19) infection, the underlying pathological mechanisms are still unclear and unexplored. In this review, we discussed the published clinical reports, research articles, and literature reviews related to vestibulocochlear manifestations following SARS-CoV-2 infections. We also summarized the current knowledge about the prevalence, epidemiological and clinical features, and potential pathological mechanisms related to vestibular and cochlear manifestations resulting from COVID-19 infections.
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Affiliation(s)
- Kathiravan Kaliyappan
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, United States
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Yu-Chen Chen
| | - Vijaya Prakash Krishnan Muthaiah
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, United States
- Vijaya Prakash Krishnan Muthaiah
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13
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Autoimmune Vestibulopathy—A Case Series. Brain Sci 2022; 12:brainsci12030306. [PMID: 35326263 PMCID: PMC8946225 DOI: 10.3390/brainsci12030306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/17/2022] Open
Abstract
Autoimmune inner ear disease (AIED) is a rare clinical entity. Its pathogenicity, heterogenous clinical presentation in the context of secondary systemic autoimmune disease and optimal treatment avenues remain poorly understood. Vestibular impairment occurring in the context of AIED is rarely subject to detailed investigation given that the auditory symptoms and their responsiveness to immunosuppression are the focus of the few proposed diagnostic criteria for AIED. We present three cases of vestibulopathy occurring in the context of autoimmune inner ear conditions, including the first known report of autoimmune inner ear pathology arising with a temporal association to administration of the Pfizer-BioNTech SARS-CoV2 vaccination. We review the available literature pertinent to each case and summarise the key learning points, highlighting the variable presentation of vestibular impairment in AIED.
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14
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Shahali H, Hamidi Farahani R, Hazrati P, Hazrati E. Acute vestibular neuritis: A rare complication after the adenoviral vector-based COVID-19 vaccine. J Neurovirol 2022; 28:609-615. [PMID: 35877063 PMCID: PMC9310685 DOI: 10.1007/s13365-022-01087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 01/13/2023]
Abstract
Vestibular neuritis was first reported in 1952 by Dix and Hallpike, and 30% of patients reporting a flu-like symptom before acquiring the disorder. The most common causes are viral infections, often resulting from systemic viral infections or bacterial labyrinthitis. Here we presented a rare case of acute vestibular neuritis after the adenoviral vector-based COVID-19 vaccination. A 51-year-old male pilot awoke early in the morning with severe vertigo, nausea, and vomiting after receiving the first dose of the ChAdOx1 nCoV-19 vaccine 11 days ago. Nasopharyngeal SARS-CoV-2 RT-PCR test and chest CT scan were inconclusive for COVID-19 pneumonia. Significant findings were a severe spontaneous and constant true-whirling vertigo which worsened with head movement, horizontal-torsional spontaneous nystagmus, abnormal caloric test, positive bedside head impulse tests, and inability to tolerate head-thrust test. PTA, MRI of the brain and internal auditory canal, and cerebral CT arteriography were normal. According to the clinical, imaging, and laboratory findings, he was admitted to the neurology ward and received treatment for vestibular neuritis. His vertigo increased gradually over 6-8 h, peaking on the first day, and gradually subsided over 7 days. Ten days later, the symptoms became tolerable; the patient was discharged with advice for home-based vestibular rehabilitation exercises. Despite the proper treatment and rehabilitation, signs of dynamic vestibular imbalances persisted after 1 year. Based on the Federal Aviation Administration (FAA) regulations, the Air Medical Council (AMC) suspended him from flight duties until receiving full recovery. Several cases of vestibular neuritis have been reported in the COVID-19 patients and after the COVID-19 vaccination. This is the first case report of acute vestibular neuritis after the ChAdOx1 nCoV-19 vaccination in a healthy pilot without past medical history. However, the authors believe that this is a primary clinical suspicion that must be considered and confirmed after complete investigations.
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Affiliation(s)
- Hamze Shahali
- Aerospace and Sub-Aquatic Medical Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Ramin Hamidi Farahani
- Dept of Infectious and Tropical Diseases, Medical Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Parham Hazrati
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hazrati
- Dept of Anesthesiology and Intensive Care, Medical Faculty, Aja University of Medical Sciences, Tehran, Iran
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Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 and presents with pneumonia as the most frequent and serious manifestation. COVID-19 vaccination is an important and urgent interest globally due to COVID-19's rapid spread and high rates of mortality and morbidity. Vestibular neuritis (VN) is an acute vestibular syndrome that causes acute and spontaneous vertigo due to unilateral vestibular deafferentiation, leading to nausea or vomiting and unsteadiness that can last from days to weeks. Reactivation of latent type 1 herpes simplex virus, autoimmune disorders, and microvascular ischemia are hypothesized to be etiologies. Herein, the case of a 54-year-old man who developed VN within three days after COVID-19 vaccination is presented. There have been no reports of VN after vaccination for COVID-19 or other viral diseases. Although the association between VN and COVID-19 vaccination remains unclear, clinicians should be aware that VN may occur as an adverse event of COVID-19 vaccination.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea,CONTACT Junhui Jeong Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang10444, Korea
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16
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Vertigo and Dizziness in Children: An Update. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111025. [PMID: 34828738 PMCID: PMC8623325 DOI: 10.3390/children8111025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 01/24/2023]
Abstract
Background: Vertigo and dizziness are relatively infrequent in paediatric patients, but specific data on the prevalence of these disorders are limited and influenced by various factors, including the age of the examined population. These conditions often have a significant impact on patients’ and parents’ quality of life. The aim of this paper is to investigate the prevalence of different aetiologies of vertigo in the paediatric population through a systematic review. Methods: According to PRISMA guidelines, a systematic review of the literature was performed. Medline and Embase were searched from January 2011 through to 10 September 2021. The search yielded 1094 manuscripts, which were reduced to 7 upon the application of inclusion criteria. Results: A total of 2470 paediatric patients were evaluated by the selected papers. Vestibular Migraine was the most frequently diagnosed condition, occurring alone or in association with other diseases. Overall, audio-vestibular disorders represented the second cause of vertigo, and the prevalence appears to increase according to age growth. Over the years, even though we assisted in the amelioration of diagnostic rates, partially related to an improvement in diagnostic tools, the aetiology of vertigo remains still unclear in a variable percentage of patients. Conclusion: Vertigo in children, despite being an uncommon symptom, requires a multidisciplinary approach, often involving Paediatricians, Neurologists and Otorhinolaryngologists. A comprehensive evaluation of children suffering from vertigo is crucial for establishing a successful therapy and reducing parental worries.
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Barreto RG, Yacovino DA, Cherchi M, Nader SN, Teixeira LJ, Silva DAD, Verdecchia DH. The Role of the Smartphone in the Diagnosis of Vestibular Hypofunction: A Clinical Strategy for Teleconsultation during the COVID-19 Pandemic and Beyond. Int Arch Otorhinolaryngol 2021; 25:e602-e609. [PMID: 34777592 PMCID: PMC8580156 DOI: 10.1055/s-0041-1736340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Vestibular disorders (VDs) are highly prevalent in primary care. Although in general they comprise conditions that are not life-threatening, they are associated with significant functional and physical disability. However, the current coronavirus disease 2019 (COVID-19) pandemic has imposed limitations on the standard treatment of benign conditions, including VDs. In this context, other resources may aid in the diagnosis and management of patients with VDs. It is well known that teleconsultation and teletreatment are both safe and effective alternatives to manage a variety of conditions, and we maintain that VDs should be among these. Objective To develop a preliminary model of clinical guidelines for the evaluation by teleconsultation of patients with suspected diagnosis of vestibular hypofunction during the COVID-19 pandemic and beyond. Methods A bibliographic review of the diagnostic feasibility in VDs by teleconsultation was carried out in the LILACS, SciELO, MEDLINE, and PubMed databases; books and specialized websites were also consulted. The legal, regulatory, and technical issues involving digital consultations were reviewed. Results We found 6 field studies published between 1990 and 2020 in which the efficiency of teleconsultations was observed in the contexts of epidemics and environmental disorders and disadvantageous geographical conditions. After reviewing them, we proposed a strategy to examine and address vestibular complaints related to vestibular hypofunction. Conclusion The creation of a digital vestibular management algorithm for the identification, counseling, initial intervention, monitoring and targeting of people with possible vestibular hypofunction seems to be feasible, and it will provide a reasonable alternative to in-person evaluations during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Renato Gonzaga Barreto
- Neurotology and Vestibular Rehabilitation, Clínica de Neurologia e Psiquiatria, São Paulo, SP, Brazil
| | - Darío Andrés Yacovino
- Otovestibular Section, Neurology Department, Hospital Dr. César Milstein, Buenos Aires, Argentina
- Neurotology and Vestibular Rehabilitation, Laboratorio de Memoria y Equilibrio, Buenos Aires, Argentina
| | - Marcello Cherchi
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Neurotology, Chicago Dizziness and Hearing, Chicago, IL, USA
| | - Saulo Nardy Nader
- Neurotology and Vestibular Rehabilitation, Clínica de Neurologia e Psiquiatria, São Paulo, SP, Brazil
| | | | | | - Daniel Hector Verdecchia
- Kinesiology and Physiatry Course, Department of Health Sciences, Universidad Nacional de La Matanza, Buenos Aires, Argentina
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Benign Paroxysmal Positional Vertigo (BPPV) in COVID-19. Audiol Res 2021; 11:418-422. [PMID: 34449541 PMCID: PMC8395413 DOI: 10.3390/audiolres11030039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: The purpose of this article is to describe BPPV in COVID-19 patients by discussing the possible mechanisms underlying the onset of this vertigo. Methods: We studied eight patients (4 F, 4 M, aged between 44 and 69 years) with COVID-19 infections complaining of vertigo. Patients were evaluated at the end of infection with an accurate clinical history, and the investigation of spontaneous, positional and positioning nystagmus. Results: The vestibular findings showed benign paroxysmal positional vertigo (BPPV) in all the patients. Three patients had a mild phenotype of the COVID infection, whereas five subjects were hospitalized for the COVID infection and in three cases intensive care was required. Vestibular evaluation showed an involvement of posterior semicircular canals in five patients and horizontal in three. Three patients were treated with the Epley maneuver, two with Semont, one with Lempert and two with Gufoni maneuvers. Conclusions: We hypothesize that BPPV in COVID-19 infections can be relate to drugs, prolonged bed rest and to direct damage by viral infection on the peripheral vestibular system and in particular on the otolitic membrane due to the cytopathic effect of the virus and to the inflammatory response. Studies on large series of patients are needed to confirm our preliminary observation and to better evaluate the pathophysiological mechanisms underlying BPPV in these patients.
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Giannantonio S, Scorpecci A, Montemurri B, Marsella P. Case of COVID-19-induced vestibular neuritis in a child. BMJ Case Rep 2021; 14:14/6/e242978. [PMID: 34078625 PMCID: PMC8173285 DOI: 10.1136/bcr-2021-242978] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Since the outbreak of the COVID-19 pandemic, there has been a growing need to fully understand all the possible clinical features of the epidemic, which often presents with unusual manifestations, especially in children. In this report, we describe the case of a child with a COVID-19 infection and suffering exclusively from vertigo and fever. Altogether, considering the clinical manifestation, laboratory tests and imaging, given the patient’s positivity to SARS-CoV-2 infection and its neurotropic potential, we assumed that the child had COVID-19-induced vestibular neuritis, which, in consideration of the spontaneous improvement of symptoms, did not require any therapeutic adjustments, apart from the natural compensation of the central nervous system. This case suggests the importance of having an index of suspicion for a COVID-19 infection in patients with paediatrics presenting with vertigo and adds valuable information to the limited literature on COVID-19 presentation and management in children.
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Affiliation(s)
- Sara Giannantonio
- Audiology and Otosurgery Department, "Bambino Gesù" Children's Hospital, Rome, Lazio, Italy
| | - Alessandro Scorpecci
- Audiology and Otosurgery Department, "Bambino Gesù" Children's Hospital, Rome, Lazio, Italy
| | - Berardo Montemurri
- Audiology and Otosurgery Department, "Bambino Gesù" Children's Hospital, Rome, Lazio, Italy
| | - Pasquale Marsella
- Audiology and Otosurgery Department, "Bambino Gesù" Children's Hospital, Rome, Lazio, Italy
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Fancello V, Hatzopoulos S, Corazzi V, Bianchini C, Skarżyńska MB, Pelucchi S, Skarżyński PH, Ciorba A. SARS-CoV-2 (COVID-19) and audio-vestibular disorders. Int J Immunopathol Pharmacol 2021; 35:20587384211027373. [PMID: 34142589 PMCID: PMC8216371 DOI: 10.1177/20587384211027373] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/03/2021] [Indexed: 12/23/2022] Open
Abstract
To describe the audio-vestibular disorders related to the newly SARS-CoV-2 infection, including the possible ototoxicity side-effects related to the use of drugs included in the SARS-CoV-2 treatment protocols. A systematic review was performed according to the PRISMA protocol. The Medline and Embase databases were searched from March 1, 2020 to April 9, 2021. Initially the search yielded 400 manuscripts, which were reduced to 15, upon the application of inclusion criteria. Sensorineural hearing loss (SNHL) is the most frequent audio-vestibular symptom described, occurring alone or in association with tinnitus and vertigo. The etiopathogenesis of the inner ear disorders related to COVID-19 infection is still poorly understood. The number of reports of COVID-19 infections associated to audio-vestibular disorders is increasing; even if the quality of the studies available is often insufficient, audio-vestibular disorders should be considered as possible manifestations to be included among the symptoms of this infection.
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Affiliation(s)
- Virginia Fancello
- ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Stavros Hatzopoulos
- ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Virginia Corazzi
- ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Magdalena B Skarżyńska
- Institute of Sensory Organs, Kajetany, Poland
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Piotr Henryk Skarżyński
- Institute of Sensory Organs, Kajetany, Poland
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
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