Audiovestibularni simptomi infekcije COVID-19

Marisa Klančnik, Petar Ivanišević, Nikola Kolja Poljak, Petar Drviš

Iako najčešće zahvaća gornji respratorni sustav sa simptomima vrućice, kašlja i umora, novi virus SARS-CoV-2 može dovesti do pneumonije i težih komplikacija poput multiorganskog zatajenja. Kako pandemija napreduje i pogađa sve veći broj osoba, pojavljuju se sve više simptomi koji nisu usko povezani s gornjim dišnjim sustavom. Javljaju se gastrointestinalni simptomi, neurološki i kardiološki simptomi, kožne promjene te simptomi unutrašnjeg i srednjeg uha poput gubitka sluha, tinitusa, otalgije i vrtoglavica. Moguća patogeneza virusno-induciranog gubitka sluha jest u direktnom oštećenju struktura unutrašnjeg uha ili u imunološki posredovanom odgovoru. Cilj rada je analizirati i prikazati bolesnike s gubitkom sluha, tinitusom i vrtoglavicom kao kliničkim manifestacijama infekcije SARS-CoV-2. Analizirirali smo 25 bolesnika u dobi između 33 i 70 godina koji se se javili u audiološku ambulantu u vremenu od 1. prosinca 2020. godine do 6. veljače 2021. godine sa simptomima gubitka sluha, tinitusom i vrtoglavicom. Rezultati studije pokazuju da je došlo do akutnoga jednostranog gubitka sluha u dvojice bolesnika, a do akutnoga obostranog u jednog bolesnika tijekom infekcije SARS-CoV-2. U jednog bolesnika je došlo do potpunog oporavka sluha nakon kortikosteroidne terapije, a u dvojice do djelomičnog oporavka. Do gubitka sluha samo u visokim frekvencijama na 4000 i 6000 Hz obostrano došlo je u 13 bolesnika. Radi se ujedno o najkarakterističnijem i najčešćem nalazu sluha. Također vidimo da je došlo do egzacerbacije tinitusa u 4 bolesnika, a do novonastalnog tinitusa u 11 bolesnika. Vrtoglavica se javila u trojice pacijenata i radi se o novonastalim vrtoglavicama. Iako smo otkrili vezu između koronavirusa i gubitka sluha, tinitusa i vrtoglavice, još uvijek ne znamo prevalenciju audioloških manifestacija bolesti jer je i dalje fokus na težim i životno ugrožavajućim stanjima pa se smetnje sluha i ravnoteže često zanemaruju ili se čeka na mogući spontani oporavak i time gubi dragocjeno vrijeme za liječenje i mogući brži oporavak.

Although it most commonly affects the upper respiratory system with symptoms of fever, cough, and fatigue, the new SARS-CoV-2 virus can lead to pneumonia and more serious complications such as multiorgan failure. As the pandemic progresses and affects an increasing number of people, more and more symptoms appear that are not closely related to the upper respiratory system. Gastrointestinal symptoms, neurological and cardiac symptoms, and inner and middle ear symptoms such as hearing loss, tinnitus, and dizziness occur. The possible pathogenesis of virus-induced hearing loss is in direct damage to the structures of the inner ear or in an immune mediated response. The aim of this study was to analyze and present patients with hearing loss, tinnitus and dizziness as clinical manifestations of SARS-CoV-2 infection. We analyzed 25 patients between the ages of 33 and 70 who admitted to the audiology clinic between from December 1, 2020 and to February 6, 2021 with symptoms of hearing loss, tinnitus and dizziness. The results of the study show that there was acute unilateral hearing loss in three patients and acute bilateral hearing loss in one patient during SARS-CoV-2 infection. In one patient there was a complete recovery of hearing after corticosteroid therapy, and in two there was a partial
recovery. Hearing loss only at high frequencies at 4000 and 6000 Hz occurred bilaterally in 13 patients. This is both the most characteristic and the most common hearing finding. We also see that exacerbation of tinnitus occurred in four patients and new-onset tinnitus occurred in nine patients. Dizziness occurred in three patients and it was a new-onset dizziness. Although we have discovered a link between coronavirus and hearing loss, tinnitus and dizziness, we still do not know the prevalence of audiological manifestations of the disease because the focus is still on more severe and life-threatening conditions.