Case Description
We present the 9th case of SSNHL in a SARS-CoV-2
positive patient. Written informed consent was obtained. This patient, a
53-year-old man of Turkish origin, presented at the emergency department
in the beginning of November 2020 because of a sudden right-sided
hearing loss. He mentioned fatigue and a subfebrile status in the past
twelve days. Anamnestically, there were no other general nor
neuro-otological symptoms such as vertigo or instability. The patient
had no medical history and was not taking any medication. On the day of
referral to the emergency department, a SARS-CoV-2 PCR was performed by
his general practitioner and proved to be positive. Clinical and
technical examination by an otorhinolaryngologist showed normal
otomicroscopy, normal tympanometry and a cophosis on the right side.
Video Head Impulse Testing showed a deficit of the right anterior
semicircular canal. Audiometric and vestibular findings are shown in
Figure 1A-C. Blood analysis showed normal hematologic and serum
biochemical levels, except for an elevated fibrinogen (6.9 g/L, range
2.0-4.0 g/L) and CRP (84 mg/L, range <10 mg/L). Serology was
performed, showing presence of specific Epstein-Barr virus and
Cytomegalovirus IgG in absence of specific IgM.
A single dose of methylprednisolone 80mg and piracetam 12g were
administered intravenously. After shared decision making, the patient
was discharged from the hospital with oral treatment consisting of
methylprednisolone once daily, piracetam 2.4g twice daily, zinc and a
proton pump inhibitor. Regular follow-up consultations were planned.
Tonal audiometry thresholds successively improved for each evaluation,
but only in the lower and middle frequencies (Figure 2). The patient did
not mention a subjective hearing improvement until two weeks after onset
of SSNHL. The per oral corticosteroid treatment was followed by
right-sided intratympanic injections of 2ml dexamethasone (5mg/ml). The
patient underwent magnetic resonance imaging of the temporal bones,
excluding retrocochlear pathology. Serology performed after two weeks
showed presence of SARS-CoV-2 IgM/IgG (15.8 UA/mL, range <1.0
UA/mL). One month after onset of SSNHL, a disabling unilateral hearing
loss remained. The timing of diagnostic assessments and therapeutical
interventions is visualized in Figure 3.