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.