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      Tinnitus and equilibrium disorders in COVID-19 patients: preliminary results

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          Abstract

          Purpose

          Tinnitus and equilibrium disorders such as dizziness and vertigo have been reported by patients with COVID-19; however, they have been rarely investigated. The aim of this study was to study the prevalence of subjective tinnitus and dizziness in a sample of COVID-19 patients using an online 10-item close-ended questionnaire.

          Methods

          A multicentric study that included 15 Italian hospitals in different regions was conducted using an online 10-item close-ended questionnaire developed to identify the presence of tinnitus and balance disorders in patients with COVID-19 between May 5 and June 10, 2020. The questionnaire was administered to 185 patients in a period of > 30 – < 60 days after diagnosis of COVID-19; responses were recorded in an online Excel spreadsheet. The questionnaire was composed of three sections: (1) demographic information; (2) presence and characteristics of tinnitus and dizziness after COVID-19 diagnosis; (3) possible association with migraine.

          Results

          Thirty-four patients (18.4%) reported equilibrium disorders after COVID-19 diagnosis. Of these, 32 patients reported dizziness (94.1%) and 2 (5.9%) reported acute vertigo attacks. Forty-three patients (23.2%) reported tinnitus; 14 (7.6%) reported both tinnitus and equilibrium disorders.

          Conclusion

          This study suggests that the presence of subjective otoneurological symptoms such as tinnitus and balance disorders can affect COVID-19 patients; further studies are necessary to investigate the prevalence and pathophysiological mechanisms underlying these subjective symptoms in COVID-19 patients.

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          A first case of meningitis/encephalitis associated with SARS-Coronavirus-2

          Takeshi Moriguchi, Norikazu Harii, Junko Goto … (2020)
          Highlights • Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly. • This is the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance. • The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF. • This case warns the physicians of patients who have CNS symptoms.
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            Hypercoagulability of COVID‐19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis

            Mauro Panigada, Nicola Bottino, Paola Tagliabue … (2020)
            Background The severe inflammatory state secondary to COVID‐19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation products such as D‐dimer, as well as low fibrinogen. Aims Whole blood from 24 patients admitted at the intensive care unit because of COVID‐19 was collected and evaluated with thromboelastography by the TEG point‐of‐care device on a single occasion and six underwent repeated measurements on two consecutive days for a total of 30 observations. Plasma was evaluated for the other parameters of hemostasis. Results TEG parameters are consistent with a state of hypercoagulability as shown by decreased values, and increased values of K angle and MA. Platelet count was normal or increased, prothrombin time and activated partial thromboplastin time were near(normal). Fibrinogen was increased and D‐dimer was dramatically increased. C‐reactive protein was increased. Factor VIII and von Willebrand factor (n = 11) were increased. Antithrombin (n = 11) was marginally decreased and protein C (n = 11) was increased. Conclusion The results of this cohort of patients with COVID‐19 are not consistent with acute DIC, rather they support hypercoagulability together with a severe inflammatory state. These findings may explain the events of venous thromboembolism observed in some of these patients and support antithrombotic prophylaxis/treatment. Clinical trials are urgently needed to establish the type of drug, dosage, and optimal duration of prophylaxis.
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              Self-reported Olfactory and Taste Disorders in Patients With Severe Acute Respiratory Coronavirus 2 Infection: A Cross-sectional Study

              Andrea Giacomelli, Laura Pezzati, Federico Conti … (2020)
              To the Editor—We read with interest the article by Wang et al [1] describing the clinical features of 69 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Wuhan, China. The authors provide a detailed description of major signs and symptoms of overt disease [2, 3], but fail to give an account of minor symptoms that may be present at earlier stages of the infection. After some patients admitted for coronavirus disease 2019 (COVID-19) at the Infectious Disease Department of L. Sacco Hospital in Milan, Italy, complained of olfactory and taste disorders (OTDs), we performed a cross-sectional survey of the prevalence of these alterations in the context of SARS-CoV-2 infection. On 19 March 2020, a simple questionnaire including questions about the presence or absence of OTDs, their type and time of onset respective to hospitalization were submitted through verbal interview to all SARS-CoV-2–positive hospitalized patients who were able to give informed consent. Of 88 hospitalized patients, 59 were able to be interviewed (29 were nonrespondents, of whom 4 had dementia, 2 had a linguistic barrier, and 23 were on noninvasive ventilation) (Table 1). Of these, 20 (33.9%) reported at least 1 taste or olfactory disorder and 11 (18.6%) both. Twelve patients (20.3%) presented the symptoms before the hospital admission, whereas 8 (13.5%) experienced the symptoms during the hospital stay. Taste alterations were more frequently (91%) before hospitalization, whereas after hospitalization taste and olfactory alteration appeared with equal frequency. Females reported OTDs more frequently than males (10/19 [52.6%] vs 10/40 [25%]; P = .036). Moreover, patients with at least 1 OTD were younger than those without (median, 56 years [interquartile range {IQR}, 47–60] vs 66 [IQR, 52–77]; P = .035). All patients reported the persistence of OTDs at the time of the interview. Table 1. Characteristics of Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection Assessed for Taste and Olfactory Disorders (N = 59) Patients No. (%) Age, y, median (IQR) 60 (50–74) Male sex 40 (67.8) Days from illness onset to hospital admission, median (IQR) 6 (4–10) Days from illness onset to the interview, median (IQR) 15 (10–21) Pneumonia at hospital admission 43 (72.8) Symptoms at hospital admission  Fever 43 (72.8)  Cough 22 (37.3)  Dyspnea 15 (25.4)  Sore throat 1 (1.7)  Arthralgia 3 (5.1)  Coryza 1 (1.7)  Headache 2 (3.4)  Asthenia 1 (1.7)  Abdominal symptoms 5 (8.5) No taste or olfactory disorders 39 (66.1) With olfactory and/or taste disorders 20 (33.9) Taste disorders only  Dysgeusia 5 (8.5)  Ageusia 1 (1.7) Olfactory disorders only  Hyposmia 3 (5.1)  Anosmia 0 (0) Mixed taste and olfactory disorders  Dysgeusia and hyposmia 2 (3.4)  Dysgeusia and anosmia 2 (3.4)  Ageusia and hyposmia 2 (3.4)  Ageusia and anosmia 5 (8.5) Data are presented as no. (%) unless otherwise indicated. Abbreviations: IQR, interquartile range; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Olfactory and taste disorders are well known to be related with a wide range of viral infections [4, 5]. SARS-CoV has demonstrated in a mice model a transneural penetration through the olfactory bulb [6]. Moreover, angiotensin-converting enzyme 2 receptor, which is used by SARS-CoV-2 to bind and penetrate into the cell, is widely expressed on the epithelial cells of the mucosa of the oral cavity [7]. These findings could explain the underlying pathogenetic mechanism of taste and olfactory disorders in SARS-CoV-2 infection. Due to limitations related to the diffusivity of the disease and emergency contingencies, it was impossible to perform a more structured questionnaire associated with validated tests (ie, Pennsylvania smell identification test) [8]. However, our survey shows that OTDs are fairly frequent in patients with SARS-CoV-2 infection and may precede the onset of full-blown clinical disease. In a pandemic context, further investigations on nonhospitalized infected patients are required to ascertain if these symptoms, albeit unspecific, may represent a clinical screening tool to orientate testing of pauci-symptomatic individuals.
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                Author and article information

                Contributors
                Davide Pisani:
                ORCID: http://orcid.org/0000-0001-7486-0140
                davidepisani@gmail.com
                Journal
                Journal ID (nlm-ta): Eur Arch Otorhinolaryngol
                Journal ID (iso-abbrev): Eur Arch Otorhinolaryngol
                Title: European Archives of Oto-Rhino-Laryngology
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0937-4477
                ISSN (Electronic): 1434-4726
                Publication date (Electronic): 23 October 2020
                Pages: 1-6
                Affiliations
                [1 ]GRID grid.411489.1, ISNI 0000 0001 2168 2547, Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, , Magna Graecia University, ; Catanzaro, Italy
                [2 ]GRID grid.7841.a, Department of Sense Organs, , Sapienza University of Rome, ; Rome, Italy
                [3 ]GRID grid.411489.1, ISNI 0000 0001 2168 2547, Laboratory of Molecular Oncology, Department of Experimental and Clinical Medicine, , Magna Graecia University, ; Catanzaro, Italy
                [4 ]GRID grid.411489.1, ISNI 0000 0001 2168 2547, Interdepartmental Center of Services (CIS), , Magna Graecia University, ; Catanzaro, Italy
                [5 ]GRID grid.4691.a, ISNI 0000 0001 0790 385X, Department of Neurosciences, Reproductives and Odontostomatologic Sciences, Unit of Audiology, , University of Naples “Federico II”, ; Naples, Italy
                [6 ]GRID grid.415845.9, Unit of Otolaryngology, , “Ospedali Riuniti”, ; Ancona, Italy
                [7 ]Unit of Otolaryngology, “S. Giuseppe Hospital”, Empoli, Firenze, Italy
                [8 ]GRID grid.419038.7, ISNI 0000 0001 2154 6641, Unit of Medicine and Rheumatology, , IRCCS Istituto Ortopedico Rizzoli, ; Bologna”, Italy
                [9 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Department of Biomedical and Neuromotor Sciences (DIBINEM), , University of Bologna, ; Bologna, Italy
                [10 ]GRID grid.11780.3f, ISNI 0000 0004 1937 0335, Department of Medicine, Surgery and Dentistry, , University of Salerno, ; Salerno, Italy
                [11 ]Unit of Otolaryngology, “Mazzini Hospital”, Teramo, Italy
                [12 ]Unit of Maxillofacial Surgery, “Mazzini Hospital”, Teramo, Italy
                [13 ]Unit of Infectious Diseases, “Pugliese-Ciaccio Hospital”, Catanzaro, Italy
                [14 ]Unit of Otolaryngology, General Hospital of Modena and Reggio Emilia, Modena, Italy
                Author information
                http://orcid.org/0000-0001-7486-0140
                Article
                Publisher ID: 6440
                DOI: 10.1007/s00405-020-06440-7
                PMC ID: 7582442
                PubMed ID: 33095432
                SO-VID: 322b93a8-5ef3-435d-bdc5-9896fa2deead
                Copyright © © Springer-Verlag GmbH Germany, part of Springer Nature 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 26 August 2020
                Date accepted : 13 October 2020
                Categories
                Subject: Otology

                ScienceOpen disciplines: Otolaryngology
                Keywords: covid-19,tinnitus,vestibular disorders,dizziness,screening
                Data availability:
                ScienceOpen disciplines: Otolaryngology
                Keywords: covid-19, tinnitus, vestibular disorders, dizziness, screening

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