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      New onset tinnitus in the absence of hearing changes following COVID-19 infection

      case-report

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          Abstract

          Background

          A variety of neurosensory symptoms including tinnitus have been associated with COVID-19 infection. While most cases of tinnitus are associated with hearing loss, here we report a case of severe tinnitus following COVID-19 infection with normal thresholds through 8000 Hz.

          Case report

          A 49-year-old male presented with new onset severe tinnitus following COVID-19 infection. Tinnitus was bilateral, constant and nonpulsatile. Audiometric evaluation revealed normal threshold through 8000 Hz, with mild hearing loss at 16,000 Hz. Conservative measures including masking strategies failed to mitigate symptoms. A trial of gabapentin 300 mg twice per day improved tinnitus with no notable side effects.

          Conclusion

          This patient may represent a subpopulation of patients who suffer from severe tinnitus following COVID-19 infection in the setting of largely normal hearing. The pathophysiology may be distinct from the more common hearing loss associated tinnitus and perhaps neuromodulators may play a larger role in mitigating tinnitus in this patient subset.

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          A systematic review of the reporting of tinnitus prevalence and severity.

          Abby McCormack, Mark Edmondson-Jones, Sarah Somerset … (2016)
          There is no standard diagnostic criterion for tinnitus, although some clinical assessment instruments do exist for identifying patient complaints. Within epidemiological studies the presence of tinnitus is determined primarily by self-report, typically in response to a single question. Using these methods prevalence figures vary widely. Given the variety of published estimates worldwide, we assessed and collated published prevalence estimates of tinnitus and tinnitus severity, creating a narrative synthesis of the data. The variability between prevalence estimates was investigated in order to determine any barriers to data synthesis and to identify reasons for heterogeneity.
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            Tinnitus: causes and clinical management.

            Berthold Langguth, Peter M Kreuzer, Tobias Kleinjung … (2013)
            Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus. With prevalence ranging from 10% to 15%, tinnitus is a common disorder. Many people habituate to the phantom sound, but tinnitus severely impairs quality of life of about 1-2% of all people. Tinnitus has traditionally been regarded as an otological disorder, but advances in neuroimaging methods and development of animal models have increasingly shifted the perspective towards its neuronal correlates. Increased neuronal firing rate, enhanced neuronal synchrony, and changes in the tonotopic organisation are recorded in central auditory pathways in reaction to deprived auditory input and represent--together with changes in non-auditory brain areas--the neuronal correlate of tinnitus. Assessment of patients includes a detailed case history, measurement of hearing function, quantification of tinnitus severity, and identification of causal factors, associated symptoms, and comorbidities. Most widely used treatments for tinnitus involve counselling, and best evidence is available for cognitive behavioural therapy. New pathophysiological insights have prompted the development of innovative brain-based treatment approaches to directly target the neuronal correlates of tinnitus. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Prevalence and characteristics of tinnitus among US adults.

              Josef Shargorodsky, Gary Curhan, Wildon Farwell (2010)
              Tinnitus is common; however, few risk factors for tinnitus are known. We examined cross-sectional relations between several potential risk factors and self-reported tinnitus in 14,178 participants in the 1999-2004 National Health and Nutrition Examination Surveys, a nationally representative database. We calculated the prevalence of any and frequent (at least daily) tinnitus in the overall US population and among subgroups. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for multiple potential confounders. Approximately 50 million US adults reported having any tinnitus, and 16 million US adults reported having frequent tinnitus in the past year. The prevalence of frequent tinnitus increased with increasing age, peaking at 14.3% between 60 and 69 years of age. Non-Hispanic whites had higher odds of frequent tinnitus compared with other racial/ethnic groups. Hypertension and former smoking were associated with an increase in odds of frequent tinnitus. Loud leisure-time, firearm, and occupational noise exposure also were associated with increased odds of frequent tinnitus. Among participants who had an audiogram, frequent tinnitus was associated with low-mid frequency (OR 2.37; 95% CI, 1.76-3.21) and high frequency (OR 3.00; 95% CI, 1.78-5.04) hearing impairment. Among participants who were tested for mental health conditions, frequent tinnitus was associated with generalized anxiety disorder (OR 6.07; 95% CI, 2.33-15.78) but not major depressive disorder (OR 1.58; 95% CI, 0.54-4.62). The prevalence of frequent tinnitus is highest among older adults, non-Hispanic whites, former smokers, and adults with hypertension, hearing impairment, loud noise exposure, or generalized anxiety disorder. Prospective studies of risk factors for tinnitus are needed. Published by Elsevier Inc.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Otolaryngol
                Journal ID (iso-abbrev): Am J Otolaryngol
                Title: American Journal of Otolaryngology
                Publisher: Published by Elsevier Inc.
                ISSN (Print): 0196-0709
                ISSN (Electronic): 1532-818X
                Publication date PMC-release: 10 September 2021
                Publication date (Electronic): 10 September 2021
                Electronic Location Identifier: 103208
                Affiliations
                [a ]Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
                [b ]Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America
                Author notes
                [* ]Corresponding author at: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States of America.
                Article
                Publisher Item ID: S0196-0709(21)00309-4 Publisher ID: 103208
                DOI: 10.1016/j.amjoto.2021.103208
                PMC ID: 8429075
                PubMed ID: 34536917
                SO-VID: 8577ded0-b0b7-4575-a1cf-b9a2de9c4769
                Copyright © © 2021 Published by Elsevier Inc.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 25 August 2021
                Categories
                Subject: Article

                Keywords: tinnitus,hearing loss,covid-19 infection,gabapentin,neuromodulators
                Data availability:
                Keywords: tinnitus, hearing loss, covid-19 infection, gabapentin, neuromodulators

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