Sudden irreversible hearing loss post COVID-19: A BMJ case r
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Sudden onset sensorineural hearing loss (SSNHL) is frequently seen by otolaryngologists. This paper presents the first UK case of SSNHL following COVID-19.

A 45-year-old patient with asthma presented to otolaryngology department following a week of hearing loss while in hospital for the treatment of COVID-19. He was admitted to hospital on day 10 of COVID-19 symptoms and subsequently required intubation and transfer to ICU due to high work of breathing. He was intubated for 30 days and his admission was further complicated by bilateral pulmonary emboli, ventilator-associated pneumonia, pulmonary hypertension and anemia.

He received remdesivir, intravenous steroids and plasma exchange to treat his COVID-19 infection and clinically improved. A week after extubation and transfer out of ITU he noticed left-sided tinnitus and sudden onset hearing loss. He had no previous history of hearing loss or ear pathology.

On examination his ear canals were patent and non-inflamed with intact tympanic membranes. Bedside testing suggested left-sided sensorineural hearing loss with a negative Rinne’s test on that side and a Weber’s test lateralizing to the opposite side. He had no further focal neurology. He was managed with 7 days of 60 mg oral prednisolone. He subsequently had a pure tone audiogram confirming the diagnosis with 2, 3, 4 and 6 kHz frequencies being the most affected and elevated hearing thresholds of 65, 75, 75 and 85 dB, respectively. He subsequently underwent a series of intratympanic steroid injections.

Following intratympanic steroid administration, his pure tone audiogram showed partial improvement with thresholds of 55, 60, 60, 80 dB at 2, 3, 4 and 6 kHz frequencies, respectively.

At the onset of his hearing loss his white cell count was within normal range with a slightly elevated CRP linked to his COVID-19. Full autoimmune screen including rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibody, centromere antibody, smooth muscle antibody and anti-cardiolipin antibody was negative. Angiotensin converting enzyme, immunoglobulins and complement C3 and C4 were within normal range. A viral screen for influenza and HIV was negative.

An MRI scan of the internal auditory meatus excluded further causes of the unilateral hearing loss.

The main treatment for the patient’s symptoms was the administration of steroids. He successfully completed a course of 60 mg oral steroids for 7 days which resulted in partial subjective improvement in his hearing. He subsequently had three rescue intratympanic injections of 0.5 mL methylprednisolone sodium succinate (125 mg/mL) which resulted in no further improvement in his hearing seen on pure tone audiograms.

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