University College London and the Royal National Throat Nose and Ear Hospital have reported the first case of sudden permanent hearing loss linked to COVID-19.
Presenting the case in BMJ Case Reports, the team describes a 45-year-old patient with asthma who presented to the otolaryngology department following a week of hearing loss while in hospital for the treatment of COVID-19.
The patient had been admitted to hospital on day 10 of COVID-19 symptoms and subsequently required intubation and transfer to the intensive care unit (ICU).
He was intubated for 30 days and subsequently suffered bilateral pulmonary emboli, ventilator-associated pneumonia, pulmonary hypertension and anaemia. He received remdesivir, intravenous steroids and plasma exchange.
He had a history of asthma but was otherwise fit and well. His medications during admission were colecalciferol, doxazosin, fluticasone, fluticasone propionate, folic acid, lansoprazole, loratadine, ramipril, rivaroxaban, salbutamol and tadalafil. He was also receiving teicoplanin and ciprofloxacin during his admission, which were completed two days before the time of onset of hearing loss. No ototoxic medications were administered.
His condition improved and was released from ICU. One week after extubation, he reported left-sided tinnitus and sudden onset hearing loss.
On examination, his ear canals were patent and non-inflamed with intact tympanic membranes.
Bedside testing suggested left-sided sensorineural hearing loss. He received seven days of 60 mg oral prednisolone.
Following intratympanic steroid administration, his pure tone audiogram showed partial improvement. He subsequently had three rescue intratympanic injections of 0.5 mL methylprednisolone sodium succinate (125 mg/mL) which resulted in no further improvement.
While no clear aetiology for the hearing loss was found, the authors postulate that this could be related to COVID-19.
They suggest that patients are asked about hearing loss in the ICU environment when applicable, and that any patient reporting acute hearing loss should be referred to otolaryngology on an emergency basis to avoid missing the treatment window and the opportunity to reduce hearing loss-associated morbidity.