Pazdro-Zastawny Katarzyna, Dorobisz Karolina, Misiak Paula, Kruk-Krzemień Anna, Zatoński Tomasz
Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland.
Front Neurol. 2022 Sep 20;13:956515. doi: 10.3389/fneur.2022.956515. eCollection 2022.
The COVID-19 clinical symptoms are primarily related to the respiratory system but may also be involved in many others, including the nervous system. Recently, vertigo or dizziness has been described as one of the clinical manifestations and possible complications of COVID-19.
This clinical study was designed to describe the otorhinolaryngological evaluation and videonystagmographic (VNG) findings in patients with an antecedent of COVID-19 infection in the last 6 months. In this study, we sought to investigate the presence of persistent vestibular damage in healed COVID-19 patients and to determine the origin of vertigo by conducting a comprehensive vestibular examination. To evaluate the association precisely, an otoneurological assessement was conducted on all participants. The study group included 58 patients aged 23-75 years with vertigo, who were diagnosed with COVID-19 infection 6 months before the examination. Each participant was submitted to an evaluation consisting of anamnesis, otorhinolaryngological evaluation, and VNG.
Spontaneous nystagmus with closed eyes was reported in 8 patients (13.8%). Positional nystagmus was observed in 15 patients (24.1%). Asymmetrical optokinetic nystagmus was observed in 18 patients (31%). A distorted record in the tracking pendulum test was present in 23 patients (39.7%). Square waves were observed in 34 COVID-19 patients (58.6%). Unilateral weakness (UW) was observed in 23 subjects (39.7%); among those with UW, 22 patients (95.7%) also demonstrated directional preponderance contralateral to the UW. Another 16 patients (27.6%) presented only directional advantage. The post-caloric recruitment was present in 38% patients.
Patients who had been diagnosed with COVID-19 seem to be more likely to suffer from vertigo/dizziness and to compensate more slowly. COVID-19 infection may cause inner ear damage and lead to vestibular dysfunction. The role of the central nervous system in the onset of equilibrium disorders should be considered. The presence of vertigo of central origin may indicate the neurotropic effect of SARS-CoV-2 following COVID-19. Imbalance may be the only symptom of COVID-19 and may also be a late complication of the disease due to post-infectious inflammation of the nervous tissue. Comprehensive studies are needed to investigate whether COVID-19 can cause long-term vestibular deficits.
新型冠状病毒肺炎（COVID-19）的临床症状主要与呼吸系统有关，但也可能累及许多其他系统，包括神经系统。最近，眩晕或头晕已被描述为COVID-19的临床表现和可能的并发症之一。
本临床研究旨在描述过去6个月内有COVID-19感染史患者的耳鼻喉科评估及视频眼震图（VNG）检查结果。在本研究中，我们试图通过全面的前庭检查来调查COVID-19康复患者中持续性前庭损伤的存在情况，并确定眩晕的根源。为了精确评估这种关联，对所有参与者进行了耳神经学评估。研究组包括58例年龄在23至75岁之间的眩晕患者，他们在检查前6个月被诊断为COVID-19感染。每位参与者都接受了包括问诊、耳鼻喉科评估和VNG的评估。
8例患者（13.8%）报告有闭眼时的自发性眼震。15例患者（24.1%）观察到位置性眼震。18例患者（31%）观察到不对称视动性眼震。23例患者（39.7%）在跟踪摆试验中有记录失真。34例COVID-19患者（58.6%）观察到方波。23例受试者（39.7%）观察到单侧前庭功能减退（UW）；在UW患者中，22例患者（95.7%）也表现出与UW对侧的优势偏向。另外16例患者（27.6%）仅表现出优势偏向。38%的患者存在冷热试验后增强现象。
已被诊断为COVID-19的患者似乎更容易出现眩晕/头晕，且代偿更慢。COVID-19感染可能导致内耳损伤并导致前庭功能障碍。应考虑中枢神经系统在平衡障碍发病中的作用。中枢性眩晕的存在可能表明COVID-19后SARS-CoV-2的嗜神经作用。失衡可能是COVID-19的唯一症状，也可能是由于神经组织感染后炎症导致的疾病晚期并发症。需要进行全面研究以调查COVID-19是否会导致长期前庭功能缺陷。
