Since the coronavirus pandemic, there have been several studies looking into alterations within the auditory system but few in the vestibular system associated with Covid-19. This review delves into the specific evidence. It is challenging to elucidate the link between vestibular pathologies and Covid-19. Some vestibular symptoms such as dizziness, vertigo and tinnitus are described as the most common in Covid-19 patients. In addition, it is difficult to determine whether the dizziness corresponds to vestibular pathology or some other dysfunction (post-covid fatigue syndrome). This review investigated the most prevalent vestibular pathologies associated with SARS-CoV-2 infection, namely, one cross-sectional study, three retrospective clinical studies, one case-control study and 12 case reports. The primary pathology described was benign paroxysmal postural vertigo (BPPV) and vestibular neuronitis. Varying objective vestibular evaluation tests were performed, however, exhaustive examination could not be performed early in the pandemic due to sanitary conditions. In addition, there was no uniformity between studies. Mechanism of SARS-CoV-2 damage in vestibular pathologies was assessed by the reviewers. Three routes of infection are postulated: (1) central nervous system via the olfactory bulb, (2) via the endolymphatic sac, and (3) by haematogenous dissemination through the stria vascularis. The most obvious hypothesis for pathophysiological damage is that the virus is directly targeting the structures of the inner ear through the ACE-2 and TMPRSS2 receptors present in some inner ear tissues. In conclusion, most selected studies show that vestibular type involvement would be transient inner ear involvement that resolves in most cases spontaneously. However, more basic science, clinical and translational studies are needed to verify and understand the short- and long-term effects of SARS-CoV-2 on the vestibular system.
Covid-19 and vestibular symptoms review
Reviewed by Aaron Ferguson
Covid-19 and Vestibular Symptoms and Assessment: A Review.
