Bilateral Sudden Sensorineural Hearing Loss and Intralabyrinthine Hemorrhage in a Patient With COVID-19

Abstract

Objective: To describe a case of bilateral sudden sensorineural hearing loss (SSNHL) and intralabyrinthine hemorrhage in a patient with COVID-19.

Study design: Clinical capsule report.

Setting: Tertiary academic referral center.

Patient: An adult woman with bilateral SSNHL, aural fullness, and vertigo with documented SARS-CoV-2 infection (IgG serology testing).

Interventions: High-dose oral prednisone with taper, intratympanic dexamethasone.

Main outcome measures: Audiometric testing, MRI of the internal auditory canal with and without contrast.

Results: A patient presented with bilateral SSNHL, bilateral aural fullness, and vertigo. Serology testing performed several weeks after onset of symptoms was positive for IgG COVID-19 antibodies. MRI showed bilateral intralabyrinthine hemorrhage (left worse than right) and no tumor. The patient was treated with two courses of high-dose oral prednisone with taper and a left intratympanic dexamethasone injection, resulting in near-resolution of vestibular symptoms, a fluctuating sensorineural hearing loss in the right ear, and a severe to profound mixed hearing loss in the left ear.

Conclusions: COVID-19 may have otologic manifestations including sudden SSNHL, aural fullness, vertigo, and intralabyrinthine hemorrhage.

FIG. 1

Interval audiograms. A, AD: moderate to severe SNHL, AS: moderate to profound SNHL. B, AD: severe to moderate to profound SNHL, AS: profound to severe to profound SNHL. C, AD: moderately severe to normal to profound SNHL, AS: profound to moderately severe to profound MHL. D, AD: severe to moderate to profound SNHL, AS: profound HL. E, AD: severe to mild to profound SNHL, AS: severe to profound MHL. AD indicates right ear; AS, left ear; HL, hearing loss; MHL, mixed hearing loss; SNHL, sensorineural hearing loss.

FIG. 2

Axial MRI of the internal auditory canal. A, Axial pre-contrast T1-weighted image demonstrates increased signal intensity due to subacute blood in the labyrinth; B, Axial post-contrast T1-weighted image does not reveal enhancement to indicate an inflammatory process or tumor; C, Addition of 3D-FLAIR provides improved sensitivity for evaluation of inner ear structures, revealing a subtle signal abnormality suggestive of hemorrhagic lesions in the right cochlea and lateral semicircular canal that are less obvious on the T1 pre-contrast image. 3D-FLAIR indicates three-dimensional fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.