One year on: an updated systematic review of SARS-CoV-2, COVID-19 and audio-vestibular symptoms

Abstract

Objective

The aim was to systematically review the literature to December 2020, in order to provide a timely summary of evidence on SARS-CoV-2, COVID-19 and audio-vestibular symptoms.

Design

The protocol was registered in the International Prospective Register of Systematic Reviews. The methods were developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Risk of bias was assessed using the National Institutes of Heath quality assessment tools.

Study sample

After rejecting 850 records, 28 case reports/series and 28 cross-sectional studies met the inclusion criteria.

Results

There are multiple reports of hearing loss (e.g. sudden sensorineural), tinnitus and rotatory vertigo in adults having a wide range of COVID-19 symptom severity. The pooled estimate of prevalence based primarily on retrospective recall of symptoms, was 7.6% (CI: 2.5–15.1), 14.8% (CI: 6.3–26.1) and 7.2% (CI: 0.01–26.4), for hearing loss, tinnitus and rotatory vertigo, respectively. However, these could be an over-estimate because it was not always clear that studies report a change in symptom.

Conclusion

There are multiple reports of audio-vestibular symptoms associated with COVID-19. However, there is a dearth of high-quality studies comparing COVID-19 cases and controls.

Review registration

Prospective Register of Systematic Reviews (PROSPERO); registration number CRD42020227038).

Keywords:

• Coronavirus
• Covid-19
• SARS-CoV-2
• hearing loss
• tinnitus
• vertigo

Acknowledgment

IA is partially funded, and KJM is supported, by the NIHR Manchester Biomedical Research Centre under Grant (number IS-BRC-1215-20007). IA is also supported by the Deanship of Scientific Research at the College of Applied Medical Sciences Research Centre at King Saud University. We thank Becky Skidmore, the information specialist, for developing the search strategy for this rapid systematic review. We thank our colleagues Hannah Guest and Chris Plack for providing rapid and helpful comments on an earlier draft of the manuscript. We also thank our colleagues Melanie Lough and Helen Whiston for assisting with data extraction. The review team also extend their gratitude to Pam Vallely (professor of medical virology) and Tanya Walsh (professor of healthcare evaluation) for their valuable input on potential mechanisms and meta-analysis, respectively. Sincere thanks to the anonymous reviewers and editors who provided helpful comments in a timely manner.

Disclosure statement

The authors declare no conflict of interest.

Notes

1 Currently there is little evidence that SARS-CoV-2 is neurotropic. For example, Frontera et al (2021) have shown that neurological disorders in hospitalised COVID-19 cases are primarily a sequelae of severe systemic illness such as admission to an ICU or a result of stroke.