key: cord-0892254-purqe8ug
authors: Finsterer, Josef; Scorza, Fulvio A; Fiorini, Ana C
title: Impaired hearing following SARS-CoV-2 vaccinations
date: 2021-12-09
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2021.12.317
sha: 5f051e17cd6e65262fe6f5f86072f3659b95a24a
doc_id: 892254
cord_uid: purqe8ug

nan

We appreciated to read the article by Jeong et al. about three patients developing sensorineural hearing loss (SNHL) 3-16 days after the second Astra Zeneca vaccine (AZV) (case-1), the first Pfizer vaccine (BPV) (case-2), and after the 2. BPV (table 1) [Jeong et al. 2021 ]. Only two patients benefited from steroids. In case-3 SNHL deteriorated under treatment [Jeong et al. 2021 ]. The study is appealing but raises concerns.

We do not agree that SNHL is a rare adverse reaction to SARS-CoV-2 vaccines [Jeong et al. 2021 ].

Searching the literature revealed that at least 1178 cases with SNHL following a SARS-CoV-2 vaccination have been reported (table 1). In the majority of cases, SNHL occurred already after the first jab. Most frequently SNHL occurred in association with the AZV. The figure does not include the self reports of the VAERS platform.

The authors propose that the viral infection could have been the cause of SNHL but they do not provide evidence that supports this assumption [Jeong et al. 2021 ]. Since it is well appreciated that SARS-CoV-2 vaccinations can cause thrombosis or autoimmune disease, including vasculitis or thrombocytopenia, these other mechanisms should be considered as they are more likely responsible than a direct viral attack for SNHL after SARS.CoV-2 vaccinations. It is also conceivable that SNHL is due to mononeuritis of cranial nerve VIII. Mono-/polyneuritis of cranial nerves have been repeatedly reported in SARS-CoV-2 infected and vaccinated [Finsterer et al. 2021a ] and may or may not go along with simultaneous affection of the peripheral nerves [Finsterer et al. 2021b ]. Additionally, it has been reported that SARS-CoV-2 vaccination can trigger autoimmune disease such as radiculitis. An argument for an immunogenic mechanism of SNHL is that at least in two of the index cases a beneficial response to steroids was reported. How can viral infection be the cause of SNHL, as suspected in the abstract, although no virus is injected by the vaccination?

Unfortunately, the case description of the three included patients does not provide information if symptoms in addition to SNHL, such as tinnitus, vertigo, dizziness, or aural fullness, were noted.

Knowing these details and investigating the patients for side effects other than SBHL is crucial for the choice of treatment and to assess the outcome of these patients.

Overall, the interesting study has several limitations which challenge the results and their interpretation. SNHL is not infrequent and the mechanism responsible for SNHL after a SARS-CoV-2 vaccination is rather immunogenic than infectious.

Ethical approval and consent to participate: not applicable Consent for Publication: not applicable Availability of data and material: all data reported are available from the corresponding author Competing interests: none Funding: none received Table 1 . Reported patients with SNHL following a SARS-CoV-2 vaccination

COVID-19 associated cranial nerve neuropathy: A systematic review

Guillain-Barre syndrome in 220 patients with COVID-19

Preliminary Analysis of Association Between COVID-19 Vaccination and Sudden Hearing Loss Using US Centers for Disease Control and Prevention Vaccine Adverse Events Reporting System Data

Sudden sensorineural hearing loss after COVID-19 vaccination

MHRA

Sudden Sensorineural Hearing Loss Following the Second Dose of COVID-19 Vaccine

Otologic Manifestations After COVID-19 Vaccination: The House Ear Clinic Experience

Author contribution: JF: design, literature search, discussion, first draft, critical comments, FS and AF: literature search, discussion, critical comments, final approval