key: cord-0957611-hsln96pv authors: Tseng, Ping-Tao; Chen, Tien-Yu; Sun, Yu-Shan; Chen, Yen-Wen; Chen, Jiann-Jy title: The reversible tinnitus and cochleopathy followed first-dose AstraZeneca COVID-19 vaccination date: 2021-07-23 journal: QJM DOI: 10.1093/qjmed/hcab210 sha: a58140901d49a05c7f24d9ea01d5f7d2611523db doc_id: 957611 cord_uid: hsln96pv The current case was the first report demonstrating a single case presenting with sudden-onset tinnitus and cochleopathy after his first dosage of the AstraZeneca COVID-19 vaccine. Audiometry revealed an abnormally high short increment sensitivity index. His tinnitus/cochleopathy was reversible and recoverable under conservative steroid management. The abnormality of the high short increment sensitivity index returned to the normal range after steroid management. This case report aimed to increase the cautionary awareness of clinicians concerning the potential adverse events of the AstraZeneca COVID-19 vaccine and the new onset of tinnitus/cochleopathy. In addition, immediate treatment is recommended for managing these patients after the onset of tinnitus/cochleopathy. Furthermore, due to the fact that the adverse event of new-onset tinnitus was reversible and recoverable, we still strongly recommend the continuation of the administration of the AstraZeneca COVID-19 vaccine, based on its merits and demerits. cochleopathy after the administration of the COVID-19 vaccine and to recommend immediate steroid treatment. Because this adverse event was reversible and recoverable, we still strongly recommend the continuation of the administration of the COVID-19 vaccine. The current case report had been edited by Elsevier Language Editing Services on 11-May-2021 (Serial number: LE-211726-88899CF904E8). The current case report had been approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No.: A202105107). The current case report did not receive any funding source. The authors declare no conflict of interest. All authors had access to the data and a role in writing the manuscript The current case was the first report demonstrating a single case presenting with sudden-onset tinnitus and cochleopathy after his first dosage of the AstraZeneca COVID-19 vaccine. Audiometry revealed an abnormally high short increment sensitivity index. His tinnitus/cochleopathy was reversible and recoverable under conservative steroid management. The abnormality of the high short increment sensitivity index returned to the normal range after steroid management. This case report aimed to increase the cautionary awareness of clinicians concerning the potential adverse events of the AstraZeneca COVID-19 vaccine and the new onset of tinnitus/cochleopathy. In addition, immediate treatment is recommended for managing these patients after the onset of tinnitus/cochleopathy. Furthermore, due to the fact that the adverse event of new-onset tinnitus was reversible and recoverable, we still strongly recommend the continuation of the administration of the AstraZeneca COVID-19 vaccine, based on its merits and demerits. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 demonstrated that the patient had recovered well by 5 pm May 3 rd , 2021 ( Figure 1A and 1B), with the THI score returning to 0. The COVID-19 real-time polymerase chain reaction (RT-PCR) detection assay revealed negative findings throughout the entire course of treatment. This is the first case report addressing the time-associated relationship between new-onset tinnitus and the first dose injection of the AstraZeneca COVID-19 vaccine. The potential adverse events of micro-thromboembolism by COVID-19 vaccine would be less likely because steroids do not have any anti-thromboembolism effects. In addition, Mr. A's PTA were normal throughout the entire course which did not fulfill the definition of sudden sensorineural hearing loss. 1 The pandemic of COVID-19 has been preliminarily found to be associated with an increased incidence of tinnitus. 2 In our case, the treatment rationale may be similar to the treatment rationale by Rahimi, V. 3 In the case report by Rahmi, V, the authors provided high dosage intratympanic corticosteroid injections to induce immunosuppression to treat a 60-year-old woman with sudden hearing loss and acute onset tinnitus following her COVID-19 infection. When considering our case, there was no infectious evidence to refute Mr. A's COVID-19 status, and his COVID-19 rt-PCR results revealed a negative finding. Therefore, tinnitus symptoms and impaired SiSi would be less likely to be associated with an actual COVID-19 attack. This case report aimed to recommend immediate steroid treatment for the management of patients of new-onset tinnitus/cochleopathy after the COVID-19 vaccination. Furthermore, due to the fact that the adverse event of new-onset tinnitus was reversible and recoverable, we still strongly recommend the continuation of the administration of the AstraZeneca COVID-19 vaccine, based on its merits and demerits. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 The figures depicted Mr. A's pure tone audiometry on April 18th, May 1st, and May 3rd (Fig 1A) ; the figures depicted his short increment sensitivity index test (SiSi test) on May 1st (the worst day) and May 3rd (symptoms subsided) (Fig 1B) . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis Sudden hearing loss and coronavirus disease 2019: the role of corticosteroid intra-tympanic injection in hearing improvement Manuscripts submitted to QJM