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Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss

  • Osman Kilic
    Affiliations
    Istanbul Medeniyet University, Faculty of Medicine, Departments of Otorhinolaryngology- Head and Neck Surgery, Goztepe Training and Research Hospital, Istanbul, Turkey
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  • Mahmut Tayyar Kalcioglu
    Correspondence
    Corresponding author at: Istanbul Medeniyet University, Faculty of Medicine, Departments of Otorhinolaryngology – Head and Neck Surgery, Goztepe Training and Research Hospital, Istanbul, Turkey.
    Affiliations
    Istanbul Medeniyet University, Faculty of Medicine, Departments of Otorhinolaryngology- Head and Neck Surgery, Goztepe Training and Research Hospital, Istanbul, Turkey
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  • Yasemin Cag
    Affiliations
    Istanbul Medeniyet University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Goztepe Training and Research Hospital, Istanbul, Turkey
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  • Ozan Tuysuz
    Affiliations
    Istanbul Medeniyet University, Faculty of Medicine, Departments of Otorhinolaryngology- Head and Neck Surgery, Goztepe Training and Research Hospital, Istanbul, Turkey
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  • Emel Pektas
    Affiliations
    Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Audiology, Istanbul, Turkey
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  • Hulya Caskurlu
    Affiliations
    Istanbul Medeniyet University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Goztepe Training and Research Hospital, Istanbul, Turkey
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  • Ferihan Cetın
    Affiliations
    Istanbul Medeniyet University, Faculty of Medicine, Departments of Physiology, Istanbul, Turkey
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Open AccessPublished:June 11, 2020DOI:https://doi.org/10.1016/j.ijid.2020.06.023

      Highlights

      • During the COVID-19 pandemic it is important to recognize every possible symptom of the virus to break the chain of transmission.
      • COVID-19 patients could present with nonspecific symptoms other than those that are commonly known.
      • Sudden sensorineural hearing loss may be one of the symptoms of COVID-19.
      • Until now there have been no reports of COVID-19 patients diagnosed with isolated sudden sensorineural hearing loss.

      Abstract

      Objective

      This study aimed to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients presenting with only sudden sensorineural hearing loss (SSHNL) during the COVID-19 pandemic.

      Methods

      The study included five male patients who presented with the sole complaint of unilateral SSNHL to the otolaryngology outpatient clinic between 03–12 April 2020. The patients were referred to the infectious diseases clinic to be evaluated for SARS-CoV-2 by real time polymerase chain reaction (RT-PCR) testing.

      Results

      RT-PCR testing for SARS-CoV-2 was positive in one of the patients and negative in the other four patients. A positive response to COVID-19-specific treatment in the SARS-CoV-2 positive SSNHL patient was noted.

      Conclusion

      It should be remembered that non-specific symptoms such as SSNHL could be the only sign with which to recognize a COVID-19 case. Awareness of such a non-specific presentation of COVID-19 patients is crucial during this pandemic period for preventing infectious spread through isolation and early initiation of COVID-19 targeted treatment.

      Keywords

      Introduction

      Emerged in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease (COVID-19), has been causing deaths from pneumonia and respiratory failure and was eventually declared a pandemic. It was identified as a clade of the family of coronaviruses, isolated from human airway epithelial cells (
      • Zhu N.
      • Zhang D.
      • Wang W.
      • Li X.
      • Yang B.
      • Song J.
      • et al.
      A novel coronavirus from patients with pneumonia in China, 2019.
      ) and reported as transmitted through droplets and direct contact, with an incubation period of 2–7 days extending up to 14 days (
      • Rubin E.J.
      • Baden L.R.
      • Morrissey S.
      • Campion E.W.
      Medical journals and the 2019-nCoV outbreak.
      ,
      • Gralinski L.E.
      • Menachery V.D.
      Return of the coronavirus: 2019-nCoV.
      ,
      • Duarte R.
      • Furtado I.
      • Sousa L.
      • Carvalho C.F.A.
      The 2019 novel coronavirus (2019-nCoV): novel virus. old challenges.
      ,
      • Carlos W.G.
      • Dela Cruz C.S.
      • Cao B.
      • Pasnick S.
      • Jamil S.
      Novel Wuhan (2019-nCoV) coronavirus.
      ,
      • Morse J.S.
      • Lalonde T.
      • Xu S.
      • Liu W.R.
      Learning from the past: possible urgent prevention and treatment options for severe acute respiratory infections caused by 2019-nCoV.
      ). The disease may be asymptomatic in about a third of the cases, accelerating the spread of the disease (
      • Lai C.C.
      • Shih T.P.
      • Ko W.C.
      • Tang H.J.
      • Hsueh P.R.
      Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges.
      ,
      • Cao Y.
      • Liu X.
      • Xiong L.
      • Cai K.
      Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis.
      ,
      • Wu D.
      • Wu T.
      • Liu Q.
      • Yang Z.
      The SARS-CoV-2 outbreak: what we know [published online ahead of print, 2020 Mar 12].
      ). The most common symptoms that accompany COVID-19 include fever, cough, sore throat, headache, muscle pain, diarrhea, and dyspnea. During the spread of the infection, nonspecific taste and smell disturbances have also been included in the spectrum of the symptoms (
      • Vaira L.A.
      • Salzano G.
      • Deiana G.
      • De Riu G.
      Anosmia and ageusia: common findings in COVID-19 patients.
      ,
      • Mao L.
      • Jin H.
      • Wang M.
      • Hu Y.
      • Chen S.
      • He Q.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      ).
      Viruses are known to cause neurological manifestations, such as anosmia, facial paralysis and sudden sensorineural hearing loss (SSNHL) (
      • Kennedy P.G.
      Herpes simplex virus type 1 and Bell's palsy-a current assessment of the controversy.
      ,
      • Cohen B.E.
      • Durstenfeld A.
      • Roehm P.C.
      Viral causes of hearing loss: a review for hearing health professionals.
      ,
      • Mateer E.J.
      • Huang C.
      • Shehu N.Y.
      • Paessler S.
      Lassa fever-induced sensorineural hearing loss: a neglected public health and social burden.
      ). During the previous SARS outbreak, coronaviruses were reported be associated with loss of sense of smell and taste due to neural injury (
      • de Haro-Licer J.
      • Roura-Moreno J.
      • Vizitiu A.
      • González-Fernández A.
      • González-Ares J.A.
      Long term serious olfactory loss in colds and/or flu.
      ,
      • Suzuki M.
      • Saito K.
      • Min W.P.
      • Vladau C.
      • Toida K.
      • Itoh H.
      • et al.
      Identification of viruses in patients with postviral olfactory dysfunction.
      ). However, it is believed that no reports of SSNHL have appeared in the literature associated with the COVID-19 pandemic. Identification of patients presenting with non-specific symptoms during the pandemic may play an important role in breaking the infection chain and reducing transmission. Given the previous literature data on coronavirus-associated SSNHL, this study aimed to investigate the presence of SARS-CoV-2 in patients presenting with only SSNHL during this pandemic.

      Materials and methods

      The study protocol was approved by the Clinical Research Ethics Committee of Istanbul Medeniyet University Goztepe Training and Research Hospital (April 9, 2020/0188).
      The subjects were eligible for the study if they presented with the sole complaint of unilateral sudden hearing loss to the otolaryngology outpatient clinic between 3 and 12 April 2020. SSNHL was defined as a hearing loss of >30 dB at three consecutive frequencies at least over a period of <3 days (
      • Weiss D.
      • Böcker A.J.
      • Koopmann M.
      • Savvas E.
      • Borowski M.
      • Rudack C.
      Predictors of hearing recovery in patients with severe sudden sensorineural hearing loss.
      ). Audiological tests confirmed SSNHL in all the patients. The patients were then referred to the infectious diseases clinic to be assessed for SARS-CoV-2. Taking strict precautions – in a safety cabinet with disposable isolation gowns, N95 masks, gloves, and shields – pharyngeal secretion samples were collected from the oropharynx and then the nasopharynx through direct contact with swabs. The samples were sent to the laboratory for real-time polymerase chain reaction (RT-PCR) testing.

      Results

      Five male patients, with a mean age of 40.8 years (range, 29–54 years), were identified. Three patients (60%) had SSNHL in the left ear, and two (40%) in the right ear. SSNHL was the only symptom present in all the patients. None of the patients had any other symptoms than SSNHL or any risk factors such as metabolic diseases, ototoxic drug usage, history of trauma, history of upper respiratory tract infections, etc.
      On audiologic examination with a tuning fork at a frequency of 512 Hz, the Weber test showed lateralization to the right in patients with left-sided hearing loss and to the left in those with right-sided hearing loss. Tympanometry results were type A for all patients, indicating normal middle ear conditions. RT-PCR testing for SARS-CoV-2 was positive in one of the patients (20.0%) and negative in the remaining four patients. Pure tone audiometry findings at 250, 500, 1000, 2000, 4000 and 8000 Hz and RT-PCR results are presented in Table 1.
      Table 1Pure tone audiometry findings and RT-PCR results in patients with sudden sensorineural hearing loss.
      CaseSexAgeAffected sideRight ear (dB) Air/BoneLeft ear (dB) Air/BoneAdditional SymptomsRT-PCR results for SARS-CoV-2
      Frequency (Hz)2505001,0002,0004,0008,0002505001,0002,0004,0008,000
      1M41LeftBT20/20-15/1515/1525/2020/2010/1060/6075/7560/6030/3020/2010/10NoNegative
      AT15/1510/1010/1015/1015/1010/1020/2015/1515/1515/1515/1510/10
      2M29RightBT60/6050/5040/4020/2010/1010/1010/1010/1010/55/55/55/5NoPositive
      AT10/1010/1010/1010/105/55/510/1010/105/55/55/55/5
      3M54RightBT40/4035/3035/3550/5080/8095/9520/2015/1510/1015/1545/4065/60NoNegative
      AT30/3035/3535/3545/4070/6585/8515/1515/1510/105/535/3065/65
      4M45LeftBT20/2020/2025/2525/2565/6570/7040/4045/4545/4575/75110+/70+110+/70+NoNegative
      AT10/1015/1515/1515/1565/6555/5515/1515/1520/2035/35100/100105/105
      5M35LeftBT15/1010/105/55/55/510/1020/2050/5075/7570/7040/4025/15NoNegative
      AT20/2015/155/55/55/510/1040/4055/5560/6030/305/530/30
      Abbreviations: M, male; BT, before treatment; AT, after treatment.
      Due to suspicion of COVID-19, no specific treatment for SSNHL was initiated until RT-PCR test results were acquired. After receiving the results the four patients who were negative for COVID-19 commenced oral prednisolone 1 mg/kg/day tapered to 16 mg every 3 days and oral vitamin B-folic acid complex and proton pump inhibitor daily. The patient who was positive for COVID-19 received oral hydroxychloroquine 200 mg twice daily for 5 days in accordance with the Republic of Turkey's Health Ministry COVID-19 guidelines.
      Due to home isolation of patients, early audiological evaluation after treatment started could not be performed. The hearing status of the patients was obtained by phone. Patient #2 with a positive test result for COVID-19 reported complete resolution of hearing complaints on day 11 of the treatment. Patients #1, #4, and #5 with negative results for COVID-19 reported complete recovery of hearing on day 10, day 11, and day 3 of the treatment, respectively. Patient #3, with a negative test result for COVID-19, reported persistence of his hearing problem on day 11 of the treatment. Control audiologic tests were performed at least 1 month after treatment and the results are shown in Table 1.

      Discussion

      SARS-CoV-2 emerged in December 2019 and has caused a pandemic, with >100,000 deaths from acute respiratory failure, across the world in a couple of months. While most patients present with the predominant symptoms of fever, cough, sore throat, muscle pain, and respiratory failure, anosmia and taste disorders alone or in combination with the common symptoms were added to the clinical spectrum of COVID-19 (
      • Vaira L.A.
      • Salzano G.
      • Deiana G.
      • De Riu G.
      Anosmia and ageusia: common findings in COVID-19 patients.
      ,
      • Mao L.
      • Jin H.
      • Wang M.
      • Hu Y.
      • Chen S.
      • He Q.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      ).
      Viral infections may involve cranial nerves, leading to SSNHL, peripheral facial paralysis, or smell and taste disorders (
      • Kennedy P.G.
      Herpes simplex virus type 1 and Bell's palsy-a current assessment of the controversy.
      ,
      • Cohen B.E.
      • Durstenfeld A.
      • Roehm P.C.
      Viral causes of hearing loss: a review for hearing health professionals.
      ,
      • Mateer E.J.
      • Huang C.
      • Shehu N.Y.
      • Paessler S.
      Lassa fever-induced sensorineural hearing loss: a neglected public health and social burden.
      ). The etiological factor for SSNHL has been reported to cover many viruses such as herpes simplex virus, human immunodeficiency virus, hepatitis virus, measles virus, rubella virus, mumps virus, Lassa virus, and enteroviruses (
      • Cohen B.E.
      • Durstenfeld A.
      • Roehm P.C.
      Viral causes of hearing loss: a review for hearing health professionals.
      ,
      • Mateer E.J.
      • Huang C.
      • Shehu N.Y.
      • Paessler S.
      Lassa fever-induced sensorineural hearing loss: a neglected public health and social burden.
      ).
      Three mechanisms have been implicated in the occurrence of SSNHL associated with viral infections: neuritis caused by viral involvement of the cochlear nerves, cochleitis due to viral involvement of the cochlea and perilymphatic tissues, and the stress response resulting from the cross-reaction of the inner ear antigens to viral infections (
      • Wilson W.R.
      The relationship of the herpesvirus family to sudden hearing loss: a prospective clinical study and literature review.
      ). Animal studies of a variety of viruses have reported induction hearing loss by direct involvement of the inner ear structures or indirectly via cerebrospinal fluid (
      • Nomura Y.
      • Kurata T.
      • Saito K.
      Cochlear changes after herpes simplex virus infection.
      ,
      • Esaki S.
      • Goshima F.
      • Kimura H.
      • Ikeda S.
      • Katsumi S.
      • Kabaya K.
      • et al.
      Auditory and vestibular defects induced by experimental labyrinthitis following herpes simplex virus in mice.
      ,
      • Yun N.E.
      • Ronca S.
      • Tamura A.
      • Koma T.
      • Seregin A.V.
      • Dineley K.T.
      • et al.
      Animal model of sensorineural hearing loss associated with lassa virus infection.
      ,
      • Cashman K.A.
      • Wilkinson E.R.
      • Zeng X.
      • Cardile A.P.
      • Facemire P.R.
      • Bell T.M.
      • et al.
      Immune-mediated systemic vasculitis as the proposed cause of sudden-onset sensorineural hearing loss following lassa virus exposure in cynomolgus macaques.
      ).
      The current findings suggest the need for RT-PCR testing for SARS-CoV-2 due to high suspicion of neurological involvement of COVID-19 in patients who present to otorhinolaryngology outpatient clinics with the sole manifestation of SSNHL during the COVID-19 pandemic. Given the speed at which the infection spreads, it is paramount that every possible symptom suggestive of the infection needs to be taken into consideration. One of the current patients had a positive RT-PCR test result.
      An important consequence of identifying COVID-19 in the etiology of SSNHL is choosing the right treatment strategy to maximize the clinical recovery and minimize the side effects and complications. Corticosteroids play a key role in the treatment of SSNHL (
      • Hara J.H.
      • Zhang J.A.
      • Gandhi K.R.
      • Flaherty A.
      • Barber W.
      • Leung M.A.
      • et al.
      Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss.
      ). On the other hand, for infection caused by this novel virus like many other viral infections, the use of corticosteroids could present a risk of increasing the severity of the infection and cause delayed viral clearance (
      • World Health Organization
      Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance V 1.2. 13 March 2020, WHO reference number: WHO/2019-nCoV/clinical/2020.4.
      ). Investigating the presence of SARS-CoV-2 in patients with SSNHL complaints and using other alternative treatment methods in COVID-19-positive cases could prevent such undesirable consequences. The patient who was diagnosed with COVID-19 in the current study was treated with oral hydroxychloroquine 200 mg twice daily for 5 days and had complete recovery from SSNHL. The rest of the cases with negative SARS-CoV-2 RT-PCR results were treated using routine therapy, which includes corticosteroids. According to the results, the patient who had COVID-19 totally recovered at 1 month after treatment; one negative patient had a complete recovery and another had partial recovery. No significant improvement in hearing was observed in two patients (Table 1). Amongst these cases, three showed complete recovery. No improvement has been observed in the fourth case to this day.
      Considering neurological involvement of SARS-CoV-2, there have been several reports addressing many different neurological manifestations, but not SSNHL.
      • Mao L.
      • Jin H.
      • Wang M.
      • Hu Y.
      • Chen S.
      • He Q.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      reported patients who presented with only nonspecific neurological symptoms such as dizziness, ataxia or stroke without smell or taste disorders, and neuralgia due to peripheral cranial nerve involvement. They emphasized the need for high levels of vigilance and evaluation of neurological manifestations in the context of SARS-CoV-2 for early diagnosis and prevention of the spread of infection through isolation, particularly in super-spreading patients. Current data suggest that the same approach may also apply to those presenting with SSNHL as the sole symptom.
      Autopsy seems to represent the only way to provide a definite evidence base for better understanding of the neural impairment caused by the virus. During the previous SARS-CoV and MERS-CoV outbreaks, studies of cerebrospinal fluid have shown the presence of viral nucleic acid and autopsy studies have reported neurological involvement (
      • Desforges M.
      • Favreau D.J.
      • Brison E.
      • Desjardins J.
      • Meessen-Pinard M.
      • Jacomy H.
      • et al.
      Human coronavirus: respiratory pathogens revisited as infectious neuroinvasive, neurotropic, and neurovirulent agents.
      ,
      • Arabi Y.M.
      • Balkhy H.H.
      • Hayden F.G.
      • Bouchama A.
      • Luke T.
      • Baillie J.K.
      • et al.
      Middle East respiratory syndrome.
      ). Similarly, autopsy results of patients with SARS-CoV-2 have shown hyperemic and edematous brain tissue with neuronal degeneration (
      • National Health Commission of the People′s Republic of China
      Diagnosis and treatment of the novel coronavirus pneumonia (Trial version 7) [D]. Published.
      ).
      The current study observed COVID-19 in one of five (20%) patients with SSNHL symptoms with no prior risk factors for hearing loss. This result is important in that it shows that infected patients can also present in clinics with symptoms different from the previously identified ones in the literature. During this pandemic it is important to recognize every possible symptom of the infection to break the chain of transmission. Even though the sample size is small, the current results carry importance for global public health as there have been no other reports of COVID-19 patients diagnosed with isolated SSNHL. Therefore, this study is the first to bring awareness to practitioners and researchers to look for SARS-CoV-2 positivity in patients with SSNHL. It is hoped that this study will contribute to the field of Epidemiology and the practice of Otorhinolaryngology by enabling early detection of these patients, their isolation, prevention of their infectiousness in the early period, and early and targeted medical treatment.

      Conclusion

      It should be remembered that non-specific symptoms such as SSNHL could be the only sign with which to recognize COVID-19 cases. Awareness of such a non-specific presentation of COVID-19 patients is crucial during this pandemic period for the prevention of infectious spread through isolation and early initiation of COVID-19-targeted treatment and avoiding potentially harmful standard SSNHL treatment that includes prednisolone.

      Acknowledgements

      We would like to thank Sermet Can, M.D., Ph.D. from Oxford, UK for his valuable feedback and suggestions during the preparation of the manuscript and language editing.
      This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      References

        • Arabi Y.M.
        • Balkhy H.H.
        • Hayden F.G.
        • Bouchama A.
        • Luke T.
        • Baillie J.K.
        • et al.
        Middle East respiratory syndrome.
        N Engl J Med. 2017; 37: 584-594
        • Cao Y.
        • Liu X.
        • Xiong L.
        • Cai K.
        Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis.
        J Med Virol. 2020; https://doi.org/10.1002/jmv.25822
        • Carlos W.G.
        • Dela Cruz C.S.
        • Cao B.
        • Pasnick S.
        • Jamil S.
        Novel Wuhan (2019-nCoV) coronavirus.
        Am J Respir Crit Care Med. 2020; 201: P7-P8https://doi.org/10.1164/rccm.2014P7
        • Cashman K.A.
        • Wilkinson E.R.
        • Zeng X.
        • Cardile A.P.
        • Facemire P.R.
        • Bell T.M.
        • et al.
        Immune-mediated systemic vasculitis as the proposed cause of sudden-onset sensorineural hearing loss following lassa virus exposure in cynomolgus macaques.
        mBio. 2018; 9: e01896-e1918
        • Cohen B.E.
        • Durstenfeld A.
        • Roehm P.C.
        Viral causes of hearing loss: a review for hearing health professionals.
        Trends Hear. 2014; 18 (2331216514541361)
        • de Haro-Licer J.
        • Roura-Moreno J.
        • Vizitiu A.
        • González-Fernández A.
        • González-Ares J.A.
        Long term serious olfactory loss in colds and/or flu.
        Acta Otorrinolaringol Esp. 2013; 64: 331-338
        • Desforges M.
        • Favreau D.J.
        • Brison E.
        • Desjardins J.
        • Meessen-Pinard M.
        • Jacomy H.
        • et al.
        Human coronavirus: respiratory pathogens revisited as infectious neuroinvasive, neurotropic, and neurovirulent agents.
        CRC Press, 2013: 93-122
        • Duarte R.
        • Furtado I.
        • Sousa L.
        • Carvalho C.F.A.
        The 2019 novel coronavirus (2019-nCoV): novel virus. old challenges.
        Acta Med Port. 2020; https://doi.org/10.20344/amp.13547
        • Esaki S.
        • Goshima F.
        • Kimura H.
        • Ikeda S.
        • Katsumi S.
        • Kabaya K.
        • et al.
        Auditory and vestibular defects induced by experimental labyrinthitis following herpes simplex virus in mice.
        Acta Otolaryngol. 2011; 131: 684-691
        • Gralinski L.E.
        • Menachery V.D.
        Return of the coronavirus: 2019-nCoV.
        Viruses. 2020; 12: 135
        • Hara J.H.
        • Zhang J.A.
        • Gandhi K.R.
        • Flaherty A.
        • Barber W.
        • Leung M.A.
        • et al.
        Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss.
        Laryngoscope Investig Otolaryngol. 2018; 3: 73-77
        • Kennedy P.G.
        Herpes simplex virus type 1 and Bell's palsy-a current assessment of the controversy.
        J Neurovirol. 2010; 16: 1-5
        • Lai C.C.
        • Shih T.P.
        • Ko W.C.
        • Tang H.J.
        • Hsueh P.R.
        Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges.
        Int J Antimicrob Agents. 2020; 55: 105924
        • Mao L.
        • Jin H.
        • Wang M.
        • Hu Y.
        • Chen S.
        • He Q.
        • et al.
        Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
        JAMA Neurol. 2020; : e201127
        • Mateer E.J.
        • Huang C.
        • Shehu N.Y.
        • Paessler S.
        Lassa fever-induced sensorineural hearing loss: a neglected public health and social burden.
        PLoS Negl Trop Dis. 2018; 12: e0006187
        • Morse J.S.
        • Lalonde T.
        • Xu S.
        • Liu W.R.
        Learning from the past: possible urgent prevention and treatment options for severe acute respiratory infections caused by 2019-nCoV.
        ChemBioChem. 2020; 21: 730-738
        • National Health Commission of the People′s Republic of China
        Diagnosis and treatment of the novel coronavirus pneumonia (Trial version 7) [D]. Published.
        2020 (http://www.nhc.gov.cn/yzyg.j/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf [Accessed 03 March 2020])
        • Nomura Y.
        • Kurata T.
        • Saito K.
        Cochlear changes after herpes simplex virus infection.
        Acta Otolaryngol. 1985; 99: 419-427
        • Rubin E.J.
        • Baden L.R.
        • Morrissey S.
        • Campion E.W.
        Medical journals and the 2019-nCoV outbreak.
        N Engl J Med. 2020; 382: 866
        • Suzuki M.
        • Saito K.
        • Min W.P.
        • Vladau C.
        • Toida K.
        • Itoh H.
        • et al.
        Identification of viruses in patients with postviral olfactory dysfunction.
        Laryngoscope. 2007; 117: 272-277
        • Vaira L.A.
        • Salzano G.
        • Deiana G.
        • De Riu G.
        Anosmia and ageusia: common findings in COVID-19 patients.
        Laryngoscope. 2020; https://doi.org/10.1002/lary.28692
        • Weiss D.
        • Böcker A.J.
        • Koopmann M.
        • Savvas E.
        • Borowski M.
        • Rudack C.
        Predictors of hearing recovery in patients with severe sudden sensorineural hearing loss.
        J Otolaryngol Head Neck Surg. 2017; 46: 27
        • Wilson W.R.
        The relationship of the herpesvirus family to sudden hearing loss: a prospective clinical study and literature review.
        Laryngoscope. 1989; 96: 870-877
        • World Health Organization
        Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance V 1.2. 13 March 2020, WHO reference number: WHO/2019-nCoV/clinical/2020.4.
        2020
        • Wu D.
        • Wu T.
        • Liu Q.
        • Yang Z.
        The SARS-CoV-2 outbreak: what we know [published online ahead of print, 2020 Mar 12].
        Int J Infect Dis. 2020; 94: 44-48https://doi.org/10.1016/j.ijid.2020.03.004
        • Yun N.E.
        • Ronca S.
        • Tamura A.
        • Koma T.
        • Seregin A.V.
        • Dineley K.T.
        • et al.
        Animal model of sensorineural hearing loss associated with lassa virus infection.
        J Virol. 2015; 90: 2920-2927
        • Zhu N.
        • Zhang D.
        • Wang W.
        • Li X.
        • Yang B.
        • Song J.
        • et al.
        A novel coronavirus from patients with pneumonia in China, 2019.
        N Engl J Med. 2020; 382: 727-733