Evaluation of COVID-19 Patients Complaining of Balance Disorders with the Dizziness Handicap Inventory

Amaç Koronavirüs Hastalığı 2019 (COVID-19) ajanı olan Şiddetli Akut Solunum Sendromu-Koronovirüs-2 (SARS-CoV-2), hızla gelişen yapısı nedeniyle vücuttaki birçok sistemi etkilemekte ve her geçen gün yeni bulgular oluşturmaktadır. Denge kaybı, son zamanlarda COVID-19’un klinik bir belirtisi olarak tanımlanmaya başlandı. Bu çalışmada, COVID-19 olan ve hastalığın aktif döneminde denge sorunları yaşayan hastalara “Baş Dönmesi Engellilik Envanteri” uygulanarak yaşam kalitesi üzerine etkileri ve hastalığın derecesi arasındaki ilişki araştırılmıştır. Gereç ve Yöntemle Nisan 2020-Temmuz 2020 tarihleri arasında hastaneye yatırılarak takip edilmiş COVID-19 hastaları hastane kayıt sisteminden dijital olarak taranarak tespit edildi ve çalışmaya dahil edilme kriterlerine uygun 300 hastaya “Google anket” bağlantısı gönderilerek ankete katılmaları istendi. Ankete geri dönen ve tüm soruları cevaplayan hastalar çalışmaya dahil edildi ve elde edilen veriler istatistiksel olarak değerlendirildi. Bulgular Anketteki tüm soruları yanıtlayan 64 hasta çalışmaya dahil edildi. Çalışmaya dahil edilen hastaların çoğunluğunu 35-44 ve 45-54 yaş gruplarındaki hastalar oluşturdu. Toplam envanter puanı ortalaması tüm hastalarda 35.90 ± 24.30 (min. 4-maks. 88) idi. Envanter skor ortalamaları, hastaneye yatırılan ve BT’de anlamlı patolojisi olanlarda daha yüksekti ve istatistiksel olarak anlamlı fark bulundu (p <0.05). Sonuç COVID-19 hastalarının dengesizlik semptomları gösterebileceği akılda tutulmalı ve yaşlılarda düşmelerin önlenmesi ve baş dönmesi için semptomatik tedavi eklenmesi gibi gerekli önlemler alınmalıdır. Anahtar Kelimeler COVID-19; dizziness; baş dönmesi; Baş Dönmesi Engellilik Envanteri Sakarya Med J 2021;11(3):500-506 EĞİLMEZ et al., : COVID-19 and Balance Disorders INTRODUCTION A novel coronavirus (severe acute respiratory syndrome-coronavirus-2: SARS-CoV-2) arose from the city of Wuhan, Hubei Province, China in December 2019 and has rapidly expanded into other countries due to its highly contagious transmission from human-to-human.1 In March 2020, the World Health Organization (WHO) named this recent viral infection as Corona Virus Disease 2019 (COVID-19) and declared it as a pandemic.2 Indeed it is responsible for >1,530,000 deaths worldwide.3 Th e most common findings of this disease since the beginning of the pandemic are fever, cough and fatigue. In addition, headache, dyspnea and diarrhea are the other detected symptoms.4 But in severe cases, pneumonia, acute respiratory distress syndrome and multi-organ failure may also develop.5 Although the most important symptoms of COVID-19 are respiratory-related, neurotropic and neuroinvasive features of coronavirus have been reported.6 COVID-19 can show a great diversity in the type and severity of neurological manifestations. Th e first reported mild neurological symptoms that emerged quickly aft er the outbreak were headache and dizziness among central nervous system (CNS) symptoms, and hyposmia, hypogeusia, diplopia, ophthalmoplegia and muscle pain among peripheral nervous system manifestations.7-14 Unlike other known upper respiratory infectious agents, COVID has neurotrophic properties and it is thought that diff erent complaints may occur with the eff ects of active cytokines. In terms of otolaryngological findings, the most focused point has been smell and taste disorders. However, with the increasing number of publications, it is seen that the virus may show diff erent symptoms in terms of otolaryngology. Another finding that occurs with the neurotrophic eff ects of the virus is balance problems and/or vertigo.15 Mao et al. reported the rate of patients having dizziness in their study as 16.8% and Korkmaz et al. reported 31%. 16,17 As it is known, loss of balance can have negative eff ects on people’s daily life. For this reason, it is important to evaluate the eff ects of balance complaints that may develop due to COVID 19 with objective tests in terms of additional treatment possibilities. However, so far, no study has been conducted to evaluate the symptoms of patients suff ering from imbalance that may be associated with COVID-19. For this purpose, in our study, the impact of disequilibrium findings was investigated by applying the “Dizziness Handicap Inventory (DHI)” to patients who had COVID-19 and had balance problems during the active phase of the disease. Questioning the balance problems that patients experience due to COVID 19 will provide us more information, as well as drawing attention to other neuro-otological eff ects of COVID-19 and developing treatment options. MATERİALS and METHODS Our study was a cross-sectional descriptive study and initiated aft er permission from the Sakarya University Faculty of Medicine Ethics Committee (No: 10.07.2020 / 401). COVID-19 patients who were hospitalized and followed up between April 2020 and July 2020 were digitally scanned from the hospital registry system and those included were: • Patients between the ages of 18-65 • Patients whose with positive nasopharyngeal swap for SARS-CoV-2 Reverse Transcriptase-Polymerase Chain Reaction test (RT-PCR) (first positive swab > 30 days– < 60 days before questionnaire administration) • Have had an outpatient follow up period or hospitalized for COVID 19 infection • Patients who had no known: • History of hearing loss or ear surgery • Balance disorder or history of vestibular system disease • Serious neurological deficit or a history of nervous system disease • Drug use aff ecting the central nervous system or vestibular system