China
endothelium. 2 Apart from that, direct invasion, hypoxia, hypercoagulopathy, as well as immune-mediated insult were among the postulated mechanism of neuroinvasion leading to dizziness. 3 A literature search was performed using articles published in PubMed on August 1, 2020, to identify dizziness as a clinical manifestation of COVID-19. The keywords used for the article search include giddiness, dizziness, vertigo, COVID-19, SARS CoV 2, Coronavirus disease. To our knowledge, this is the first article that outlines the association between dizziness and COVID-19.
We obtained 14 articles, which include 3 case reports and 11 studies (Table 1 ). A total of 141 patients were pooled from this review. All patients included in this review had dizziness/vertigo as a presenting symptom. Dizziness was the initial presentation of COVID-19 in 3/141 patients (2.13%), 9, 11, 13 whereby in 2 of these patients, dizziness was later followed by respiratory symptoms. 9, 13 Most of the studies reporting on dizziness as a clinical manifestation hails from China (11/14) , the epicenter which gave rise to the pandemic. Of the 14 studies included, dizziness was specifically investigated and treated only in 2 studies 9,11 as dizziness was not the highlight in most studies, it was not investigated and described thoroughly. Additionally, the outcome of dizziness was mentioned only in 1 study by Malayala et al, 11 whereby vestibular rehabilitation was carried out for the patient successfully.
Dizziness, albeit a nonspecific COVID-19 symptom, requires thorough investigation notably to determine its leading cause including, acute labyrinthitis, vestibular neuritis, acute otitis media, or secondary to stroke following COVID-19.
We would like to emphasize that dizziness should not be taken lightly as it has been proven to be a notable clinical manifestation among COVID-19 patients. Parallel to that, association with other audiovestibular manifestations such as hearing loss and tinnitus ought to be determined. Persistent dizziness posttreatment from COVID-19 requires referral to the Otorhinolaryngology Department for thorough examination and investigation. Additionally, we recommend vestibular rehabilitation therapy, which has revealed promising results, to be carried out for stable COVID-19 patients with dizziness. Lastly, it is imperative that attending physicians remain vigilant, especially when managing nonspecific symptoms such as dizziness, as it can be easily overlooked.
Jeyasakthy Saniasiaya https://orcid.org/0000-0003-1974-4379