A year and a half after the coronavirus pandemic ravaged our collective lives, our society continues to grapple with fear and insecurity. As a result, we have seen misinformation spread like wildfire, and many people resort to bizarre and wrong ways of dealing with the virus. With this column, which will be published every Sunday, we aim to address any health or vaccine-related questions that our readers may have. coronavirus Universal pandemic.
In this week’s column, Professor (Dr) Saurabh Varshney, Executive Director and CEO, All India Institute of Medical Sciences, Deoghar answers questions related to hearing loss, vertigo and other ENT-related issues due to COVID-19.
Do people who have hearing loss due to COVID infection get their hearing back after recovery? Or is it permanent damage?
Otolaryngologists often see a sudden onset of sensorineural hearing loss (SSNHL). The exact pathophysiology of the disease is still unknown, with the most likely causative factor being a viral infection. Immediate steroids are the best treatment to improve the prognosis. Reports are pointing to the fact that even after the patient has recovered from the infection, the deafness due to Kovid has not been cured.
The virus can travel through the blood cells to the brain. Our brains have lots of ACE2 receptors, the cell surface protein that SARS-CoV-2 uses to enter healthy cells. The temporal lobe of the brain (present on either side of the head), which controls hearing, also contains many ACE2 receptors. When the virus affects this area, it releases cytokines which, in turn, damage the auditory centers in the brain.
Does COVID 19 cause dizziness? Can it affect a person’s balance?
Dizziness and lightheadedness are two neurological symptoms of COVID-19. The percentage of people reporting dizziness is between 4 and 30 percent. In addition, COVID-19 can affect the inner ear, causing conditions such as dizziness or lightheadedness. One such condition is vestibular neuritis.
Vestibular neuritis occurs when an infection causes inflammation of the nerve that connects the inner ear to the brain. There are case reports of vestibular neuritis during or shortly after COVID-19.
These are the reasons why COVID-19 causes these symptoms: the effects of inflammation from infection, a direct viral infection of nerve tissue, damage to nerve tissue from low oxygen (hypoxia) or injury related to increased blood clotting (hyper-coagulopathy) )
Have black fungus cases decreased after the second wave? How is Delta affecting ENT functions?
So far (MOHFW 22.07.2021) more than 45,000 cases of mucormycosis or ‘black fungus’ have been reported in the country, while around 4,000 patients have died due to the disease across the country. It affects the nose, eyes and sometimes the brain and usually strikes 12-18 days after recovery from COVID. About half of those infected are still undergoing treatment.
The fungus is related to steroids used to treat COVID, and diabetics are at particular risk. But they also lower immunity and increase blood sugar levels in both diabetic and non-diabetic COVID-19 patients. It is believed that this decline in immunity may trigger cases of mucormycosis in diabetics or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS. Doctors say that an anti-fungal injection (amphotericin B) is the only effective medicine against the disease.
Following a steady decline in the number of COVID-19 cases, the past few weeks have seen a significant drop in mucormycosis (black fungus) cases.
The coronavirus variant “Delta” (also known as b.1.617.2) driving India’s devastating Covid-19 second wave is by far the most contagious to emerge. The delta variant was the “primary cause” behind the country’s deadly second wave and is 50% more contagious than the alpha strain. In ENT manifestations- Some COVID patients seek medical care for hearing loss, swelling around the neck and severe tonsillitis.
Why are people’s sense of smell changing after COVID? How does infection affect our ability to smell correctly?
Loss of smell (anosmia) or loss of smell (hyposmia) was observed in about 30.19 per cent of COVID cases. The incidence was higher in moderate to severe cases. Usually, it occurs between 3-5 days after infection and takes 2-3 weeks to recover. Therefore, anosmia was considered as a powerful indicator for COVID suspicion in otherwise asymptomatic cases.
The first contact of the COVID virus is with the nasal epithelium, which also contains ACE receptors. SARS-CoV-2 requires dual expression of two genes, angiotensin-converting enzyme-2 (ACE2) and transmembrane protease Serine2 (TMPRSS2) receptors, to enter the host. ACE2 binds to the viral spike protein, and TMPRSS2 facilitates the priming of the S protein. Both ACE 2 and TMPRSS2 are expressed in permanent cells of the human olfactory epithelium in the nose. However, in the case of asymptomatic carriers, where we do not see a complete loss of olfaction, elevated inflammatory cytokines, or an ionic imbalance in permanent cells may affect the electrical threshold causing olfactory dysfunction of varying severity.
How to differentiate between COVID 19 and nasal allergies?
Nasal allergies are usually seasonal, with localized symptoms of sneezing, nasal discharge, and nasal obstruction. Other symptoms may include headache, itchy nose, throat, and eyes. There is a systemic presentation of COVID 19. Therefore, the most common symptoms of COVID-19 are fever, cough and fatigue. But there are many other possible signs and symptoms.
COVID-19 causes a system-wide reaction, whereas an allergy, which is an overreaction of the immune system to exposure to a trigger, is usually more localized. People with allergies may also have asthma, which can cause wheezing, coughing, and chest tightness. While many people with COVID-19 have a cough and chest tightness or difficulty breathing, most of the time, it is not accompanied by wheezing. The main points that determine whether one has an allergy or a COVID infection is mainly the timeline and history of the patient. Often people with allergies have a history of seasonal allergies, and allergy symptoms are much longer-lasting than viral symptoms. Allergy symptoms usually respond to allergy medications. Allergies usually make people itchy. Itching is not a symptom of a viral disease. Patients with allergies do not have fever. Often people with COVID-19 do. Patients with allergies may also have asthma, which can cause coughing, shortness of breath, chest tightness, and wheezing. COVID-19 does not usually cause wheezing.
Are there any ENT-related side effects of taking the vaccine?
No, this has not yet been reported in the literature.
What are some of the most common ENT-related long-term effects of COVID19 on people?
Most people who have coronavirus disease 2019 (COVID-19) make a full recovery within a few weeks. But some people — even those who have had milder versions of the disease — continue to experience symptoms after their initial recovery. These people sometimes describe themselves as “long-lasting,” and the conditions are referred to as post-COVID-19 syndrome or “long-lasting COVID-19.” Similarly, these health problems are sometimes referred to as post-COVID-19 conditions. They are generally thought of as an effect of COVID-19 that persists for more than four weeks after you have been diagnosed with the COVID-19 virus.
Older people and those with a number of serious medical conditions are most likely to experience COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for weeks to months after infection. Common ENT signs and symptoms that persist over time include fatigue, shortness of breath or difficulty breathing, cough, loss of smell or taste, dizziness upon standing, loss of hearing, sensorineural hearing loss—that is of sudden onset and may be permanent/residual, loss/loss of smell (anosmia/hyposmia) – usually reversible, but may be residual and dizziness (sense of imbalance) – rare, reversible.
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