Sensorineural Hearing Loss Post-COVID-19 Infection: An Update

Round 1

Reviewer 1 Report

Very nice update on an important topic, SSHL loss following covid-19 infection. Nice introduction, well-structured results and thorough discussion. I would  like to see a paragraph in the Discussion section about the cases of SSHL following covid-19 vaccination. You could add two interesting studies for this purpose:

1) Formeister EJ, Chien W, Agrawal Y, Carey JP, Stewart CM, Sun DQ. Preliminary Analysis of Association Between COVID-19 Vaccination and Sudden Hearing Loss Using US Centers for Disease Control and Prevention Vaccine Adverse Events Reporting System Data. JAMA Otolaryngol Head Neck Surg. 2021;147(7):674–676. doi:10.1001/jamaoto.2021.0869

2) Tsetsos N, Poutoglidis A, Vlachtsis K, Kilmpasanis A, Gougousis S. Sudden Sensorineural Hearing Loss Following the Second Dose of COVID-19 Vaccine. Cureus. 2021 Aug 25;13(8):e17435. doi: 10.7759/cureus.17435. PMID: 34589343; PMCID: PMC8462391.

Other than this I suggest acceptance.

Author Response

Many thanks for your precious advice. As suggested, we added a paragraph about SNHL and vaccines. 

" Curiously, since December 2020 the European medicines agency (EMA) approved the first vaccine against COVID-19 (Pfizer-BioNTech) and a massive immunization campaign began, we observed flourishing literature on potential related adverse effects.

The analysis of sensorineural hearing loss following COVID-19 vaccination on the data from the Centers for Disease Control and Prevention's Vaccine Adverse Events Reporting System (VAERS), by Formeister et al., did not reveal any associations. (35)

Few case reports and small sample studies suggested a possible link between vaccination and increased risk of SNHL, however with a very low level of evidence. (36,37,38,39,40)"

Reviewer 2 Report

Dear author’s

I was pleased to review your manuscript “Sensorineural Hearing Loss post COVID-19 infection: an update“ The topic is interesting.

However, the manuscript should be further improved. In order to improve the manuscript a have the following comments.

What new information brings your article in the literature? 

There are some important findings that can improve the clinical and management Covid19 in order to prevent the Sensorineural Hearing Loss?

Please modify the references accordingly.

Punctuations and English reviews are necessary;

Author Response

Many thanks for your suggestions.

Thank you very much for your suggestions. We improve our discussion as recommended.

The development of prevention strategies based on these early data is arduous. According to the reported findings, in rare cases, COVID 19 may be associated with a dramatic deterioration of hearing. Therefore, a prompt diagnosis is of paramount importance to establish treatment but also early rehabilitation strategies.

 

 

Reviewer 3 Report

The authors summarized reports on sensorineural hearing loss and COVID-19 infection. Authors may want to discuss differences in outcomes of sudden deafness before the COVID-19 pandemic, and sensorineral hearing loss associated with COVID-19 infection.

Author Response

Thank you for your observations.

As suggested, we added a new paragraph on the discussion.

Few studies have reported a decrease in sudden SNHL during the pandemic (Chari, Parikh). The widespread use of medical masks and social distancing may have limited the spread of other viral infections, which are frequently blamed for SNHL development, influencing these findings.

Furthermore, as challenges in the management of even life-threatening conditions, such as stroke and myocardial infarction, were reported in the disease outbreak, delays in diagnosis and treatment may have also impacted the correct categorization of hearing loss.

Reviewer 4 Report

This paper provides a rigorous systematic literature review of the possible association between SNHL and COVID 19 infection.

Only 2 suggestions for the Authors:

1) Page 4, lines 88-89: whilst in 87,3% of cases SNHL was associated to other symptoms (Figure 3). In the figure 3,  SNHL was associated to tinnitus in 87,3% of cases.

2) Could you report if SNHL is directly related or associated with mild/moderate or severe SARS-CoV-2 infection from the current data available?

Author Response

1) Page 4, lines 88-89: whilst in 87,3% of cases, SNHL was associated with other symptoms (Figure 3). In figure 3, SNHL was associated with tinnitus in 87,3% of cases.

Thank you for your observation; we changed graphic 3 accordingly, correcting the rates of associated symptoms.

 2) Could you report if SNHL is directly related or associated with mild/moderate or severe SARS-CoV-2 infection from the current data available?

Unfortunately, because the quality of the studies and their frequent annedoctal nature, it is difficult to prove a certaine correlation.

As stated in the CONCLUSION paragraph

“To date, the knowledge about the potential role of SARS-COV 2 in the aetiology of SNHL is still in preliminary stages. Currently available data show that SARS-CoV-2 may have hamper cochlear function; however, since the available reports are limited, further studies are necessary particularly to evaluate the possible etiopathogenetic features.”