Microsoft Word - IJHHS IMAM 23rd ASC 2022


  
 

 S26

 
COVID-19 and Spectrum of Vestibular Dysfunctions: A Case Report   
 
Intan Kartika Kamarudin1  
  
COVID-19 infection had shown to affect multiple systems. A positive COVID-19 case with multiple 
vestibular problems, its management and a review of the literature were reported.  

A 63-year-old lady who was a Category 5 COVID-19 infection patient, complicated by mild 
frontal stroke, left isolated mononeuropathy causing foot drop, had persistent dizziness lasting hours to 
days in the first month after being extubated. She underwent vestibular rehabilitation which did not 
resolve her vertigo. Upon presentation to the vestibular clinic at 3-months post-extubation, she 
complained of vertigo on changing positions lasting a few seconds with dizziness in between. Her 
Dizziness Handicap Inventory (DHI) was severe, with severe abnormal Depression Anxiety Stress 
Scale 21 (DASS 21). Vestibular assessments showed oculomotor abnormalities with positive left 
posterior Benign Paroxysmal Positional Vertigo (BPPV) on Dixhallpike test. During Epley maneuver, 
there was canal conversion to the anterior canal which was resolved with a deep head hanging 
maneuver. The canal repositioning maneuver was done in serial, and her vertigo reduced tremendously. 
Her Video Head Impulse Test showed abnormalities in all semicircular canals bilaterally, rotatory chair 
showed lateral vestibular weakness and videonystagmography showed abnormal smooth pursuit, 
saccade and optokinetic suggesting central lesion. Her cervical and ocular vestibular evoked myogenic 
potential were normal reflecting normal saccular and utricular function. Tympanometry showed type A 
bilaterally with right mild and left mild to moderate sensorineural hearing loss. Magnetic resonance 
imaging of the Internal Acoustic Meatus showed bilateral vascular loop with no cerebellopontine angle 
tumour. Upon review three months later, the patient was asymptomatic of vestibular complaint with 
normal DHI and DASS21 score. Her foot drop had also resolved.   

Evidence in the literature showed up to 16.8% of COVID-19 patients reported vestibular 
symptoms. The mechanism of this vestibular neuritis is unclear but may be similar to the pathogenesis 
causing anosmia or vasculopathy.  
  
Keywords: COVID-19, Vestibular dysfunction, Multicanal BPPV, Vestibular neuritis, Vertigo 
 

1. Department of Otorhinolaryngology Head and Neck Surgery, Universiti Teknologi 
MARA, Malaysia.   

  

 

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Correspondence to:  Intan Kartika Kamarudin, Senior Lecturer and Otorhinolaryngology Head and 
Neck Surgeon, Department of Otorhinolaryngology Head and Neck Surgery, Universiti Teknologi 
MARA, Malaysia, kartika@uitm.edu.my  

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DOI: http://dx.doi.org/10.31344/ijhhs.v7i70.528