Ototoxic and Vestibulotoxic Effects of Chloroquine/Hydroxychloroquine and Remdesivir in the Treatment of COVID-19: Update Review

Introduction: Antiviral drugs have been extensively used as a potential treatment during the COVID-19 pandemic. Based on previous studies, there were concerns about some of these drugs’ ototoxic and vestibulotoxic effects. Still, these concerns were exacerbated by the widespread use of these drugs at the beginning of the COVID-19 pandemic. Therefore, this article was done to comprehensively review the effects of ototoxicity and vestibulotoxicity of chloroquine (CQ)/hydroxychloroquine (HCQ) and remdesivir with different administration models and compare with the COVID-19 treatment guidelines in the world and Iran. Materials and Methods: This study collected the related published studies in PubMed, Scopus, Google Scholar, and Web of Science with the main keywords “chloroquine”, “hydroxychloroquine”, “remdesivir”, “ototoxicity”, “vestibulotoxicity”, and “COVID-19”. Results: The dose or duration of used HCQ/CQ drugs that caused ototoxic or vestibulotoxic effects in some diseases was reported mainly more than in COVID-19 guidelines, especially in Iran. These findings align with a recent study on slight HCQ-induced ototoxicity in patients with COVID-19 at low doses and short lengths of use. No evidence of possible cochlear damage after taking remdesivir is reported. Conclusion: It seems that the concern about the ototoxic effects of some drugs used in the COVID-19 pandemic should be according to some factors that affect the pharmacological effects of drugs, such as dose, length of use, and co-administration of drugs. Therefore, lower dosage and length of use in some administration models in COVID-19 treatment, such as Iran, are associated with limited and reversible ototoxicity effects. However, further studies are needed

Cervicogenic vertigo: etiology, diagnosis and treatment

Background and Aim: Cervicogenic dizziness is induced by a specific neck position and the earth’s gravity has no effect on provoking of it. The precise incidence of cervicogenic dizziness is not certain but, 20-58% of patients following sudden head injuries experience its symptoms . In this article, the etiology, diagnosis and treatment of cervicogenic vertigo is discussed. Methods: At first, articles of cervicogenic dizziness from electronic databases of Google scholar , PubMed, Scopus, Ovid and CINAHL were searched from 1987 up to 2012. Then, the articles in them vertigo, disequilibrium or nystagmus were consistent with neck disorders were searched. Conclusion: Articles with title of cervicogenic vertigo (cervical vertigo) were limited. Clinical researches about cervicogenic vertigo up to now implicate on several points; all signify that we cannot diagnose it certainly and there is not any specific single test for that. Recently, smooth pursuit neck torsion test (SPNTT) has introduced for diagnosis of cervicogenic vertigo that is not valid yet. There is no protocol for diagnosis of cervicogenic vertigo and diagnosis is often based on limited clinical experiences of clinicians. Physiotherapy, medication and manual therapies are options for treatment but there is no distinct and effective treatment for it and in just one article, a combination of treatments for cervicogenic vertigo as a protocol has recommended

Spontaneous Nystagmus in Benign Paroxysmal Positional Vertigo: Is It A New Sign?

Benign Paroxysmal Positional Vertigo (BPPV) is a condition that indicates a benign inner ear disorder. It is generally believed that BPPV is due to the dislodged otoconial particles from otolith organs and unusual collection of them within any of semicircular canals or even in all three semicircular canals. Although the typical features of nystagmus in BPPV have been well-studied, very few studies (just four articles) have highlighted the presence of spontaneous nystagmus in BPPV recently. During the past 10 years, 2850 patients have been examined at the audiology unit of our department, and 254 patients have received diagnoses of BPPV but recently 2 patients presented with BPPV and spontaneous nystagmus, a new symptom that has been never observed in our clinical records. We herein describe this rare symptom in 2 case of BPPV. A 50-year-old woman with BPPV who showed an 18 degree spontaneous nystagmus treated with Epley maneuver and a 53-year-old man with 3 degree spontaneous nystagmus

A review of the challenges facing people with hearing loss during the COVID-19 outbreak: toward the understanding the helpful solutions

Background and Aim: COVID-19 is a pandemic infectious disease caused by a novel coronavirus has made dramatic changes in people's individual, family, and social lifestyle. Most countries have implemented some regulations including wearing face masks, face shields, and gloves and physical, and social distance in public places to reduce the spread of the virus. However, these global recommendations may be associated with significant social, communication, and behavioral challenges for hearing-impaired people. This review explains the problems that hearing-impaired people may experience in the COVID-19 outbreak and also some helpful solutions that can be implemented by audiologists, healthcare professionals, and other members of the society that somehow interact with these people in such conditions that communication barriers increase. Recent Findings: Recent findings indicate that wearing face masks, physical, and social distan­cing, e-learning and virtual communications during COVID-19 pandemic have provided some problems for people with hearing loss. This can, in turn, have negative consequences including increased feelings of loneliness, isolation and also some limitations in access to educational materials and rehabilitation training of lockdowns of schools and rehabilitation centers or some challenges of online learning at home. Conclusion: People with hearing loss may experience problems during COVID-19 pandemic. There are some strategies that can be implemented to partially solve some communicative and social problems in this group. The use of transparent face masks, compensatory strategies, as well as optimization of virtual, and telehealth, telerehabilitation and tele-education services can be helpful for hearing-impaired people during this pandemic era

Evaluating the effectiveness of dichotic training in the elderly adults: a single subject study

Background and Aim: Elderly people usually show poor performance in dichotic listening tasks. In this condition, the left ear being often the weaker one shows a performance below the normal limits. Studies have shown the effectiveness of dichotic listening training in auditory and language processing for adults and children with neurological disorders. This study aimed to deve­lop a home-version of dichotic training and investigate its effectiveness in elderly adults. Methods: Participants in this single-subject interventional study (AB design) were four elderly subjects (two males and two females) aged 65−75 years. The main inclusion criteria were dichotic listening deficit demonstrated by the dichotic digit test (DDT), no neurological or cognitive disorders, and normal hearing threshold. Dichotic listening training was performed with an informal home-version of dichotic interaural intensity difference (DIID) training program for seven weeks. DDT was performed seven consecutive weeks before (phase A) and after the intervention (phase B) at the end of each week. Results: Data were analyzed by single-subject study statistics. Findings demonstrated an imp­rovement in DDT scores for the left ear and decrease in right ear advantage scores in all the elderly adults after DIID training program. It seems that this training program could remediate poor performance in dichotic listening tasks in elderly people. Conclusion: The advantage of this method is that it can be easily done at home and is cost-effective. However, further studies are needed to approve the neuroplasticity and structural chan­ges in the brain after the DIID training program in this population

Self-assessed hearing handicap in the elderly: a pilot study on Iranian population

Background and Aim: Presbycusis is a prevalent chronic condition in the elderly which may have potential adverse effects on social and emotional aspects of their life. There is no one to one relationship between audiogram and the perceived handicap in elderly. A good way to measure hearing handicap are self-assessment tools. This study was aimed to translate, adapt and establish face validity of Short form of Hearing Handicap Inventory for the Elderly (HHIE-S) and the correlation with pure-tone and speech audiometry results as well as score of the other self-assessmnet tool (Self-Assessment of Communication: SAC) in the Iranian elderly. Methods: HHIE-S was translated into Persian and face validity was established.  It was administered in 80 elderly participants. Correlation of their scores with their pure tone averages of 3 and 4 frequencies (PTA0.5-1-2 and PTA0.5-1-2-4), word recognition score (WRS) in quiet, and SAC sco­res was determined. Results: The experts mean scores to PHHIE-S was 99.63%. There were significant correlations between PHHIE-S with SAC (r = 0.89; p 0.05). Conclusion: Simply evaluation of the hearing levels is not adequate in elderly. Self-assessment tools can shed light on the specific disability induced by hearing loss. PHHIE-S appears to be an easy and fast tool that may helpful to distin­guish patients who might need rehabilitative services