The Pfizer-BioNTech coronavirus illness 2019 (COVID-19) messenger ribonucleic acid (mRNA) vaccine was among the many most celebrated breakthroughs of the continuing pandemic. Together with the Moderna vaccine developed on the identical platform, the Pfizer-BioNTech vaccine has excessive efficacy in opposition to symptomatic an infection and extreme COVID-19; nonetheless, it additionally has some severe, although unusual, hostile results.
One uncommon aspect impact of the Pfizer-BioNTech COVID-19 vaccine is vaccine-associated tinnitus, which might scale back the standard of life. A brand new QJM: An Worldwide Journal of Medication research discusses one case wherein this aspect impact was relieved with a short course of Transcranial Magnetic Stimulation (TMS) remedy.
Tinnitus related to the COVID-19 vaccine was first recognized after the intensive rollout of those vaccines. Initially, this aspect impact was considered an inflammatory vaccine-induced immune response. Steroids have been subsequently thought of to be applicable administration to reverse the irritation, together with different anti-inflammatory brokers.
Finally, clinicians discovered that these sufferers didn’t report aid after a course of steroids, thus disproving the possibly inflammatory nature of this uncommon aspect impact.
Case research
Within the present research, a girl obtained two doses of the Pfizer-BioNTech vaccine. Whereas she first skilled bilateral tinnitus in 2020, it remained secure thereafter.
The affected person was managed for the situation with a tinnitus handicap index (THI) of 92, in 2021. Early that yr, a high-resolution computed tomography (HRCT) scan confirmed delicate irritation of the temporal bone, as with a earlier affected person. This was adopted up with baseline pure tone audiometry (PTA) that confirmed delicate sensorineural listening to loss at excessive excessive tones in the proper ear and mild-to-moderate loss within the left ear.
From mid-Might 2021, the affected person was prescribed a low dosage of the antibiotic ceftriaxone and reported a sluggish discount in tinnitus thereafter. The THI additionally decreased to 12 by the tip of September 2021.
A couple of month later, the affected person obtained her first dose of the vaccine and the second dose one month after. Whereas she didn’t have every other unintended effects, her tinnitus started to worsen inside three days, particularly in the proper ear. The THI went as much as 96.
The PTA was repeated, displaying extra extreme listening to loss that was once more extra intensive in the proper ear. She was thought to have a cochlear illness related to the vaccine and was prescribed the steroid protocol used on the authors’ middle.
Extra particularly, the affected person was prescribed a single 10 mg dose of dexamethasone intravenously adopted by 5 mg prednisolone 3 times a day for 3 days. This was given in direction of the tip of December 2021. This remedy allowed the THI to barely lower to 88.
Initiation of rTMS
With out proof of serious aid, the affected person was began on repetitive TMS (rTMS) on February 16, 2022. She obtained 3,000 pulses over the realm of the left dorsolateral prefrontal cortex as soon as a day.
Encouragingly, she skilled aid. The THI decreased to 66 inside per week and, by March 9, 2021, her THI was 9. The repeat PTA carried out on the identical day exhibited a major enchancment within the listening to threshold from 11.2K to 16K.
That is among the many earliest case studies the place rTMS has been used to deal with COVID-19-associated cochleopathy. The target proof of efficacy could also be noticed with the alterations within the PTA and THI, thus confirming the etiology and results of remedy with this modality.
Implications
An earlier meta-analysis confirmed that tinnitus with out a particular trigger might be handled by rTMS. Within the present case research, rTMS relieved the situation that occurred following COVID-19 vaccination. This corroborates findings of earlier animal research, the place rTMS decreased irritation in each the goal and distant mind areas, probably because of the immune response.
This may clarify why the tinnitus responded to the rTMS, which has an anti-inflammatory impact. Thus, rTMS might be a viable different to steroid use in vaccine-associated tinnitus.
Importantly, the researchers emphasize that regardless of this hostile impact, which they termed “minor and reversible”, the COVID-19 vaccine stays a advisable and secure selection to guard people in opposition to symptomatic and particularly extreme COVID-19.
Journal reference:
Chen, J., Zeng, B., Lui, C., et al. (2022). Pfizer–BioNTech COVID-19 Vaccine Related Tinnitus and Remedy with Transcranial Magnetic Stimulation. QJM: An Worldwide Journal of Medication. doi:10.1093/qjmed/hcac124.
