Can Coronavirus disease (COVID-19) cause persistent vertigo?

From the Guidelines

Yes, COVID-19 can cause persistent vertigo in some individuals, as evidenced by audiovestibular manifestations of long COVID, including vertigo, as reported in a recent study published in Nature Reviews Microbiology 1. This symptom may appear during the acute infection or develop as part of long COVID syndrome, potentially lasting for weeks or months after the initial infection. The vertigo is typically caused by the virus affecting the inner ear (vestibular system) or through neurological inflammation, with possible mechanisms including neuroinflammation, damage to blood vessels by coagulopathy and endothelial dysfunction, and injury to neurons 1. Some key points to consider in the management of persistent vertigo after COVID-19 include:

• Treatment options such as vestibular rehabilitation therapy, medications like meclizine (12.5-25mg every 4-6 hours as needed) or diazepam (2-5mg as needed) for symptom management, and ensuring proper hydration and rest.
• Gradual head movement exercises may help the brain recalibrate and improve symptoms.
• If experiencing persistent vertigo after COVID, it's essential to consult a healthcare provider for proper evaluation, as they may recommend referral to an ENT specialist or neurologist if symptoms are severe or prolonged 1. The condition typically improves over time as the body heals from the viral infection, though recovery timelines vary significantly between individuals, with some studies suggesting that cognitive impairment and other neurological symptoms can persist for at least 2 years after infection 1.

From the Research

Covid-19 and Vertigo

• Covid-19 infection may cause inner ear damage and lead to vestibular dysfunction, which can result in persistent vertigo 2.
• A study found that patients who had been diagnosed with Covid-19 were more likely to suffer from vertigo/dizziness and to compensate more slowly 2.
• The presence of vertigo of central origin may indicate the neurotropic effect of SARS-CoV-2 following Covid-19 2.
• Another study reported a case of new-onset vertigo after Covid-19 infection, suggesting a possible association between the two 3.
• A survey of Long Covid patients found that 60% reported the presence of vertigo or dizziness, with a mean severity of 4.6 ± 2.7 on a scale of 1 to 10 4.

Prevalence of Vertigo in Covid-19 Patients

• A systematic review found that clinical manifestations of Covid-19 include symptoms of vertigo and dizziness, which may be due to the neurotropic effects of SARS-CoV-2 5.
• The review suggested that the cytokine storm, CNS infiltration of the virus through ACE 2 receptors, and other systemic factors can be responsible for the significant number of Covid-19 patients reported to experience symptoms of vertigo and dizziness 5.
• A study found that approximately one fifth of Long Covid patients with tinnitus and vertigo or dizziness rated their symptoms as severe, highlighting the need for effective management 4.

Vestibular Dysfunction and Covid-19

• Covid-19 infection may cause vestibular dysfunction, which can result in persistent vertigo 2.
• A study found that patients with Covid-19 infection had abnormal vestibular function tests, including spontaneous nystagmus, positional nystagmus, and asymmetrical optokinetic nystagmus 2.
• The study suggested that the role of the central nervous system in the onset of equilibrium disorders should be considered in patients with Covid-19 2.