Dear Editor,
The global pandemic of new Coronavirus disease (COVID-19) is a grave
threat to both physical and mental health. We must be mindful of the
consequences of psychological effects that caused by COVID-19 in healthy
population and people with psychiatric problems (Asmundson et al.,
2020). In many countries, health anxiety was reported, which is
characterized by catastrophic interpretations of bodily sensations and
physical changes, which generates dysfunctional beliefs about health and
illness, may lead to different clinical symptoms and disorders.
Recently, the outpatient department of Xiangya, Changsha, received a
couple of patients with tinnitus when onset is related to stress or
anxiety due to COVID-19 pandemic. We report a case of tinnitus in a
patient with anxiety and insomnia related to COVID-19 and recover
rapidly after psychiatric intervention and therapy.
The patient, female, 64 year-old, without any known previous somatic or
psychiatric diseases went to a local hospital for body check due to
tinnitus in the first month. The physical test showed no significant
abnormalities. The test of acoustic duct reveals no abnormality. The
patient denied vertigo, otorrhea or otalgia and had no history of ear
infections, otologic surgery or trauma, occupational or recreational
noise exposure. The acoustic impedance test and electro-audiogram were
normal. No abnormality was found on brain MRI. After a detailed review
of past history, she recalled that tinnitus happened right after her
travel during COVID-19 pandemic in Wuhan in February. She was extremely
upset after knowing one of the neighbors living on the same apartment
next-door contacted COVID-19 and could not fall asleep for the whole
night, then she starts to feel tinnitus lasting constantly for several
seconds or minutes like current sound, which makes her hard to focus
during the day or fall asleep at night. She orally took prednisone and
as a routine treatment of tinnitus for about a week and Apozolam or
Zopiclone for a month and there was no improvement for symptoms. Test of
anxiety inventory showed that the Zung Self-Rating Anxiety Scale (SAS)
score was 56 while the Hamilton Anxiety Rating Scale (HAM-A) score was
22, both indicate mild to moderate anxiety severity. Test of insomnia
inventory showed that Athens Insomnia Scale (AIS) score was 6 while the
Insomnia Severity Index (ISI) score is 14, indicate sub-threshold or
mild insomnia.The physicians considered that she was no organic disease,
and gave her several psychiatric interventions and psychological
treatments such as suggestive therapy, psychological nursing,
psychoeducation (typically called counseling in the context of tinnitus
treatment in Xiangya) and tinnitus retraining therapy. After the
outpatient visit and, telephone follow-up was conducted in the third
week after the out-patient visit and the patient declared disappearance
of tinnitus and improvement of sleep within the second week after the
out-patient visit.
Previous studies revealed that tinnitus is associated with mental state
(Karaaslan et al., 2020). Recently, psychosis is also reported due to
COVID-19 (Huarcaya-Victoria et al., 2020). In these studies, a number of
clinical disorders belong COVID-19 pandemic related psychosomatic
disease due to its close relations with psychosocial factors. Generally,
this case shows the following: psychosocial factors such as anxiety and
insomnia related to COVID-19 can result in obvious and negative
influence on tinnitus.Great attention must be paid to the whole process
of diagnosis and course. Also, accumulating data and cases have begun to emerge suggesting psychiatric
intervention and psychological treatments may serve as potential
therapeutic modalities for treating tinnitus with psychiatric problems related to COVID-19 and its related
complications.