As the number of Australians receiving COVID-19 vaccinations continue to rise, our clinicians and the clinic are receiving an increased number of queries regarding the vaccines and dizziness.
COVID 19 is a new strand of the coronavirus and therefore we are still learning about it.
Nothing can be said for certain given there is limited research surrounding this novel COVID-19 virus.
Taking a look into data published on government health websites:
* Dizziness is listed as a less common side effect that may be experienced after the AstraZeneca Vaccine as per the Australian Government website. The information pamphlet for AstraZeneca listed on the government website states that symptoms usually occur within 1 day from having the vaccine and usually resolve within 2 days after onset. It is suggested that if you are suffering dizziness for longer than this to seek medical advice.
* Dizziness and weakness are listed as side effects, which may be related to allergic reactions. It is highly recommended that you seek medical advice if you are experiencing such symptoms. Dizziness and shortness of breath can also be signs of severe complications- so please seek medical advice if suffering such symptoms.
* It is suggested that dizziness, if experienced, will usually present within 24 hours of vaccine administration and anecdotally (in clinical trials) usually only lasted 2-3 days post administration. If you are experiencing symptoms lasting longer than this then please seek medical advice.
What we know about the incidence of dizziness prior to COVID-19:
* Epidemiology of dizziness: about 15% of the population experience dizziness, 40% of such presentations tend to have an inner ear/vestibular cause (Hain, T (2021) Chicago Dizziness and Hearing).
Ongoing dizziness in patients who have had COVID-19 infection:
* Has proven to be a common clinical manifestation- roughly 30% of COVID 19 patients suffer dizziness.
* Systematic review regarding neurological manifestations and complications post COVID-19 infection suggest neurological symptoms are not specific to COVID-19. More research is required to determine any relationship thus far.
* The same is said for dizziness, hearing loss and tinnitus in another systematic review regarding otological symptoms and COVID-19. A link between COVID-19 and otological symptoms can be seen, however given limited research, care should be taken when assuming cause and effect.
* Persistent dizziness post COVID-19 infection warrants a neurology/neuro-otology/ENT review.
COVID-19 patients, dizziness and Vestibular Rehab:
* Vestibular Rehabilitation Therapy has been recommended for patients suffering ongoing dizziness post COVID-19 infection. There has been little research performed in the arena of Vestibular Rehab post COVID-19 infection. What has been completed so far is very promising however further research is recommended.
Dizziness and Vestibular Physiotherapy:
* Systematic literature reviews support the use of vestibular rehabilitation in the treatment of vestibular and neurological disorders such as: BPPV, unilateral vestibular disorders (E.G following a Vestibular Neuritis), Post Concussion, Chronic Dizziness, Multiple Sclerosis.
Overall recommendations if you are suffering dizziness post COVID-19 vaccine or COVID-19 infection from our vestibular physiotherapy clinical point of view:
* Seek GP/Medical Advice.
* Referral to appropriate specialist such as Neurology/ENT will be made by your treating GP if there are any concerns.
* Dizziness is a highly prevalent symptom suffered in the community (15% world-wide), for which 40% of these presentations (prior to COVID-19) stem from Inner Ear Pathologies.
* Vestibular Rehab and Canalith Repositioning Techniques are recommended in literature to treat BPPV and other vestibular conditions which cause dizziness.
* Once medical advice has been sought, it is a safe and reasonable option to seek an opinion from your Vestibular Physiotherapist.
References:
* Korkmaz, M. Ö., Eğilmez, O. K., Özçelik, M. A., & Güven, M. (2021). Otolaryngological manifestations of hospitalised patients with confirmed COVID-19 infection. European Archives of Oto-Rhino-Laryngology, 278(5), 1675-1685.
* Saniasiaya, J., & Kulasegarah, J. (2021). Dizziness and COVID-19. Ear, Nose & Throat Journal, 100(1), 29-30.
*Chen, X., Laurent, S., Onur, O. A., Kleineberg, N. N., Fink, G. R., Schweitzer, F., & Warnke, C. (2021). A systematic review of neurological symptoms and complications of COVID-19. Journal of neurology, 268(2), 392-402.
* Jafari, Z., Kolb, B. E., & Mohajerani, M. H. (2021). Hearing loss, tinnitus, and dizziness in COVID-19: a systematic review and meta-analysis. Canadian Journal of Neurological Sciences, 1-33.
* The effectiveness of vestibular rehabilitation interventions in treating unilateral peripheral vestibular disorders: a systematic review. Physiotherapy Research International, 22(3), e1635.
* Synnott, E., & Baker, K. (2020). The effectiveness of vestibular rehabilitation on balance related impairments among multiple sclerosis patients: a systematic review. Journal of Multiple Sclerosis, 7(1), 1-7.
* Kinne, B. L., Bott, J. L., Cron, N. M., & Iaquaniello, R. L. (2018). Effectiveness of vestibular rehabilitation on concussion-induced vertigo: a systematic review. Physical Therapy Reviews, 23(6), 338-347.
* Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., ... & Corrigan, M. D. (2017). Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1-S47.
* Hain, T (2021) Chicago Dizziness and Hearing.