Persisting, unilateral tinnitus 22 days after first dose of an mRNA-based SARS-CoV-2 vaccine

OBJECTIVES: Although vaccination with vector-based or mRNA-based SARS-CoV-2 vaccines is usually well tolerated, they are not free of side effects. Some of these side effects can be severe and concern the primary care physician, otorhinolaryngologist, and the neurologist. Persisting, unilateral tinnitus time-linked to the first dose and worsening after the second dose of an mRNA-based SARS-CoV-2 vaccine has not been reported. STUDY DESIGN: Case report. METHODS: Routine tests were applied to investigate the patient. RESULTS: A 35-year-old male experienced sudden onset of right-sided tinnitus, diffuse headache, and ear respectively facial pressure 22 days after the first dose of an mRNA-based SARS-CoV-2 vaccine. Since symptoms worsened after the second dose, 28 days later, the patient started a self-medication with non-steroidal anti-inflammatory drugs, without benefit. After an otolaryngologist suspected Meniere’s disease, prednisone was given for 5 days with significant improvement. After discontinuation of steroids, however, previous symptoms recurred with similar intensity as before. Cetirizin and loratadin were started resulting in complete resolution of headache and pressures but persistence of tinnitus. After exclusion of various differentials, a causal relation between clinical presentation and vaccination was suspected. CONCLUSIONS: SARS-CoV-2 vaccination can be followed by unilateral persisting tinnitus, headache, and ear respectively facial pressure. Since steroids and anti-histamines had a beneficial effect, an immunological pathophysiology is quite likely.