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Is Hearing Loss Another Unusual Symptom of COVID-19?

Doctors explore possible virus connection, also link hearing problems to masks

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COVID-19 has been linked to a variety of unusual symptoms and long-term complications, and issues related to hearing are not exempt from the list. 

It’s common for some changes in hearing to accompany any viral infection of the upper respiratory tract, says Elias Michaelides, M.D., codirector of the Cochlear Implant Program and medical director for outpatient otorhinolaryngology and audiology at Rush University Medical Center in Chicago. That’s because the mucous membranes tend to “get very stuffy” and, as a result, “sometimes fluid can build up behind the eardrums,” he says. This symptom, however, does not cause permanent damage “and often will just clear up on its own” once the infection has passed.

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But anecdotal reports and a handful of studies that have emerged since the beginning of the pandemic suggest an association between more persistent hearing problems and COVID-19. For example, researchers from the University of Manchester combed through nearly 60 case reports on the topic and found that about 15 percent of COVID-19 patients experienced tinnitus, or ringing in the ears, after diagnosis, while roughly 8 percent reported hearing loss and 7 percent noted vertigo. The report was published in the International Journal of Audiology in March 2021. An earlier study printed in the same journal found that about 13 percent of patients reported a change in hearing and/ or tinnitus since their COVID diagnosis.

Researchers from the Massachusetts Institute of Technology have also discovered that the virus that causes COVID-19 (SARS-CoV-2) can directly infect cells in the inner ear, which could explain the hearing and balance issues in some COVID-19 patients. And a team from Johns Hopkins School of Medicine found evidence of the virus in the middle ear of COVID-19 patients in an autopsy study, published in 2020 in JAMA Otolaryngology — Head & Neck Surgery.

Despite these findings, experts caution there’s not enough evidence to draw a direct link between a SARS-CoV-2 infection and hearing problems. “But I think it’s an important question to be asking,” says Sarah Sydlowski, audiology director of the Hearing Implant Program at the Cleveland Clinic. 

Medications, COVID complications can add to hearing issues

Medical care muddies the waters when it comes to better understanding a possible connection between SARS-CoV-2 and hearing. For starters, a number of factors related to being critically ill can drive hearing loss, especially in older patients, researchers point out. And several drugs currently (and previously) used to treat patients with COVID-19 — including remdesivir, as well as chloroquine and hydroxychloroquine — are ototoxic, meaning they can cause damage to the ear.

“And that’s going to confound our understanding of the difference between hearing loss that’s caused by a viral infection or hearing loss caused by the usage of an ototoxic medication that’s given for therapeutic reasons,” says C. Matthew Stewart, M.D., associate professor of otolaryngology and head and neck surgery at the Johns Hopkins School of Medicine and a coauthor on the aforementioned JAMA study. What’s more, interruptions in circulation can lead to hearing loss and tinnitus, since the cochlea (the part of the inner ear responsible for hearing) is highly vascularized, Sydlowski says, meaning it contains a lot of blood vessels. And mounting evidence suggests that COVID-19 is not just a respiratory disease, but also a vascular one, that can damage blood vessels and even lead to clots. 

What don’t seem to affect hearing, however, are the COVID-19 vaccines, despite some reports linking them to sudden hearing loss. Stewart and a team of experts, also at Johns Hopkins, combed through the data and found “there is no evidence that people receiving a COVID-19 vaccination are at higher risk of developing sudden hearing loss than those who have not been vaccinated,” study coauthor Daniel Sun, M.D., said in a statement. While the researchers note that more studies are needed, they write that they’re hopeful their findings “will reassure health care clinicians and patients to receive all scheduled doses of the vaccination as recommended by current public health guidelines.” 

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Masks magnify hearing problems 

Other public health efforts put in place to help slow the spread of the virus, however, can play a surprising role in hearing problems. Rush University’s Michaelides has seen a number of patients who say their hearing has worsened since the start of the pandemic.

“It turns out that their hearing hasn’t changed,” but their ability to communicate with others has, he says. And that’s because so many Americans are wearing face masks when they’re out in public. They’re also standing farther from each other to keep a safe distance.

“When you’re wearing a mask, it muffles your voice and sometimes can make it harder for other people to hear [you],” Michaelides points out. Masks also interfere with people’s ability to pick up on visual cues when another person speaks. 

“I’ve heard many reports with people saying, ‘You know, I didn’t realize how much I relied on lip reading,’ ” Sydlowski adds. “So I don’t think that the pandemic, itself, caused that hearing loss, but it did bring it to people’s attention, much more than” before masks were commonly worn. 

Other possible contributors: stress and isolation brought on by the pandemic. While neither causes hearing loss directly, Sydlowski says both can exacerbate it. For instance, sitting in a silent room by yourself for hours on end may make a mild case of tinnitus more pronounced. “Oftentimes running the radio or having a fan going or [having] something else in the environment that helps stimulate the ear can distract from paying attention to it. But when you’re just at home in a quiet environment, it can be more noticeable,” Sydlowski says. 

Notice a change? Talk to your doctor 

As researchers continue to study the short- and long-term effects of a coronavirus infection, experts say the public can expect to see more hearing-specific studies surface. In the meantime, if you experience worsening hearing loss, contact a health care provider who can recommend tools, such as hearing aids, to improve your quality of life. 

“There are a lot of patients that have been just getting by without hearing aids and decided now is the time” to get them, Michaelides says.

There are also treatments that may be able to help some people with tinnitus, which is listed as a symptom of long COVID by the United Kingdom’s National Health Service.

If your hearing loss is sudden, consider it a medical emergency and seek care right away from an ear, nose and throat physician, Sydlowski says. “There is a limited window of time to treat and possibly have it recover,” she adds. 

Editor's Note: This story, originally published Aug. 28, 2020, has been updated to include new information.

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