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Is Hearing Loss Another Unusual Symptom of COVID-19?

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

Doctor giving a man an ear exam

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En español | COVID-19 has been linked to an array of unusual symptoms and long-term complications, and scientists have been questioning whether hearing loss should be added to this list.

It's common for some hearing-related symptoms to accompany any viral infection of the upper respiratory tract, says Elias Michaelides, M.D., codirector of the Auditory Implant Program and medical director of audiology and otolaryngology 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.

But a number of studies have linked more persistent hearing problems tied to COVID-19. A 2020 survey of 121 people in the United Kingdom that was published in the International Journal of Audiology, for example, found that about 13 percent of patients reported a change in hearing and/or tinnitus (ringing in the ears) since their COVID-19 diagnosis. Another 2020 report, published in Mayo Clinic Proceedings, provides details of an older COVID-19 patient who experienced deafness with loud tinnitus, even after other symptoms improved; a similar case was described in the American Journal of Otolaryngology.

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What's more, a team of researchers from the Johns Hopkins School of Medicine found evidence of the coronavirus (SARS-CoV-2) in the middle ear of COVID-19 patients in an autopsy study published in JAMA Otolaryngology — Head & Neck Surgery. While determining the impact of the virus’s presence in the ear was outside the study's scope, corresponding author C. Matthew Stewart, M.D., says it raises some concern, especially given that other viral infections are known to cause hearing loss.

"If there is an active viral infection in that part of the body, you could get the whole host of symptoms associated with other types of viral infections in that area,” including inflammation in the ear that could impair hearing or cause tinnitus, dizziness and imbalance, says Stewart, associate professor of otolaryngology and head and neck surgery at the Johns Hopkins School of Medicine.

Researchers have also pointed out that cochlear hair cells, which process sound vibrations, are “particularly vulnerable” to damage caused by restricted oxygen and blood supply — two complications that have been reported in patients hospitalized with COVID-19.

Experts caution there's not enough evidence yet to draw a direct link between a SARS-CoV-2 infection and hearing problems. Still, Stewart argues, “we can be reasonably suspicious” that the coronavirus may affect hearing in some patients.

Medications, masks add to hearing problems

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 the federally approved treatment, remdesivir, as well as chloroquine and hydroxychloroquine, which are not recommended treatment options — 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,” Stewart says.

What doesn’t seem to affect hearing, however, are the COVID-19 vaccines, despite recent 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 co-author Daniel Sun, M.D., explained in a statement. The results were published in JAMA Otolaryngology — Head & Neck Surgery. “We hope these findings will reassure health care clinicians and patients to receive all scheduled doses of the vaccination as recommended by current public health guidelines,” the study authors wrote. 

But other public health efforts put in place to help slow the spread of the virus 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 cloth face coverings when they're out in public. They're also standing farther away from each other to keep a safe distance.

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"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. “For most people, it's not much of an issue. But in elderly patients who may already have some hearing loss, this can sometimes push them to the point where they're having difficulty understanding speech,” he adds.

As researchers continue to study the short- and long-term effects of a SARS-CoV-2 infection, experts say the public can expect to see more hearing-specific studies surface. In the meantime, if you experience worsening or sudden hearing loss, contact your doctor right away. Early treatment can prevent permanent damage in some instances, Michaelides says. Your doctor may also 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.

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.​

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

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