Audiological Manifestations of COVID-19

Daniel J. Romero, AuD, PhD

Gary P. Jacobson, PhD

On March 11, 2020, the world changed when severe acute respiratory syndrome coronavirus (SARS-CoV-2) was declared a pandemic by the World Health Organization (WHO). The ramifications of SARS-CoV-2 (the virus that causes coronavirus disease 2019 or COVID-19) can still be felt in our daily lives. Additionally, COVID-19 has caused a severe socio-economic impact in more than 190 countries around the world.

To date, more than 38 million cases of COVID-19 have been confirmed in the United States, with 215 million confirmed cases worldwide.[1] Cases of COVID-19 have been confirmed in all 50 states; it is a highly transmissible virus that primarily spreads from person to person through respiratory droplets.[2] [3] [4] More recently, the highly contagious Delta variant remains the dominant strain in the United States, with data suggesting this strain leads to a more serious illness than previous mutations.[5]

COVID-19 can result in a wide range of reported symptoms that appear to affect individuals differently. Symptoms typically appear 2–14 days after exposure to the virus and include fever, chills, cough, shortness of breath, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion, nausea or vomiting, and diarrhea.[2] Given the vast combination of symptoms, it is not surprising that several reports have documented auditory symptoms following a COVID-19 infection. While this relationship is not well understood, there is a small amount of research focusing on auditory symptoms in individuals with COVID-19 disease.

This issue includes a paper written by our Turkish colleagues Koparal and Yilmazer, titled “Evaluation of Post-Infection Hearing with Audiological Tests in Patients with COVID-19: A Case-Control Study.”[6] The authors conducted audiometric assessments on two groups, each consisting of 43 subjects. The experimental group had polymerase chain reaction (PCR)-verified COVID-19 and no reported hearing problems prior to the COVID-19 infection. The control group had no hearing problems and was not COVID positive. The mean ages of both groups were equivalent (i.e., the mean ages were 40 years for the control group and 42 years for the experimental group).

Among other things, the authors reported significant group differences in audiometric thresholds, where the experimental group demonstrated poorer thresholds, specifically for the higher frequencies. It was suggested by the investigators that COVID-19 should be considered as a source of unexplained and sudden sensorineural hearing loss in COVID-positive patients.

This study is one of few in the literature aiming to understand the relationship between COVID-19 and auditory symptoms. While the underlying mechanisms of how COVID-19 affects the inner ear is not well known (if at all), other viruses such as measles, mumps, and varicella zoster viruses have been known to cause direct damage to inner ear structures and/or lead to immune-mediated loss.[7]

As related to the current pandemic, there is still much to learn about the symptoms not typically considered when someone is diagnosed with COVID-19. However, considering the effects of other viruses on the auditory system, it is important to continue exploring the relationship between COVID-19 and auditory symptoms. In addition, the proximity of the auditory and vestibular structures should warrant further research into vestibular symptoms following a COVID-19 infection.

Disclaimer

Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.

Publication History

Article published online:
30 November 2021

• References

• 1 Centers for Disease Control and Prevention. 2021 COVID-19. U.S. Department of Health and Human Services.
• 2 Kerbl R, Zepp F. [Coronavirus disease 2019]. Monatsschr Kinderheilkd 2021; 169 (04) 308-311
• 3 Li J, Huang DQ, Zou B. et al. Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol 2021; 93 (03) 1449-1458
• 4 Park M, Cook AR, Lim JT, Sun Y, Dickens BL. A systematic review of COVID-19 epidemiology based on current evidence. J Clin Med 2020; 9 (04) 967
• 5 Kannan SR, Spratt AN, Cohen AR. et al. Evolutionary analysis of the Delta and Delta Plus variants of the SARS-CoV-2 viruses. J Autoimmun 2021; 124 (July): 102715
• 6 Koparal M, Yılmazer C. Evaluation of postinfection hearing with audiological tests in patients with COVID-19: a case–control study. J Am Acad Audiol 2021; 32: 464-468
• 7 Cohen BE, Durstenfeld A, Roehm PC. Viral causes of hearing loss: a review for hearing health professionals. Trends Hear 2014; 18: 1-17