Experts suggest that it may be a combination of the infection as well as the inflammation caused due to the virus in the ear that may be responsible for sensorineural hearing loss in COVID-19 patients
A visualisation of the COVID-19 virus. Image courtesy Fusion Medical Animation
A recent study published in the British Medical Journal (BMJ) reported the first case of sudden-onset sensorineural hearing loss (SSNHL) in a COVID-19 patient in the UK.
SSNHL is a common condition seen in otolaryngology, affecting about five to 160 people per 100,000 every year. In most of the cases, the cause of the condition is unknown but is attributed to damage to the inner ear and the neurons that connect the ear to the brain, mostly due to a viral infection, immune reaction or stress response from body cells. Various viral infections, including herpes and cytomegalovirus infection, have been associated with hearing loss.
Hearing loss has also previously been seen in COVID-19 patients as early as April 2020. Some studies indicate neural damage and damage to the cochlear hair (tiny hair present in the inner ear that send and receive signals from the brain to help perceive and interpret sounds) to be responsible for COVID-19 related hearing loss. However, more studies are still needed to understand sensorineural hearing loss.
The case study
The case study included a 45-year-old man who presented with hearing loss while being treated for COVID-19 in a hospital.
The man was admitted to the hospital on day 10 of COVID-19 symptoms and required intubation. He was transferred to the ICU and was intubated for a month. He suffered bilateral pulmonary emboli, ventilator-associated pneumonia, anemia and pulmonary hypertension. He was given remdesivir, plasma exchange and steroids and his condition gradually improved. About seven days after extubation, he started to notice tinnitus in his left ear and sudden-onset hearing loss.
The man had no history of hearing loss and showed no damage or inflammation in his eardrum. However, the lab tests indicated sensorineural hearing loss. He was given intratympanic steroid injections after which his hearing ability improved a bit.
Infection or inflammation
SARS-CoV-2, the causative agent of COVID-19, uses ACE2 receptors present on the surface of healthy cells to identify and gain entry into these cells. It has previously been suggested that ACE2 receptors are present in the brain’s temporal lobe and various ear cells have ACE2 receptors.
Experts suggest that it may be a combination of the infection as well as the inflammation caused due to the virus in the ear that may be responsible for sensorineural hearing loss in COVID-19 patients. The study suggested that coronavirus patients should be screened for hearing loss so that they can be treated on time and permanent hearing loss may be prevented in these patients.
Additionally, more studies are needed to understand the benefits of steroid administration in idiopathic SSNHL.
For more information, read our article on COVID-19.
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