A man in the United Kingdom lost his hearing while hospitalized with a severe case of COVID-19, making him the first reported person in the nation to experience hearing loss possibly linked to the coronavirus.
Cases of hearing loss after COVID-19 infection have been reported previously in other countries including the U.S., but large-scale data is still lacking about the correlation between the virus and hearing problems, Dr. Alfred Iloreta, an ear nose and throat (ENT) physician at Mount Sinai's Center for Post-COVID Care in New York City, told TODAY.
What did the case report find?
The U.K. man, 45, who suffers from asthma, had been experiencing COVID-19 symptoms for 10 days before being hospitalized, according to a case report released Tuesday in BMJ. He was transferred to an intensive care unit because he was struggling to breathe, was put on a ventilator for 30 days and then developed other complications as a result. He started to improve after being treated with intravenous steroids, blood transfusion and the antiviral drug remdesivir.
A week after his breathing tube was removed, the man noticed a ringing in his left ear, a condition called tinnitus, followed by sudden hearing loss. He hadn't experienced hearing problems before, and asthma was his only underlying condition.
Doctors confirmed his hearing loss with a test, but found no blockages or inflammation after examining his ear canal. The patient also tested negative for other possible causes, including rheumatoid arthritis, flu and HIV. This led doctors to conclude that the symptom was associated with his COVID-19 infection. The man's hearing partially recovered after a series of steroid tablets and injections.
Can COVID-19 cause hearing loss?
Without more data, it's impossible to know for sure if the coronavirus causes hearing loss, but Iloreta said he thinks it's possible and he's "not surprised" by reports of the phenomenon. Sudden hearing loss after a viral infection is frequently seen by ENT doctors, according to the case report.
Iloreta added that the most common ear symptom among his COVID-19 patients is ringing in the ears, which he's also seen with other viruses, like herpes. "A small set of patients present with this, and that indicates some sort of damage to the nerve cells that transmit our sense of hearing," he said.
For context, loss of smell and fatigue seem to be "more prevalent" long-term symptoms, he noted.
If COVID-19 did play a role in the man's hearing loss, Iloreta explained that it could be because the coronavirus tends to attack a protein called the ACE2 receptor, present in the ear area, as well as the nose, lungs and other organs.
"We know that the sense of hearing is a very fragile sensation, so any sort of cellular stress can cause loss of hearing," he said. "Death of the cell actually comes in the form of the ringing of the ear."
While the physicians in the BMJ report ruled out many possible causes of the condition, Iloreta said he believes it could've been caused by the treatment the patient received. In particular, antivirals, like hydroxychloroquine, can have a side effect of ear toxicity.
"(Patients) get a ton of medications when they're in the ICU," Iloreta explained. "It's unclear to me with this case report specifically that COVID-19 directly caused the sudden hearing loss because he was a really sick person."
Dr. Oliver Adunka, director of Wexner Medical Center's division of otology, neurotology and cranial base surgery in Columbus, Ohio, also has reservations about the case report.
Since the coronavirus outbreak began, the medical ENT community hasn't "really seen any increase in cases of sudden sensory hearing loss," he said. He added that because COVID-19 cases are still rising, he believes hearing loss would be reported more widely if there was a connection.
"I don't think COVID causes hearing loss," he stated. "I would think differently if we had a certain percentage of COVID patients (with) hearing loss. This is just a case report."
Asked about the BMJ patient's hearing loss, he said it could be a "coincidence. ... At some point (COVID-19 and hearing loss) will collide."
"We can't completely dismiss these case reports, and that's certainly not what I want to do," he continued. "On the other hand, the evidence that COVID causes sudden sensory loss is very limited."
What does this mean for the public?
The existing case reports on COVID-19 and hearing loss aren't a reason "to ring the alarm," Iloreta said. It's still unclear at this stage how common hearing loss may be with COVID-19, if a patient's hearing will return and whether some patients are more susceptible than others.
But, Iloreta said, the BMJ report means hearing problems are now "on (his) radar" as something to ask patients about. He also said the public should "be aware" of this potential symptom.
"There is a definitely significant potential for a COVID infection to affect your hearing, from the mild symptom of ringing in your ears to the most severe symptom of permanent hearing loss," he said. "If (you) have any hearing loss ... seek treatment from a care provider. ... The longer you wait, the less likely your hearing is going to come back."