Evaluation of Postinfection Hearing with Audiological Tests in Patients with COVID-19: A Case–Control Study

Abstract

Background Some viral infections can cause congenital or acquired unilateral or bilateral hearing loss. It is predicted that the coronavirus disease 2019 (COVID-19) virus, which can affect many systems in the body, may also have a negative effect on hearing. Purpose This study evaluated the effects of COVID-19 infection on pure-tone average. Research Design A case–control study. Materials and Methods A total of 104 volunteers (48 control, 56 experimental group) who applied to the ENT clinic of Adıyaman University Training and Research Hospital were included in this study. After the detailed clinical examination and medical history, 13 volunteers of the experimental group and 5 volunteers from the control group were excluded from the study. In this way, each group consisted of 43 volunteers. While the experimental group consisted of patients who did not have any hearing problems before but had COVID-19. The control group consisted of healthy volunteers who did not have any hearing problems and were not infected with COVİD-19. Audiological test was applied to all volunteers to determine their pure-tone average. On the data obtained, it was analyzed whether COVID-19 affects the pure-tone average and how it changes according to variables such as age and gender. Results The evaluation of the 43 (50.0%) COVID-19-positive patients and 43 (50.0%) healthy controls showed no significant differences (p > 0.05) at 250 and 500 Hz, whereas at 4000, 6000, and 8000 Hz, the two groups differed significantly. In addition, significant differences were found in the left and right ears at 1000 and 2000 Hz (p < 0.05). The differences between the two groups in the pure-tone average of the left and right ear were statistically significant (p < 0.05). However, there were no significant sex-based differences in the pure-tone average between males and females (p > 0.05) Conclusion The pure-tone average of COVID-19 positive patients was significantly worse than those of the healthy control group. Thus, COVID-19 should also be considered in patients presenting with unexplained hearing loss. Further studies should investigate the effects of COVID-19 on hearing and the underlying pathophysiology.

Cochleovestibular findings linked to COVID-19: A scoping review for clinical care planning in South Africa

“…The reported rate of otological or vestibular symptoms varied significantly. For example, Korkmaz et al (2021) Ricciardiello et al (2021) reported that both ears can equally be affected, and the impairment could be unilateral or bilateral, and if bilateral, the symptoms can be symmetrical or nonsymmetrical (Karimi-Galougahi et al, 2020;Koparal & Yılmazer, 2021;Koumpa et al, 2020;Sriwijitalai & Wiwanitkit, 2020), with the severity of the hearing loss documented to range from mild loss to profound hearing loss (Beckers et al, 2021;Chern et al, 2021;Koparal & Yılmazer, 2021;Koumpa et al, 2020;Pokharel et al, 2021) and some evidence of puretone average being substantially worse in patients with COVID-19 when compared with healthy control groups, particularly in the high frequencies (Koparal & Yılmazer, 2021). Mustafa (2020) found that pure-tone hearing thresholds in high frequencies and amplitudes of transient evoked otoacoustic emissions (TEOAE) were significantly worse in this population, thus concluding that COVID-19 infection potentially has adverse effects on cochlear hair cell function even when infected individuals are asymptomatic for the cardinal disease symptoms.…”

“…Nonetheless, notwithstanding this research quality challenge, the limited evidence that exists seems to warrant the need for careful audiological assessment and monitoring and polymerase chain reaction (PCR) testing for COVID-19 diagnosis in patients with sudden unexplained cochleovestibular features during COVID-19 (Beckers et al, 2021 ; Jafari et al, 2021 ; Koparal & Yılmazer, 2021 ) and children born to mothers who were COVID-19 positive during pregnancy (Alan & Alan, 2021 ; Oskovi-Kaplan et al, 2022 ; Yıldız et al, 2021 ). This is particularly important as definitive evidence is required to ensure that appropriate treatment is provided that takes into cognisance the therapeutic dilemmas surrounding the use of steroids in this population, as raised by Karimi-Galougahi et al ( 2020 ), the need for patient isolation and the possibilities of monitoring for late onset hearing loss in children born to mothers who were COVID-19 positive during pregnancy.…”

“…Koumpa et al ( 2020 ) argued that this prompt screening and diagnosis of cochleovestibular symptoms post-COVID-19 facilitates prescription of an early course of steroids, thus providing the patient with the best chance of symptom resolution. Koparal and Yılmazer ( 2021 ) stressed that in cases presenting with unexplained hearing loss or vestibular dysfunction, it is critical to prioritise PCR testing to determine the possibility of COVID-19 causing the symptoms because of two important reasons: (1) prevention of virus spread (patient isolation) and (2) offering the patient therapy for acute hearing loss with steroids while taking into cognisance the therapeutic dilemmas surrounding the use of steroids in this population (Karimi-Galougahi et al, 2020 ), thus affording the infected patient an opportunity to recover from the symptoms.…”

“…Findings from the review reveal uncertainty and inconsistency regarding the underlying pathophysiology of the cochleovestibular symptoms in COVID-19 positive patients, with Pokharel et al ( 2021 ) maintaining that the absence of a clear pathophysiologic mechanism linking COVID-19 to SSNHL creates a vague association. Therefore, Koparal and Yılmazer’s ( 2021 ) recommended more research to examine the impact of COVID-19 on hearing, including the underlying pathophysiology. So far, current evidence suggests that otologic features found in this population are potentially because of (1) direct viral invasion of the labyrinth or cochlear nerve and intralabyrinthine haemorrhage from COVID-19-associated coagulopathy (Chern et al, 2021 ); (2) an inflammatory process in the cochlea (virus-triggered, immune-mediated inflammation), as observed in MRI findings (Degen et al, 2020 ); (3) the possibility of COVID-19 invading the neural pathways involved in hearing and balance (Karimi-Galougahi et al, 2020 ); and (4) in neonates, delayed neuromaturation because of factors such as preterm birth, foetal growth restriction and perinatal mortality (Alan & Alan, 2021 ).…”

Is COVID‐19 to Blame for Sensorineural Hearing Deterioration? A Pre/Post COVID‐19 Hearing Evaluation Study

“…Because there was no reason to assume that the virus would attack a specific ear and as previous studies have shown similar effects in both ears, 3 , 8 , 9 , 10 the results in the right and left ears of each participant were averaged. To answer our research questions, the air conduction thresholds were divided into three frequency ranges: low = 250–500 Hz, mid = 1000–3000 Hz, and high = 4000–8000 Hz.…”