Can COVID-19 Cause Hearing Loss?

Right now, the best answer anyone can give to this question is “maybe.” Although a definitive link has not yet been established, there is some evidence to suggest COVID infection may contribute to hearing loss in some patients. Why? Here is what we currently know:

Ear Damage Directly Related to COVID

While it is not yet possible to prove that COVID-19 infection is directly responsible for hearing loss, the virus can and does enter the ear – probably through the Eustachian tube, which connects the nose and middle ear. Once it gains entry to the ear, the virus can actively infect both the cochlear (hearing) and vestibular (balance) hair cells, potentially causing:

• Sensorineural hearing loss. Hearing loss caused by damage to the inner ear or the nerve from the ear to the brain. This type of hearing loss is permanent.
• Vestibular dysfunction: Problems with balance.

In addition, COVID-19 is not just a respiratory disease. It can affect almost all of the major organ systems in the body, including the vascular system. Vascular effects may include blood vessel damage and/or the formation of microemboli (tiny clots) that can interrupt blood flow. If the artery that supplies blood to the inner ear is damaged or blocked, it can affect both the cochlea (a highly vascularized organ in the inner ear responsible for hearing) and the vestibular organs responsible for balance.

Middle Ear Congestion

COVID-19 is a viral illness and, like any virus, it infects the body by invading cells and using components of that cell to make copies of itself and spread. Although COVID-19 often has far more serious health implications than other viruses like the common cold and influenza, it does have one thing in common with them – it frequently results in upper respiratory symptoms such as coughing along with nasal and sinus congestion.

And, because COVID-19 causes inflammation in the nose and nasopharynx (the upper part of the throat located behind the nose), the Eustachian tube (the tube that connects the nose and middle ear) may also become inflamed during the course of the infection and lead to middle ear congestion.

“Inflammation of the Eustachian tube often results in an acute buildup of fluid in the middle ear space,” says ear, nose and throat specialist, Sarah Mowry, MD. “This middle ear fluid results in congestion, fullness and a feeling of ‘underwater’ hearing. This fluid often clears spontaneously within a few weeks of the inflammation. If it doesn’t, a physician can drain the fluid to improve the hearing-related symptoms, usually with a simple office procedure.”

COVID Vaccination 

There are some anecdotal reports of patients experiencing tinnitus and/or dizziness after receiving the two-dose vaccine regimens from Moderna and Pfizer. However, the reason for this is unclear because the vaccines do not actively affect the inner ear tissues. It is, therefore, unlikely that hearing and balance symptoms are directly linked to vaccination.

Hearing Loss as a Later Symptom

Since COVID-19 was first recognized in early 2020, we have gained much understanding of how the virus can affect the body both during the initial phase of infection and in the weeks and months that follow. When symptoms persist or develop well after the acute infection, it is often called Long Haul Syndrome or Long COVID.

Although relatively rare, there are a few studies that have documented hearing symptoms in post-COVID patients that were not present earlier in the infection process. Symptoms included mild to profound hearing loss, vertigo and/or tinnitus in one or both ears.

More Research is Needed

Much more research is needed before we can fully understand how COVID-19 and its variants affect hearing and balance. In the beginning, much of the research being done was related to the prevention, diagnosis and treatment of the virus in the acute phase of infection. As the pandemic winds down, research efforts will likely become more focused on the long-term effects of the virus and how it can affect various body functions, including hearing and balance.

Always Seek Help for Sudden Hearing Loss

If your hearing loss is sudden, consider it a medical emergency. You should always seek care right away at an emergency room or from an ear, nose and throat physician. There can be numerous reasons for sudden hearing loss and, the sooner it is diagnosed, the more likely your hearing can be restored.