Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Mar;49(2):184-195.
doi: 10.1017/cjn.2021.63. Epub 2021 Apr 12.

Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis

Zahra Jafari  1 , Bryan E Kolb  1 , Majid H Mohajerani  1
Affiliations
Meta-Analysis

Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis

Zahra Jafari et al. Can J Neurol Sci. 2022 Mar.

Abstract
in English, French

Objectives: Extensive studies indicate that severe acute respiratory syndrome coronavirus (SARS-CoV-2) involves human sensory systems. A lack of discussion, however, exists given the auditory-vestibular system involvement in CoV disease 2019 (COVID-19). The present systematic review and meta-analysis were performed to determine the event rate (ER) of hearing loss, tinnitus, and dizziness caused by SARS-CoV-2.

Methods: Databases (PubMed, ScienceDirect, Wiley) and World Health Organization updates were searched using combined keywords: 'COVID-19,' 'SARS-CoV-2,' 'pandemic,' 'auditory dysfunction,' 'hearing loss,' 'tinnitus,' 'vestibular dysfunction,' 'dizziness,' 'vertigo,' and 'otologic symptoms.'

Results: Twelve papers met the eligibility criteria and were included in the study. These papers were single group prospective, cross-sectional, or retrospective studies on otolaryngologic, neurologic, or general clinical symptoms of COVID-19 and had used subjective assessments for data collection (case histories/medical records). The results of the meta-analysis demonstrate that the ER of hearing loss (3.1%, CIs: 0.01-0.09), tinnitus (4.5%, CIs: 0.012-0.153), and dizziness (12.2%, CIs: 0.070-0.204) is statistically significant in patients with COVID-19 (Z ≤ -4.469, p ≤ 0.001).

Conclusions: COVID-19 can cause hearing loss, tinnitus, and dizziness. These findings, however, should be interpreted with caution given insufficient evidence and heterogeneity among studies. Well-designed studies and follow-up assessments on otologic symptoms of SARS-CoV-2 using standard objective tests are recommended.

Pertes auditives, acouphènes et étourdissements chez des patients atteints de la COVID-19 : une étude systématique et une méta-analyse.

Objectifs :: Des études approfondies indiquent désormais que le syndrome respiratoire aigu sévère lié au coronavirus (SRAS-CoV-2) peut affecter les systèmes sensoriels humains. L’impact du virus sur les systèmes auditif et vestibulaire est tel qu’on peut considérer qu’il existe à l’heure actuelle un manque de discussions quant à cet impact. L’étude systématique et la méta-analyse qui suivent ont été effectuées afin de déterminer justement la fréquence des pertes auditives, des acouphènes et des étourdissements causés à partir de 2019 par le SRAS-CoV-2.

Méthodes :: Nous avons interrogé certaines bases de données (PubMed, ScienceDirect, Wiley) mais aussi les mises à jour de l’Organisation mondiale de la santé (OMS) au moyen des mots-clés combinés suivants : « COVID-19 », « SRAS-CoV-2 », « pandémie », « dysfonction auditive », « pertes auditives », « acouphènes », « dysfonction vestibulaire », « étourdissements », « vertiges » et « symptômes otologiques ».

Résultats :: Au total, 12 articles ont satisfait à nos critères d’admissibilité et ont été inclus dans cette étude. Ces articles étaient prospectifs et basés sur un seul groupe, de nature transversale, de nature oto-rhino-laryngologique et rétrospective, de nature neurologique ou axés sur les symptômes cliniques généraux de la COVID-19. Tous ont recouru à des évaluations subjectives dans la collecte des données (historique des cas, dossiers médicaux). Les résultats de la méta-analyse ont ainsi démontré que les fréquences de pertes auditives (3,1 %, IC : 0,01-0,09), d’acouphènes (4,5 %, IC : 0,012-0,153) et d’étourdissements (12,2 %, IC : 0,070-0,204) étaient statistiquement significatives chez des patients atteints de la COVID-19 (Z ≤ −4,469, p ≤ 0,001).

Conclusions :: La COVID-19 peut entraîner des pertes auditives, des acouphènes et des étourdissements. Ces résultats devraient toutefois être interprétés prudemment étant donné le manque de preuves et l’hétérogénéité des articles en cause. Des études bien conçues et des évaluations des symptômes otologiques du SRAS-CoV-2 lors de suivis à l’aide de tests standardisés objectifs sont donc recommandées.

Keywords: Coronavirus; Dizziness; Hearing loss; Otologic symptoms; SARS-CoV-2; Tinnitus; Vertigo.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
PRISMA flow diagram demonstrating the summary of literature search and screening process. PRISMA, preferred reporting items for systematic reviews and meta-analyses.
Figure 2:
Figure 2:
Forest plot for the event rate of hearing loss in four studies (A), tinnitus in six studies (B), and dizziness in nine studies (C). The square size indicates the statistical weight for each study. The horizontal line represents 95% CI, and the diamond summarizes the overall estimate of event rate and its corresponding 95% CI. CI, confidence interval.
Figure 3:
Figure 3:
Auditory and vestibular neural pathways in humans. (A) Cranial nerves (I–XII) at the base of the brain. (B) Innervation of the cochlea and vestibule (i.e., semicircular channels, utricle, and saccule) by auditory and vestibular branches of the auditory–vestibular nerve (cranial nerve VIII). (C) The major ascending auditory neural pathways. (D) Vestibular neural pathways. The afferent fibers from the vestibular labyrinth project to each of the vestibular nuclei located in the rostral medulla and the caudal pons. Neural fibers from semicircular canals project to the SVN and rostral portion of the MVN. Neural fibers from the utricle and saccule terminate in LVN. Some saccular neural fibers project to the IVN. DCN, dorsal cochlear nucleus; IVN, inferior vestibular nucleus; LVN, lateral vestibular nucleus; MLF, medial longitudinal fasciculus; MVN, medial vestibular nucleus; SVN, superior vestibular nerve; VCN, ventral cochlear nucleus.
See this image and copyright information in PMC

References

    1. Cascella C, Rajnik M, Cuomo A, Dulebohn S, Di Napoli R. Features, Evaluation, and Treatment of Coronavirus (COVID-19). Treasure Island (FL): StatPearls; 2020. - PubMed
    1. Pascarella G, Strumia A, Piliego C, et al. COVID-19 diagnosis and management: a comprehensive review. J Int Med. 2020;288:192–206. - PMC - PubMed
    1. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Eng J Med 2020;382:1708–20. - PMC - PubMed
    1. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: a review. Clin Immunol 2020;215:108427. - PMC - PubMed
    1. Agyeman AA, Chin KL, Landersdorfer CB, Liew D, Ofori-Asenso R. Smell and taste dysfunction in patients with COVID-19: a systematic review and meta-analysis. Mayo Clin proceed. 2020;95:1621–31. - PMC - PubMed

Publication types