Sudden Sensorineural Hearing Loss in Mild COVID-19: Case Series and Analysis of the Literature

Abstract

Background: There is growing evidence of otoneurological involvement of SARS-CoV-2, such as tinnitus and balance disorders and smell and taste disorders, but HL in COVID-19 patients has still been marginally studied. Investigating the role of SARS-CoV-2 as an aetiological factor of Sudden Sensorineural Hearing Loss (SSNHL) may offer the opportunity to address treatment strategies to maximize clinical recovery and avoid side effects.

Methods and results: For this purpose, we will present case studies of five patients who experienced SSNHL during COVID-19. Patients were selected from COVID-19 positive adult subjects with mild clinical presentation, admitted to the outpatient Ear Nose and Throat Department of Cardarelli Hospital due to the onset of SSNHL during the infection. All underwent a complete audio-vestibular investigation before and after SSNHL treatment protocol. Each patient is described with a detailed analysis.

Conclusions: SSNHL could be an occasional symptom of COVID-19, even in mild manifestations of the disease. Our experience leads us to underline the value of promptly recognizing and addressing this and other uncommon symptoms, giving patients the opportunity to receive early treatment.

Keywords: COVID-19; SARS-CoV-2; SSNHL; coronavirus; hearing loss; sudden sensorineural hearing loss; tinnitus; treatment; vertigo.

Figure 1

Hearing threshold at baseline, after 3 cycles of therapy and during the vestibular rehabilitation (IV and V).

Figure 2

Hearing threshold from baseline to outcome (after 3 cycles of therapy).

Figure 3

Hearing threshold from baseline to outcome (3 cycles of therapy).

Figure 4

Hearing threshold of the left ear, from baseline to outcome (after 2 cycles of therapy).

Figure 5

Hearing threshold of the right ear, from baseline to outcome (after 2 cycles of therapy).

Figure 6

Hearing threshold from baseline to outcome (after 1 cycle of therapy).

Figure 7

The overall Mean Hearing Level had a significative improvement after treatment (p = 0.0016).

Figure 8

Each patient had an improved mean hearing level after treatment.

Figure 9

THI showed a significative subjective improvement of Tinnitus after treatment (p = 0.0018). Acufenometry values confirmed this trend.

Figure 10

Each patient had an improved THI score after treatment; patient No. 2 was the only one to not experience tinnitus, and patient No.5 fully recovered from tinnitus.