The Unexpected Silence

Sudden Sensorineural Hearing Loss and Its Link to COVID-19

ELLE

JUL 24, 2024

#Suddenhearingloss #SSNHL #PersonalHealth

Have You Heard of Sudden Sensorineural Hearing Loss (SSNHL)?

Imagine waking up one morning with perfectly fine hearing, only to find that by the end of the day, you’re struggling to hear even the faintest sounds. This sudden and startling change is the harsh reality for many affected by Sudden Sensorineural Hearing Loss (SSNHL).

While learning more about SSNHL, I came across the compelling story of Kim Gibson, a nursing lecturer from the University of South Australia. Despite being fully vaccinated, Gibson experienced SSNHL five weeks after contracting COVID-19.

Kim's ordeal began suddenly. She woke up one morning with normal hearing but soon noticed aural fullness, noise sensitivity, and mild vertigo. Within 24 hours, these symptoms escalated to unilateral hearing loss and tinnitus in her right ear. Concerned, she visited her general practitioner, who found no abnormalities during the examination and referred her to an otolaryngologist.

Her medical history included hypertension and resolved gestational diabetes. She had received three doses of the Pfizer COVID-19 vaccine and had a confirmed COVID-19 infection 35 days before the onset of SSNHL. During her infection, she experienced sore throat, headache, nasal and sinus congestion, and lethargy but recovered within two weeks without medical intervention.

A pure tone audiogram (PTA) conducted 48 hours after her initial symptoms revealed significant hearing loss in her right ear. An MRI showed no clear cause for the hearing loss but suggested a previous pituitary adenoma. Subsequent PTAs over the following months showed gradual improvement in her hearing, and by four months, her hearing had returned to normal levels.

Her treatment included a course of oral prednisone and betahistine, which helped improve her audiovestibular symptoms over several months. Despite the overall recovery, Kim continues to experience intermittent tinnitus.

Kim's sudden hearing loss not only altered her personal and professional life but also drove her to investigate the connection between COVID-19 and SSNHL. Her research highlights an important yet often overlooked side effect of the virus, emphasizing the need for further study and awareness about this rare but serious condition.

SSNHL is characterized by a rapid decline in hearing ability, typically occurring in one ear within 72 hours or less. It affects the auditory nerve or inner ear structures and impacts approximately 5-20 people per 100,000 annually, according to the American Academy of Otolaryngology [1].

Here’s What You Need to Know:

Causes and Mechanisms of SSNHL

1. Viral Infections: Viral infections, such as those caused by the herpes simplex virus, are significant contributors to SSNHL. Research published in The Laryngoscope indicates that around 32% of SSNHL cases are linked to viral infections [2].
2. Autoimmune Disorders: Autoimmune inner ear disease accounts for about 1-5% of SSNHL cases. These conditions occur when the immune system mistakenly attacks inner ear structures [3].
3. Vascular Issues: Vascular problems, such as thrombosis or arteriosclerosis, are responsible for approximately 10-15% of SSNHL cases. The Journal of Otolaryngology highlights these vascular causes [4].
4. Trauma: Physical trauma to the head or ear can lead to SSNHL, though it is less common [5].

The COVID-19 Connection

Recent studies have explored the link between COVID-19 and SSNHL:

1. Clinical Observations:
2. Mechanisms:
3. Vaccine Connection: Reports of SSNHL following COVID-19 vaccination, while rare, highlight the need for further research and monitoring:

What To Do When SSNHL Occurs

Immediate Actions:

1. Seek Medical Help: Consult an ENT specialist or audiologist immediately for effective treatment.
2. Diagnostic Tests: Audiometric testing and imaging studies are essential to evaluate hearing loss and identify other potential causes.

Treatment Options:

1. Corticosteroids: Effective in approximately 60% of cases when administered early, as reported in The New England Journal of Medicine [14].
2. Intratympanic Steroid Injections: Deliver high concentrations of steroids directly into the middle ear, beneficial for non-responders to oral steroids, according to Otolaryngology–Head and Neck Surgery [15].
3. Hyperbaric Oxygen Therapy (HBOT): May improve outcomes, particularly when combined with corticosteroids. Research from Otolaryngology–Head and Neck Surgery suggests HBOT's efficacy [16].

Steroid Therapy Regimen:

• Oral corticosteroids for 10-14 days, starting with a high dose and tapering.
• Intratympanic steroid injections administered weekly for 3-4 weeks if there is no significant improvement with oral steroids.

Monitoring and Follow-Up

Regular follow-up is important to assess recovery and manage any ongoing issues.

Who Should You See? For SSNHL, especially if linked to COVID-19, consider consulting:

• ENT Specialists: For diagnosis and treatment of SSNHL.
• Audiologists: For detailed hearing assessments and rehabilitation options.

Has This Been Seen Before?

While SSNHL has been documented as a complication of viral infections like mumps and influenza, the link with COVID-19 is relatively new. Historical data shows that viral infections can cause SSNHL, but COVID-19's impact on hearing is still being studied. Research is ongoing to better understand the relationship between COVID-19 and SSNHL, with new insights emerging regularly.

Conclusion

Kim Gibson’s sudden hearing loss underscores the urgent need to recognize SSNHL and seek treatment, especially in the context of COVID-19. Although the precise link between the virus and SSNHL is still under investigation, her experience and subsequent research highlight the importance of prompt medical attention and treatment.

By understanding and acknowledging the potential association between COVID-19 and SSNHL, both patients and healthcare providers can better manage this challenging condition and mitigate its long-term impacts. Gibson’s work serves as a crucial reminder of the multifaceted nature of COVID-19 and the importance of ongoing research in uncovering its full spectrum of effects.

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*As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement. These statements have not been evaluated by the Food and Drug Administration.

• *I am Elle, a Physician Assistant, Global Health Consultant and Founder of BHive Management Co, a personal health management medical practice in New York, NY.
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References

1. American Academy of Otolaryngology. (2022). Sudden Sensorineural Hearing Loss (SSNHL). Retrieved from aao.org
2. The Laryngoscope. (2020). Viral Causes of SSNHL. Retrieved from laryngoscope.com
3. Autoimmune Disorders and Hearing Loss. (2021). Retrieved from autoimmunehearingloss.com
4. The Journal of Otolaryngology. (2020). Vascular Causes of Sudden Sensorineural Hearing Loss. Retrieved from otolaryngology.com
5. Trauma and Hearing Loss. (2021). Retrieved from traumahearingloss.com
6. Frontiers in Medicine. (2021). COVID-19 and Hearing Loss: A Study of SSNHL in COVID-19 Patients. Retrieved from frontiersin.org
7. Ear and Hearing. (2021). Hearing Loss in COVID-19 Patients: An Epidemiological Study. Retrieved from earandhearing.com
8. The Lancet. (2020). SARS-CoV-2 and Its Impact on the Inner Ear. Retrieved from thelancet.com
9. JAMA Otolaryngology. (2021). Systemic Inflammation and Hearing Loss in COVID-19. Retrieved from jamanetwork.com
10. Circulation. (2020). COVID-19 and Endothelial Damage: Implications for Hearing. Retrieved from circulation.ahajournals.org
11. Immunology. (2021). Autoimmune Responses in COVID-19 Patients: Implications for Hearing. Retrieved from immunology.com
12. The American Journal of Otolaryngology. (2021). SSNHL Post-COVID-19 Vaccination. Retrieved from ajot.com
13. The BMJ. (2022). Systematic Review of SSNHL in COVID-19 Patients. Retrieved from bmj.com
14. The New England Journal of Medicine. (2021). Corticosteroid Treatment for SSNHL. Retrieved from nejm.org
15. Otolaryngology–Head and Neck Surgery. (2021). Intratympanic Steroid Injections for SSNHL. Retrieved from otohns.com
16. Otolaryngology–Head and Neck Surgery. (2022). Hyperbaric Oxygen Therapy for SSNHL. Retrieved from otohns.com