No COVID-19 in Patients with Sudden Sensorineural Hearing Loss (SSNHL)

Sudden Sensorineural Hearing Loss Before COVID-19, During COVID-19, and After Inactivated Vaccination: Experience From a Tertiary Referral Center in China

OBJECTIVE

The purpose of this study was to investigate the incidence rate and audiological characteristics of sudden sensorineural hearing loss (SSHL) before the COVID-19 pandemic, during the COVID-19 pandemic, and after inactivated vaccination, and to analyze whether the novel coronavirus or inactivated vaccination have an impact on hearing loss.

MATERIALS AND METHODS

The clinical data of all patients who visited the hospital in July 2019 (before pandemic), July 2020 (during pandemic) and July 2021 (after the inactivated vaccination at least the first basic dose of COVID-19 vaccination) were retrospective analyzed. All patients diagnosed with sudden sensorineural hearing loss in these three periods were screened, and their incidence rate, hearing characteristics, and prognosis were compared.

RESULTS

Overall, the incidence rates of sudden hearing loss in July 2019, July 2020, and July 2021 were 0.59, 0.60, and 0.52% (25 of 4225, 20 of 3322, 28 of 5432), respectively, without significant difference ( χ2 = 0.372, p = 0.830). A significant difference was noted in the incidence of hypertension ( p = 0.02), whereas no significant difference was noted in age ( p = 0.591, p = 0.66), sex ( p = 0.19, p = 0.08), main symptoms ( p = 0.18, p = 0.15), side ( p = 0.483, p = 0.89), audiogram shape ( p = 0.56, p = 0.989), average hearing threshold of affected frequency ( p = 0.81, p = 0.89), average hearing threshold of normal ear affected frequency ( p = 0.65, p = 0.68), average hearing threshold of affected frequency after treatment ( p = 0.49, p = 0.38), days between symptoms onset and hospital visit ( p = 0.62, p = 0.85), treatment plan ( p = 0.551, p = 0.474), and effectiveness ( p = 0.104, p = 0.050).

CONCLUSION

Our study failed to find a correlation between the novel coronavirus pandemic and inactivated vaccination and SSHL, and there was no direct evidence supporting that COVID-19 or inactivated vaccination had an impact on the incidence rate and prognosis of SSHL patients.

Sudden Hearing Loss before, during, and after the Pandemic: Investigating COVID-19 Illness and Vaccine-Related Symptoms

INTRODUCTION

Accumulating reports suggest an increase in sudden sensorineural hearing loss during the COVID-19 pandemic and vaccination periods. However, clear evidence is lacking. The goal of this study was to determine if sudden sensorineural hearing loss is associated with COVID-19 illness or its vaccine.

METHODS

Retrospective chart review of 50 randomly selected patients from three, 6-month time periods: "pre-pandemic," "early pandemic," and "late pandemic." Group comparisons were performed for demographics, comorbid conditions, audiologic history, audiometric data, speech reception thresholds, and word recognition.

RESULTS

One hundred 50 patients were included in this study. A mean difference was observed in that the relative percentage of sensorineural hearing loss (SNHL) cases increased over time, corresponding to a relative decrease in conductive hearing loss cases. However, this change was not explained by proportional changes in sudden SNHL. Patients in the early pandemic time period were more likely to report tinnitus. Otherwise, the patient groups did not differ on demographic variables, hearing health history, hearing loss presentation, pure tone averages, speech reception thresholds, or word recognition performance.

CONCLUSIONS

Proportion of patients with sudden sensorineural hearing loss did not change over time from the pre-pandemic period to the early or late pandemic phases. Despite a randomized sample, these findings do not support the hypothesis that COVID-19 illness or vaccine is associated with sudden sensorineural hearing loss.

Sudden Hearing Loss Waves: The Effect of COVID-19 Infection and Vaccination on the Inner Ear

Sudden sensorineural hearing loss (SSNHL) has emerged as a potential complication of COVID-19 infection and vaccination. Various mechanisms by which the SARS-CoV-2 virus can cause hearing loss have been reported, including direct viral invasion, neuroinflammation, blood flow disturbances, and immune-mediated response. However, the temporal relationship between COVID-19 infection and SSNHL remains unclear, with mixed findings and conflicting results reported in different studies. Similarly, while anecdotal reports have linked COVID-19 vaccination to SSNHL, evidence remains scarce. Establishing a correlation between COVID-19 vaccines and SSNHL implies a complex and multifactorial pathogenesis involving interactions between the immune system and the body's stress response. Nevertheless, it is important to consider the overwhelming evidence of the vaccines' safety and efficacy in limiting the spread of the disease and remains the primordial tool in reducing death.

Association between COVID-19 and sensorineural hearing loss: Evidence from a Mendelian randomization study in European and East Asian population

BACKGROUND

Long coronavirus disease (COVID), characterized by persistent and sometimes debilitating symptoms following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has garnered increasing attention as a potential public health crisis. Emerging evidence indicates a higher incidence of hearing loss in individuals who have had COVID 2019 (COVID-19) compared to the general population. However, the conclusions were inconsistent, and the causal relationship between COVID-19 and sensorineural hearing loss remains unknown.

METHODS

To addresses this outstanding issue, we performed Mendelian randomization analysis to detect the causal association between COVID-19 and hearing loss using the largest genome-wide association study data to date in the European population and confirmed the results in the East Asian population. Comprehensively sensitive analyses were followed, including Cochran's Q test, Mendelian randomization (MR)-Egger intercept test, MR-pleiotropy residual sum and outlier, and leave-one-out analysis, to validate the robustness of our results.

RESULTS

Our results suggested that there is no causal association between COVID-19 and the risk of hearing loss in the European population. Neither the susceptibility, hospitalization, and severity of COVID-19 on hearing loss (inverse variance weighted method: odds ratio (OR) = 1.046, 95% confidence interval (CI) = 0.907-1.205, p = .537; OR = 0.995, 95% CI = 0.956-1.036, p = .823; OR = 0.995, 95% CI = 0.967-1.025, p = .76). Replicated analyses in the East Asian population yielded consistent results. No pleiotropy and heterogeneity were found in our results.

CONCLUSION

In conclusion, our MR results do not support a genetically predicted causal relationship between COVID-19 and sensorineural hearing loss. Thus, the associations observed in prior observational studies may have been influenced by confounding factors rather than a direct cause-and-effect relationship. More clinical and mechanism research are needed to further understand this association in the future.

COVID-19 and transtympanic injections for sudden sensorineural hearing loss

BACKGROUND

Multiple reports have linked COVID-19 infection with sudden sensorineural hearing loss (SSNHL), although other studies have failed to demonstrate this association. The current study was conceived to examine the rates of SSNHL across a large, principally national, population by characterizing the rate of transtympanic injections for SSNHL during the pandemic.

METHODS

Retrospective review of all patients that underwent transtympanic injection from 2019 to 2020.

RESULTS

Covering a unique beneficiary population of 9.6 million individuals of all ages in the United States, a statistically significant decrease in transtympanic injections for SSNHL was performed from 2019 to 2020 (p = 0.04, IRR = 0.91, 95 % CI = 0.84-0.99). No patient receiving a transtympanic injection also had a COVID-19 diagnosis.

CONCLUSIONS

These findings support the idea that COVID-19 infections do not clinically significantly increase patients' risk of developing SSNHL. In fact, the decreased exposure through social isolation to other common viruses implicated in causing SSNHL may have actually led to a lower rate of SSNHL during the pandemic.

Sudden Hearing Loss Following Vaccination Against COVID-19

Importance

Spontaneous adverse reaction reports of sudden hearing loss have been observed, and a population-based cohort study conducted in Israel showed an increase in the incidence of sudden sensorineural hearing loss (SSNHL) following vaccination with messenger RNA COVID-19 vaccine BNT162b2 (Pfizer-BioNTech). However, in this setting, the possibility of confounding remained.

Objective

To assess a potential association between COVID-19 vaccinations and SSNHL.

Design, Setting, and Participants

This register-based country-wide retrospective cohort study of 5.5 million Finnish residents was conducted from January 1, 2019, to April 20, 2022, and included all individuals who were identified from the population information system who were alive or born during the study period except individuals who had SSNHL during 2015 to 2018 according to specialized care derived diagnosis codes for SSNHL (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code H91.2) as a primary or secondary diagnosis.

Exposures

The a priori primary risk period was 0 to 54 days following each COVID-19 vaccination. The risk periods for different vaccine doses did not overlap so that a later vaccine exposure ended the previous risk period. The secondary risk period was from 55 days following each COVID-19 vaccination until a subsequent COVID-19 vaccination. A secondary analysis included a risk time from 0 to 54 days following a positive polymerase chain reaction test result for SARS-CoV-2.

Main Outcomes and Measures

The incidences of SSNHL following COVID-19 vaccination were compared with the incidences before the COVID-19 epidemic in Finland. The Poisson regression model included calendar time, age, sex, diabetes, cardiovascular disease, other chronic diseases, and the number of visits in primary health care.

Results

For the 5.5 million Finnish residents included in the study, the comparison time comprised 6.5 million person-years, the primary risk time of 1.7 million person-years, and the secondary risk time of 2.1 million person-years. Before the COVID-19 epidemic in Finland, 18.7/100 000 people received a diagnosis of SSNHL annually. The study data suggested no increased risk for SSNHL following any COVID-19 vaccination. In particular, adjusted incidence rate ratios with 95% confidence intervals for the BNT162b2 vaccine's 3 doses were 0.8 (95% CI, 0.6-1.0), 0.9 (95% CI, 0.6-1.2), and 1.0 (95% CI, 0.7-1.4), respectively. There was no association between SARS-CoV-2 infection and an increased incidence of SSNHL.

Conclusions and Relevance

The results of this cohort study show no evidence of an increased risk of SSNHL following COVID-19 vaccination. The study accounted for previous disease and other potential confounding factors. These results are based on diagnosis codes in specialized care but still need to be verified in settings that are capable of evaluating the degree of hearing loss.

Evaluation of Disturbances in Hearing, Tinnitus, and Dizziness as Signs of COVID-19 Infection

BACKGROUND

There have been reports and studies indicating audiovestibular disturbances in COVID-19 patients with variations in the percentage of sensorineural hearing loss (SNHL). The purpose of this study is to compare the incidence of newly diagnosed SNHL, sudden idiopathic hearing loss (SIHL), tinnitus, and vestibular disturbances between infected and uninfected patients, as well as to identify population groups at risk.

METHODS

This study used TriNetX to obtain statistics on COVID-19 (+) and COVID-19 (-) patients from 61 healthcare organizations. Propensity score with 1:1 matching was used to control confounding variables. This study evaluated the relative risk of developing audiovestibular disturbances up to 1 month after a COVID-19 test and further investigated the incidence in COVID-19 (+) subset groups.

RESULTS

Between COVID-19 (+) and COVID-19 (-) patients who had an audiogram, there was no statistically significant difference in SNHL or SIHL (SNHL: relative risk [RR] = 0.69, 95% confidence interval [CI] = 0.46-1.04; SIHL: RR = 1.00, 95% CI = 0.42-2.40). Race/ethnicity or specified comorbidity did not affect the incidence of SNHL or SIHL. There was a statistically significant difference in tinnitus and vestibular disturbances between the COVID-19 (+) and the COVID-19 (-) groups (RR = 1.29, 95% CI = 1.01-1.66; RR = 2.33, 95% CI = 2.19-2.48).

CONCLUSION

New onset hearing loss is not more common in patients with a positive COVID-19 test than those with a negative COVID-19 test. Audiologic evaluation is needed to verify reported hearing disturbances. Although statistically significant in specific population groups, tinnitus and vestibular disturbances may not be clinically significant due to the low incidence.

COVID-19 and Sudden Sensorineural Hearing Loss: A Systematic Review

A growing body of evidence suggests that patients with the 2019 Coronavirus disease (COVID-19) have a risk of developing sudden sensorineural hearing loss (SSNHL). The pathogenesis of COVID-19-related SSNHL remains unclear. This systematic review examined whether COVID-19 causes an increased incidence of SSNHL and the clinical characteristics of patients with COVID-19-related SSNHL according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. SSNHL usually developed between a few days and 2 months after the diagnosis of COVID-19, and a proportion of patients developed it before the diagnosis of COVID-19. The literature is inconsistent regarding whether COVID-19 causes an increased incidence of SSNHL, and this matter remains unclear. This review included 23 patients with COVID-19-related SSNHL, all adult patients with an average age of 43.1 years. Of these patients, 60.9% had accompanying tinnitus symptoms. Glucocorticoids are the preferred medication to treat COVID-19-related SSNHL. Intratympanic administration may be considered to reduce the side effects of the drug. Hearing tests are suggested when hearing loss is suspected in COVID-19 individuals, and if SSNHL is detected, prompt and aggressive treatment is vital. Large-scale, multicenter research on the pathophysiology, treatment, and prognosis of COVID-19- related SSNHL should be conducted in the future.