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Abdul Rahim NS, Lim XJ, Leong EL, Lim SY, Amri NA, Lim CC, Devesahayam PR. Association of COVID-19 infection and COVID-19 vaccination with idiopathic sudden sensorineural hearing loss in Malaysia: a case-control study. BMC Public Health 2025; 25:920. [PMID: 40055620 PMCID: PMC11889865 DOI: 10.1186/s12889-025-21765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 02/04/2025] [Indexed: 05/13/2025] Open
Abstract
BACKGROUND Previous studies indicated that the SARS-CoV-2 virus and COVID-19 vaccines may contribute to idiopathic sudden sensorineural hearing loss (ISSNHL). This nationwide study sought to evaluate the correlation between COVID-19 infection and vaccination with ISSNHL. METHODS This case-control study analysed samples from adults aged 18 years and older who visited the otorhinolaryngology department in 32 government hospitals in Malaysia for pure tone audiometry(PTA) between January 25, 2020 and June 30, 2022. Cases comprised patients diagnosed with ISSNHL, while controls consisted of individuals with normal PTA assessments presenting for other otorhinolaryngology-related symptoms during the same period. Patients with known causes of hearing loss were excluded. Cases and controls were matched in a 1:5 ratio based on age (± 5 years) and index date (± 10 days). The study investigated the association between ISSNHL and both COVID-19 vaccination and COVID-19 infection using conditional logistic regression, with statistical significance set at P < 0.05 for two-sided tests. RESULTS A total of 187 ISSNHL cases and 935 matched controls were included. The mean (SD) age of participants was 42.4 (12.3) years, and 704 (62.7%) were female. Cases had a higher proportion of COVID-19 infections compared to controls [16 (8.6%) vs 44 (4.7%), P = 0.034], while both groups had similar proportions of COVID-19 vaccination [90 (48.1%) vs 415 (44.5%), P = 0.377]. Individuals who tested positive for COVID-19 had a significantly higher likelihood of developing ISSNHL compared to those without COVID-19 infection at the time of diagnosis (aOR:2.49; 95% CI:1.176 - 5.260; P = 0.017). However, there was no statistically significant association between COVID-19 vaccination and ISSNHL. CONCLUSIONS This study provides significant insights into the intricate correlation between ISSNHL, COVID-19 infection, and vaccination. The recognized hazard linked to infection emphasizes the significance of monitoring auditory health in COVID-19 patients.
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Affiliation(s)
- Nur Sabrina Abdul Rahim
- Clinical Research Centre, Level 4, Ambulatory Care Centre (ACC), Hospital Raja Permaisuri Bainun, Jalan Raja Ashman Shah, Ipoh, Perak, 30450, Malaysia.
| | - Xin-Jie Lim
- Clinical Research Centre, Level 4, Ambulatory Care Centre (ACC), Hospital Raja Permaisuri Bainun, Jalan Raja Ashman Shah, Ipoh, Perak, 30450, Malaysia
| | - E-Li Leong
- Clinical Research Centre, Level 4, Ambulatory Care Centre (ACC), Hospital Raja Permaisuri Bainun, Jalan Raja Ashman Shah, Ipoh, Perak, 30450, Malaysia
| | - Su-Yin Lim
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Nur Azyani Amri
- Otorhinolaryngology Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Chee Chean Lim
- Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Philip Rajan Devesahayam
- Clinical Research Centre, Level 4, Ambulatory Care Centre (ACC), Hospital Raja Permaisuri Bainun, Jalan Raja Ashman Shah, Ipoh, Perak, 30450, Malaysia
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
- Otorhinolaryngology Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
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Skare TL, de Carvalho JF, de Medeiros IRT, Shoenfeld Y. Ear abnormalities in chronic fatigue syndrome (CFS), fibromyalgia (FM), Coronavirus-19 infectious disease (COVID) and long-COVID syndrome (PCS), sick-building syndrome (SBS), post-orthostatic tachycardia syndrome (PoTS), and autoimmune/inflammatory syndrome induced by adjuvants (ASIA): A systematic review. Autoimmun Rev 2024; 23:103606. [PMID: 39209013 DOI: 10.1016/j.autrev.2024.103606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 09/04/2024]
Abstract
Chronic fatigue syndrome (CFS), fibromyalgia (FM), silicone breast implants (SBI), Coronavirus-19 infectious disease (COVID), COVID-19 vaccination (post-COVIDvac-syndrome), Long-COVID syndrome (PCS), sick-building syndrome (SBS), post-orthostatic tachycardia syndrome (PoTS), and autoimmune/ inflammatory syndrome induced by adjuvants (ASIA) are a cluster of poorly understood medical conditions that have in common a group of ill-defined symptoms and dysautonomic features. Most of the clinical findings of this group of diseases are unspecific, such as fatigue, diffuse pain, cognitive impairment, paresthesia, tachycardia, anxiety, and depression. Hearing disturbances and vertigo have also been described in this context, the underlying pathophysiologic process for these conditions might rely on autonomic autoimmune dysbalance. The authors procced a literature review regarding to hearing and labyrinthic disturbances in CSF, FM, SBI, COVID, post-COVIDvac-syndrome, PCS, SBS, POTS, and ASIA. The PRISMA guidelines were followed, and the literature reviewed encompassed papers from January 1990 to January 2024. After the initial evaluation of the articles found in the search through Pubmed, Scielo and Embase, a total of 172 articles were read and included in this review. The prevalence of hearing loss, dizziness, vertigo and tinnitus was described and correlated with the diseases investigated in this study. There are great variability in the frequencies of symptoms found, but cochlear complaints are the most frequent in most studies. Vestibular symptoms are less reported. The main pathophysiological mechanisms are discussed. Direct effects of the virus in the inner ear or nervous pathways, impaired vascular perfusion, cross-reaction or autoimmune immunoreactivity, oxidative stress, DNA methylation, epigenetic modifications and gene activation were implicated in the generation of the investigated symptoms. In clinical practice, all patients with these autoimmune conditions who have any audiological complaint an ENT consultation followed by an audiometry are needed.
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Affiliation(s)
- Thelma L Skare
- Serviço de Reumatologia, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | - Jozélio Freire de Carvalho
- Núcleo de Pesquisa em Doenças Crônicas não Transmissíveis (NUPEN), School of Nutrition from the Federal University of Bahia, Salvador, Bahia, Brazil.
| | | | - Yehuda Shoenfeld
- Reichman University, Herzelia, Israel; Zabludowicz Center for Autoimmune Diseases (Founder), Sheba Medical Center, Tel-Hashomer, Israel
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Mielle LP, Maximiano MVA, Neves-Lobo IF, Silva LAF, Goulart AC, Romagnolli C, de Oliveira GSS, Samelli AG, Matas CG. Peripheral and brainstem auditory evaluation in post-COVID-19 individuals. Clinics (Sao Paulo) 2024; 79:100472. [PMID: 39098145 PMCID: PMC11334733 DOI: 10.1016/j.clinsp.2024.100472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 06/21/2024] [Accepted: 07/21/2024] [Indexed: 08/06/2024] Open
Abstract
PURPOSE The purpose of this study was to investigate the peripheral and central auditory pathways in adult individuals after COVID-19 infection. METHOD A total of 44 individuals aged between 19 and 58 years, of both genders, post-COVID-19 infection, confirmed by serological tests, with no previous hearing complaints and no risk factors for hearing loss, were assessed. All the participants underwent the following procedures: pure tone audiometry, logoaudiometry, immitanciometry, and Brainstem Auditory Evoked Potentials (BAEP), in addition to answering a questionnaire about auditory symptoms. RESULTS Thirteen individuals (29.5 %) had some hearing threshold impairment, mainly sensorineural hearing loss. In the BAEP, 18 individuals (40.9 %) presented longer latencies, mainly in waves III and V. According to the questionnaire answers, 3 individuals (9.1 %) reported worsened hearing and 7 (15.9 %) tinnitus that emerged after the infection. As for the use of ototoxic drugs during treatment, 7 individuals (15.9 %) reported their use, of which 5 showed abnormalities in peripheral and/or central auditory assessments. CONCLUSION Considering the self-reported hearing complaints after COVID-19 infection and the high rate of abnormalities found in both peripheral and central audiological assessments, it is suggested that the new COVID-19 may compromise the auditory system. Due to the many variables involved in this study, the results should be considered with caution. However, it is essential that audiological evaluations are carried out on post-COVID-19 patients in order to assess the effects of the infection in the short, medium, and long term. Future longitudinal investigations are important for a better understanding of the auditory consequences of COVID-19.
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Affiliation(s)
- Lucas Pinto Mielle
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Maria Vanderléia Araujo Maximiano
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Ivone Ferreira Neves-Lobo
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Liliane Aparecida Fagundes Silva
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Alessandra C Goulart
- Department of Epidemiology, School of Public Health, Universidade de São Paulo (USP), São Paulo, SP, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Carla Romagnolli
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Gerson Sobrinho Salvador de Oliveira
- Division of Internal Medicine, Hospital Universitário, Universidade de São Paulo (USP), São Paulo, SP, Brazil; Infection Control Department, Hospital das Clínicas, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Alessandra Giannella Samelli
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Carla Gentile Matas
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Deniz-Sakarya M, Yorulmaz İ. Does coronavirus disease 2019 affect peripheral and central auditory systems? Matched group cross-sectional study and six-month follow up. J Laryngol Otol 2024; 138:601-607. [PMID: 38456283 PMCID: PMC11096835 DOI: 10.1017/s0022215124000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE This study aimed to compare the peripheral-to-central auditory systems of people with coronavirus disease 2019 to a well-matched control group and examine the long-term effects of coronavirus disease 2019 on the auditory system. METHOD Participants who were outpatients of coronavirus disease 2019 (n = 30) were compared with a well-matched control group (n = 30). Behavioural and electrophysiological tests were performed, and tests were repeated at six months in the coronavirus disease 2019 group. RESULTS Statistically significant differences were observed in the right ear at 10 kHz (p = 0.007) and 12.5 kHz (p = 0.028), and in the left ear at 10 kHz (p = 0.040) and 12.5 kHz (p = 0.040) between groups. The groups had no difference regarding the other audiological test results (p > 0.05). CONCLUSION Extended high-frequency thresholds were affected in the coronavirus disease 2019 patients. No other findings indicated that the peripheral-to-central auditory system was affected. The effect on extended high-frequency thresholds appeared permanent, but no clinically significant new, late-onset auditory system effects were observed.
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Affiliation(s)
- Merve Deniz-Sakarya
- Department of Audiology, Faculty of Health Sciences, Baskent University, Ankara, Turkey
| | - İrfan Yorulmaz
- Department of Otorhinolaryngology—Head and Neck Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Shibafar S, Jafarlou F. A review on the impacts of COVID-19 on the auditory system: Implications for public health promotion research. Health Promot Perspect 2023; 13:280-289. [PMID: 38235010 PMCID: PMC10790126 DOI: 10.34172/hpp.2023.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/26/2023] [Indexed: 01/19/2024] Open
Abstract
Background Currently, there are few studies on the relationship between COVID-19 and the auditory system. In the current study, a review of the studies conducted in the fields of etiopathology, clinical manifestations, research, and treatment of hearing loss caused byCOVID-19 was conducted, which can be used as a baseline for future studies. Methods We utilized the research approach suggested by Arksey and O'Malley to carry out this scoping review. Search was conducted in Farsi and English with a focus on the onset of hearing loss in patients with COVID-19 through Medline and PubMed, and Google Scholar search engine. Studies included were those involving adult patients diagnosed with COVID-19 who experienced hearing loss, ear pain, ear discharge, and otitis media. Studies were eligible for inclusion if there was a description of the otologic dysfunction, specifically onset, duration, or clinical outcomes. Results Among 90 studies identified, 35 studies were included in the review process. Our findings suggest several possible mechanisms for sudden sensorineural hearing loss (SSNHL) in COVID-19 patients, and COVID-19 infection could have deleterious effects on the inner ear, specifically on the hair cells of the cochlea despite patients being asymptomatic and early identification of SSNHL in COVID-19patients can save the hearing and also patient. Conclusion Hearing loss in COVID-19 infection has not received much attention by health care professionals. Sensorineural hearing loss (SNHL), tinnitus, and/or vertigo have been shown to occur during and following COVID-19 infection. Due to lack of research studies, and the inconsistency and even contradictory of the findings, it remains questionable whether COVID-19 contributes to the high incidence of hearing loss. The proper understanding of the mechanisms behind hearing loss in COVID-19 infections needs further research. However, it seems likely that SNHL could be included among the manifestations of those-called "long COVID" syndrome.
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Affiliation(s)
- Samin Shibafar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Audiology, School of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Jafarlou
- Department of Audiology, School of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Goulioumis A, Angelopoulou M, Kourelis K, Mourtzouchos K, Tsiakou M, Asimakopoulos A. Hearing screening test in neonates born to COVID-19-positive mothers. Eur J Pediatr 2023; 182:1077-1081. [PMID: 36565323 PMCID: PMC9789365 DOI: 10.1007/s00431-022-04770-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/17/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022]
Abstract
SARS-CoV-2, the responsible virus for the COVID-19 pandemic, has demonstrated neurotropic properties indicated by cases presenting with auditory and vestibular system insults. The expression of ACE-2 receptors in the placenta and the detection of IgM antibodies against the virus in the fetuses of pregnant women suffering from COVID-19 render vertical transmission of the infection to the fetus possible. Thus, our study aims to examine whether, similar to other viruses like CMV, SARS-CoV-2 is responsible for congenital hearing loss. This is a retrospective study in a regional pediatric hospital. The medical records of newborns (n = 111) born by mothers positive for COVID-19 during pregnancy who underwent screening hearing tests with Transient Evoked Otoacoustic Emissions (TEOAE) and Automatic Auditory Brainstem Response (AABR) from February 2020 to June 2022 were reviewed. Neonates with additional aggravating factors for congenital hearing loss were excluded from the study. For the study period, nine mothers were found positive during the first trimester, twenty mothers in the second trimester, and eighty-three mothers in the third trimester. TEOAEs test and AABR test scored PASS bilaterally in all neonates tested. CONCLUSION Infection with COVID-19 during pregnancy was not a risk factor for hearing loss, similar to other studies. WHAT IS KNOWN • The pathogenetic mechanism of the viral-induced impairment of the organ of Corti includes direct damage to the hair cells and indirect damage due to the induction of the innate inflammatory response. • Early data suggested that the SARS-CoV-2 virus also has neurotropic properties with manifestations from the sensory epithelia. WHAT IS NEW • Although the intrauterine infection remains controversial, the expression of the ACE-2 receptor on the placenta and the detection of IgM antibodies, as well as the covid-19 genome in fetuses, make the vertical transmission tenable. • In our study, the newborn hearing screening results indicate that COVID-19 infection during pregnancy is not a risk factor for hearing loss.
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Affiliation(s)
- Anastasios Goulioumis
- Department of Otorhinolaryngology, Pediatric Hospital "Karamandanio", Erythrou Stavou 40, 26331, Patras, Greece.
| | - Maria Angelopoulou
- Department of Otorhinolaryngology, Pediatric Hospital "Karamandanio", Erythrou Stavou 40, 26331, Patras, Greece
| | - Konstantinos Kourelis
- Department of Otorhinolaryngology, Pediatric Hospital "Karamandanio", Erythrou Stavou 40, 26331, Patras, Greece
| | - Konstantinos Mourtzouchos
- Department of Otorhinolaryngology, Pediatric Hospital "Karamandanio", Erythrou Stavou 40, 26331, Patras, Greece
| | - Magdalini Tsiakou
- Department of Otorhinolaryngology, Pediatric Hospital "Karamandanio", Erythrou Stavou 40, 26331, Patras, Greece
| | - Athanasios Asimakopoulos
- Department of Otorhinolaryngology, Pediatric Hospital "Karamandanio", Erythrou Stavou 40, 26331, Patras, Greece
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