September 11, 2020

I Can't Hear You: Hearing Loss and COVID-19

I Can't Hear You: Hearing Loss and COVID-19

Ch-ch-ch-changes

In less than 12 months, the novel coronavirus has transformed every conceivable aspect of our lives in increasingly dramatic ways. Everything from work processes to public safety precautions to personal health accountability have had to adapt to life in a global pandemic.

While it’s nice to imagine we’ll get back to normal (and there’s a very strong chance we will), our understanding of what is normal may be changed forever. But as difficult as this is, health systems around the world are rallying to create solutions with promises of positive change. 

Man sitting in hazmat suit drinking coffee and reading paper

The Spanish flu epidemic of the early 20th century not only revealed a universal vulnerability, but transformed our understanding of healthcare, leading to the development of radically new immunotherapies still in use today. Change may not always be pretty, but how we adapt to it can be the real test of our humanity.

So how complex is our understanding of COVID-19? Unfortunately, not very, particularly when it comes to preexisting health conditions. Depression and anxiety may not be wholly symptomatic of the novel coronavirus, but the ramifications of the pandemic on mental health are nothing short of disastrous.

But it’s not just emotional stability that’s threatened as a result of COVID-19. We’re only just beginning to comprehend just how significant an impact the novel coronavirus has on many physical conditions. And nowhere else is this apparent than hearing loss.

Dynamics of Hearing Loss and the Coronavirus

Very rarely does hearing loss occur overnight. It’s a gradual process. It may begin with ringing in your ears. Or diminished audibility. Voices may seem muffled or altogether indistinct. But progressively, the symptoms become gradually worse, with some cases resulting in partial or total deafness.

Audiogram illustrating hearing loss and risk threshold

It's been estimated that 48 million Americans suffer from hearing loss, with 13% of the U.S. population over the age of 12 suffering from hearing loss in both ears, and 15% of adults indicating some degree of difficulty hearing.

It’s also important to remember that hearing loss can come in three distinct forms:

  • Conductive (involving the outer ear)
  • Sensorineural (involving the inner ear)
  • Mixed (involving both)

The distinction is an important one. Many of the effects of noise induced hearing loss in your outer ear can be reduced significantly through hearing aids, therapy and in some cases, surgery.  But hearing loss is a neurological condition. And the impact of sensorineural hearing loss can affect more than just the ability to hear.

Up to 45% of all cases of sensorineural hearing loss have identifiable causes, including autoimmune and sudden traumatic disorders, including stress. It may be hard to think of any other period in modern history in which exposure to excessive stress has been greater than over the past year, but it’s even harder to think of a period in which exposure to stress has been simply unavoidable.  

But there are precedents linking hearing loss to seemingly non-endemic conditions. A 2018 study from the University of Texas found that sudden onset sensorineural hearing loss (SSHL) occurred in over one-third of West African survivors of the Lassa Fever virus.

Radiation-induced hearing loss has been noted in survivors of radiation and chemotherapies as early as 1988. And a recent survey from the University of San Pablo revealed a demonstrable link between hearing loss and inadequate diet and nutrition, suggesting further nutrient resources as a potential therapy to combat auditory impairment.

The Cumulative Effects Of Hearing Loss

Hearing loss isn’t just a burden on your auditory system, however. The end result of hearing loss is a diminished quality of life. The cumulative effects of hearing loss on both our mental, social, emotional and physical health can’t be understated, nor can they be dismissed as purely coincidental.

Hearing loss impacts a variety of physical and neurological functions

And it's increasing around the world:

  • Hearing loss increased globally by over 28% between 2005 and 2015. 
  • A 2012 study published by the American Academy of Neurology found a substantially high link between cognitive decline and noise induced hearing loss over a period of 17 years.
  • According to a 2009 article from the American Journal of Neuroradiology, one of the immediate indicators of peripheral and central vertigo and related disorders such as Ménière Disease is a persistent ringing in the ears similar to symptoms found in long term hearing loss.
  • A 2015 study published in the American Medical Association’s Journal of Otolaryngology–Head & Neck Surgery found that moderate and severe hearing impairment has been associated with a 54 percent increased risk of mortality among senior citizens.
  • In a 2014 study published by the Academy of Otolaryngological Head and Neck Surgery,  it was revealed that hearing loss was associated with an increase in social isolation among women aged 60 to 69 years old.
  • Over 25,000 hearing loss patients in the U.S. have also reported symptoms of moderate psychological distress and the use of antidepressant and antianxiety medication, according to a 2020 review from John Hopkins University.

Anxiety, depression and isolation are just three of the effects which may result from the coronavirus pandemic. But is there a definitive link between COVID-19 and hearing loss?

Unfolding Implications for Hearing Loss During the Pandemic

While there may be precedence linking the effects of hearing loss to viral and non-viral impairments, we also happen to be living in largely unprecedented times. Our understanding of the human auditory and immune systems have broadened in unimaginable ways compared to a mere decade ago. But despite warnings of epidemiologists, few people were quite prepared for both the reach and severity of the novel coronavirus.

A definitive link between hearing loss and COVID-19 has yet to be fully established but mounting evidence suggests a correlation. A recent article published in the American Journal of Otolaryngology noted that there may be a link between COVID-19 and hair cell damage in the inner and outer ear canals, while additional research has suggested that the coronavirus has also been found to colonize in middle ear effusions.

Another study conducted at The University of Manchester evaluated the clinical records and health outcomes of 121 people who had been sickened with Covid-19. The results came out in the International Journal of Audiology and found that 16 (13.2%) of the patients had a measurable change in hearing and/or tinnitus since their illness. While the number of participants is not statistically significant it is another clear sign we do not understand the full ramifications of how the novel Coronavirus affects our sense of hearing.

Yet for individuals with existing hearing damage, the effects of COVID-19 may present additional challenges. The requirement of face masks and other PPE in healthcare facilities make already hindered communication difficult; and in severe cases of hearing loss requiring lip reading, virtually impossible.

While the focus on respiratory transmission is deserved, it’s easy to neglect the unintended consequences of limited communications for those with hearing loss.

Man and woman wearing face masks behind plastic wrap

Interested in learning more about the connection between COVID-19 and hearing damage? Read our post Is Tinnitus the Not-So-Silent COVID-19 Symptom?

 

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