A 45-year-old man suddenly lost his hearing because of his Covid-19, doctors have claimed in the first British case of its kind.
The unidentified patient, who suffered from asthma but was otherwise ‘fit and well’, needed intensive care treatment after catching the disease.
After a long stint in hospital, he complained about losing hearing in his left ear. He had no previous history of hearing loss or ear problems.
He suffered with sudden onset sensorineural hearing loss (SSNHL), which scientists said can be triggered by viruses, including HIV, mumps and syphilis. Doctors who treated him revealed he has only partially recovered some of his hearing.
This case — discussed in a British Medical Journal publication — is the first formal recorded tale of Covid-linked hearing loss in the UK. Four other cases have been reported elsewhere in the world.
Experts from University College London and the Royal National Throat Nose and Ear Hospital in the capital cautioned that sudden hearing loss can ‘easily be missed in an intensive care setting’.
They urged medics to be aware of the complication, saying raising awareness could enable doctors to give an early course of treatment to cut the odds of permanent hearing loss.
Researchers at Manchester University have previously said one in eight coronavirus patients may see a change in their hearing after battling the disease.
A British 45-year-old man has suffered sudden hearing loss linked to Covid-19
The British man was admitted to hospital 10 days after he started experiencing Covid-19 symptoms.
He was taken into intensive care and needed help breathing for 30 days, requiring intubation – the insertion of a tube through the airways.
The patient suffered various complications as a result of Covid-19, including high blood pressure, anaemia, ventilator-associated pneumonia and a blood clot.
CORONAVIRUS MAY CAUSE HEARING PROBLEMS IN ONE IN EIGHT COVID-19 PATIENTS
Coronavirus may cause hearing problems in one in eight patients, according to a study published in the summer.
Audiologists at the University of Manchester followed 121 adults who were admitted to Wythenshawe Hospital with coronavirus.
When asked about changes to their hearing, 16 people said their hearing was worse eight weeks after being discharged; eight reported worse hearing, but four said they already had some problems with their hearing before Covid-19.
The other eight reported tinnitus — hearing noises, usually a ringing, in the ear.
Notably the average age of the patients who reported hearing problems was 64 years old.
The results of the study, published in a letter to the International Journal of Audiology, added to fears that Covid-19 could have long-term impacts on hearing, particularly for those with existing issues.
Lead researcher Professor Kevin Munro said: ‘It is possible, in theory, that Covid-19 could cause problems with parts of the auditory system including the middle ear or cochlea.’
The middle ear is the tube that leads from the ear drum to the auditory nerve and throat.
It passes by the cochlear — a hollow, spiral-shaped bone found in the inner ear that plays a key role in the sense of hearing.
Professor Munro said: ‘For example, auditory neuropathy, a hearing disorder where the cochlea is functioning but transmission along the auditory nerve to the brain is impaired, could be a feature.’
People with auditory neuropathy have difficulty hearing when there is background noise, such as in a pub.
A condition called Guillain-Barre syndrome is also linked to auditory neuropathy, which is also known to be linked with the coronavirus.
Doctors gave him remdesivir, the first approved medicine for NHS patients in the UK, intravenous steroids and a blood transfusion after which he started to get better.
A week after his breathing tube was removed and he left the intensive care unit, he noticed left-sided tinnitus – a continuous ringing in the ear. Then he experienced sudden onset hearing loss.
A week later, he was seen by specialists who ran examinations of his ear canals, which revealed no blockages or inflammation.
But a hearing test showed that he had severely lost his hearing in the left ear.
Tests showed sounds in the human range of frequency – like a conversation – would need to be loud in order for the man to hear them, and high frequency sounds would have to be very loud. But they did not reveal exactly what he could and couldn’t hear.
The man was treated with the oral steroid prednisolone for seven days, which resulted in partial improvement in his hearing.
He also had a small amount of steroid injected directly into the middle ear – the tube that leads from the ear drum to the auditory nerve and throat.
But the man felt no further benefit from the extra treatment.
‘Hearing loss and tinnitus are symptoms that have been seen in patients with both Covid-19 and influenza virus but have not been highlighted,’ the authors wrote in the BMJ Case Reports.
‘In the case presented here, the patient was previously well with no other attributable cause for his SSNHL.’
The researchers added: ‘It must be noted that the patient mentioned the difficulty acknowledging the hearing loss in the busy ITU environment and his realisation afterwards.
‘We suggest that patients are asked about hearing loss in the ITU environments when applicable, and any patient reporting acute hearing loss should be referred to otolaryngology on an emergency basis.’
Sudden hearing loss adds to the long list of long-term complications Covid-19 has been linked to, with heart, lung and liver damage all being reported in survivors.
Between five and 160 cases per 100,000 people are reported by specialists worldwide every year, the BMJ report said.
It’s not clear what the causes are, but the condition can follow a viral infection. These include the flu, herpes, rheumatoid arthritis and HIV – which the man tested negative for.
The researchers said: ‘Despite the low numbers of studies, it is significant to consider the possibility of a relationship between Covid-19 and SSNHL.’
They added: ‘This is the first reported case of sensorineural hearing loss following Covid-19 infection in the UK.
‘Given the widespread presence of the virus in the population and the significant morbidity of hearing loss, it is important to investigate this further.
‘This is especially true given the need to promptly identify and treat the hearing loss and the current difficulty in accessing medical services.’
The doctors tried to give an explanation for how Covid-19 affected hearing. Although primarily a respiratory disease that affects the lungs, Covid-19 is often described as a ‘multi system disease’ because it leads to so many problems in the body.
SARS-CoV-2, the virus responsible for Covid-19, is thought to lock on to a particular type of cell lining the lungs.
And the virus has also recently been found in similar cells lining the middle ear, explain the report authors.
SARS-CoV-2 also generates an inflammatory response and an increase in the chemicals that have been linked to hearing loss.
At the onset of his hearing loss, the man slightly elevated inflammatory proteins linked to his Covid-19.
Therefore, both a direct entry into the ear and inflammation leading to cell stress may be the mechanisms that lead to hearing loss during coronavirus infection.
But scientists have also noted some medications, including some used to treat the coronavirus, carry a relatively high risk of hearing loss, tinnitus or vertigo as a side effect.
Known as ‘ototoxicity’, it can be caused by drugs including hydroxychloroquine – the malaria-drug being trialled against Covid-19.
‘These antiviral medications have known adverse events, including tinnitus and hearing loss, and the symptoms may be misdiagnosed as being caused by Covid-19,’ according to the authors of the scientific review published by Manchester researchers in May.
The team said high-quality studies are needed to investigate the effects of Covid-19 on hearing.
The first case mentioning sensorineural hearing loss in a Covid-19 positive patient came from Thailand in April. Very few details were given about the elderly woman, but it said there had been no improvement with medication.
Another 60-year-old man from Hannover, Germany, who suffered from hearing loss was described by doctors in August.
He had severe Covid-19 requiring ITU stay before developing right-sided deafness and left sensorineural hearing loss. He went on to get a cochlear implant.
Doctors in Egypt reported a patient last month who had tested positive for the coronavirus but had no symptoms other than hearing loss. Steroid injections led to some improvement.
Both cases were described in Covid-19 patients who also did not have any previous hearing difficulties, or possible causes of hearing loss.
The fourth case was described by medics in Turkey, who conducted Covid-19 tests on five people with SSNHL. One of the five patients was found to be SARS-CoV-2 positive, but had no other symptoms.