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Explained: Reasons for post-COVID-19 associated hearing loss

A recent study published in BMJ Case Reports, conducted by researchers from University College London and the Royal National Throat Nose and Ear Hospital in the UK, says COVID-19 may affect the hearing of some patients.
What does the study say?
Researchers report the case of a 45-year-old patient with asthma who reported hearing loss while being treated in hospital for COVID-19. The patient was admitted to the hospital on the tenth day of developing COVID-19 symptoms and subsequently required intubation and admission into the ICU. The patient was intubated for 30 days and his admission was complicated further owing to reasons such as pulmonary hypertension and anaemia. After receiving remdesivir, plasma therapy and intravenous steroids the patient’s condition improved, however, a week after extubation and transfer out of the ICU, he reported left-sided tinnitus and sudden hearing loss.
What does this mean?
According to the study, hearing loss and tinnitus are both symptoms associated with COVID-19 and influenza. Researchers mention that the first case of hearing loss in a SARS-CoV-2 patient was reported in April in a paper published in the American Journal of Otolaryngology. Another two cases were reported with new-onset hearing loss in COVID-19 patients in two separate papers.
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Both patients did not have previous otological problems. One patient among these two was a 60-year-old man with severe COVID-19 who required ICU admission and developed right-sided deafness and left sensorineural hearing loss. The second patient was otherwise asymptomatic but presented to the clinic with sensorineural hearing loss.
In this study, the researchers conclude that while the number of studies regarding hearing loss and COVID-19 have been low, “it is significant to consider the possibility of a relationship between COVID-19 and SSNHL” (Sudden onset sensorineural hearing loss).
What are the possible explanations for this?
Researchers have stated two reasons. One could be the presence of ACE-2 receptors that SARS-CoV-2 binds with. The receptor was recently found to be expressed in the epithelial cells in the middle ear of mice. Another way that COVID-19 could affect hearing is through the immune system response to the infection. In this case, the inflammatory responses and an increase in cytokines due to infection could lead to hearing loss in case there is direct entry into the cochlea leading to inflammation and cell stress.
Further, researchers suggest that patients with COVID-19 in the ICU should be inquired if they are experiencing hearing loss, which should be treated promptly.
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