Cochlear Function in Adults Exposed to Severe Acute Respiratory Syndrome Coronavirus 2.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a viral infection with a wide variety of symptoms, including fever, coughing, sneezing, fatigue, and a loss of taste and smell. Moreover, there are some recent studies that investigate the effects of SARS-CoV-2 on hearing and auditory performance. With this current study, we investigate the early effects of the coronavirus disease on hair cells in the cochlea. METHODS: In the current study, there were 25 subjects (17 females, 8 males) who tested positive for polymerase chain reaction on nasopharyngeal swabs. They had reported normal auditory functions and no history of otology before SARS-CoV-2. To determine auditory functions, pure-tone audiometry, otoacoustic emissions (OAE) tests, and threshold equalizing noise (TEN) tests were used. RESULTS: Although the hearing thresholds increased at higher frequencies, they were within normal limits according to four-frequency pure-tone averages. All participants had normal OAE, and there were no detected dead regions for any of the subjects. Even so, there were significant increases in hearing thresholds in TEN. CONCLUSION: There is no cochlear dysfunction discovered by OAE and TEN in SARS-CoV-2-affected individuals. Nonetheless, the increase in hearing thresholds at higher frequencies, other than the pure-tone average frequencies detected by TEN, and the decrease in the presence of detected OAE could be related to deterioration in the basal part of the cochlea.

Audiological profile of adult Long COVID patients.

INTRODUCTION: Hearing loss is one of the self-reported symptoms of Long COVID patients, however data from objective and subjective audiological tests demonstrating diminished hearing in Long COVID patients has not been published. MATERIALS AND METHODS: Respondents of a large Long COVID online survey were invited to the ENT-department for an otologic exam. The participants were split into three groups based on their history of SARS-CoV-2 infection and persistence of symptoms. Respondents with a history of a SARS-CoV-2 infection were allocated to the Long COVID group, if they reported persistent symptoms and to the Ex COVID group, if they had regained their previous level of health. Participants without a history of SARS-CoV-2 infection made up the No COVID control group. In total, 295 ears were examined with otoscopy, tympanograms, pure tone audiometry and otoacoustic emissions. Ears with known preexisting hearing loss or status post ear surgery, as well as those with abnormal otoscopic findings, non-type A tympanograms or negative Rinne test were excluded. RESULTS: Compared to the No COVID and Ex COVID groups, we did not find a clinically significant difference in either hearing thresholds or frequency specific TEOAEs. However, at 500 Hz the data from the left ear, but not the right ear showed a significantly better threshold in the Ex COVID group, compared to Long COVID and No COVID groups. Any of the other tested frequencies between 500 Hz and 8 kHz were not significantly different between the different groups. There was a significantly lower frequency-specific signal-to-noise-ratio of the TEOAEs in the Long COVID compared to the No COVID group at 2.8 kHz. At all other frequencies, there were no significant differences between the three groups in the TEOAE signal-to-noise-ratio. CONCLUSION: This study detected no evidence of persistent cochlear damage months after SARS-CoV-2 infection in a large cohort of Long COVID patients, as well as those fully recovered.

Effects of multiple sclerosis on the audio-vestibular system: a systematic review.

OBJECTIVE: Systematically investigate the effects of multiple sclerosis (MS) on the audio-vestibular system. METHODS: Systematic review of literature investigating audio-vestibular conditions in persons with MS (PwMS) aged ≥18 years. PubMed, Scopus, NICE and Web of Science were searched. Randomised controlled trials, and cohort, case-control, observational and retrospective studies in English, published from 2000 to 21 November 2021, evaluated PwMS with at least one outcome (pure tone audiometry, auditory brainstem response, otoacoustic emissions, cortical auditory evoked potentials, functional MRI assessing auditory function, vestibular evoked myogenic potentials, videonystagmography, electronystagmography, posturography, rotary chair, gaps in noise, word discrimination scores, duration pattern sequence test), were included. Study selection and assessments of bias were independently conducted by two reviewers using the Risk of Bias Assessment Tool for Non-randomized Studies, Newcastle-Ottawa Scale (NOS) and the NOS adapted for cross-sectional studies. RESULTS: 35 studies were included. Auditory function was evaluated in 714 PwMS and 501 controls, vestibular function was evaluated in 682 PwMS and 446 controls. Peripheral auditory function results were contradictory between studies; some found abnormalities in PwMS, and others found no differences. Tests of brainstem and central auditory functions were more consistently found to be abnormal in PwMS. Most vestibular tests were reported as abnormal in PwMS, abnormalities were either peripheral or central or both. However, quantitative analyses could not be performed due to discrepancies between studies in results reporting, test stimulus and recording parameters. CONCLUSIONS: Although abnormal results on auditory and vestibular tests were noted in PwMS, specific effects of MS on the audio-vestibular system could not be determined due to the heterogeneity between studies that restricted the ability to conduct any quantitative analyses. Further research with consistent reporting, consistent stimulus and consistent recording parameters is needed in order to quantify the effects of MS on the auditory and vestibular systems. PROSPERO REGISTRATION NUMBER: CRD42020180094.

Slight High-Frequency Hearing Loss, Effect of COVID-19 or Hydroxychloroquine Usage?

BACKGROUND AND OBJECTIVES: Concerns about ototoxic and vestibulotoxic effects have been raised with the use of antiviruses in the treatment of COVID-19. This study aimed to determine the effect of hydroxychloroquine (HCQ) and examine the auditory system and its associated auditory and vestibular symptoms in patients with COVID-19. STUDY DESIGN: Prospective study. PATIENTS: Thirty patients with a history of HCQ (HCQ+) and 30 patients without drug use (HCQ-), and 30 healthy adults as the control group participated. MAIN OUTCOME MEASURES: Audiological assessments and evaluation of audio-vestibular symptoms. Evaluations were also repeated 1 month later. RESULTS: Both HCQ+ and HCQ- groups showed poor pure-tone audiometry (PTA) thresholds and decreased transient evoked otoacoustic emission amplitudes at high frequencies in comparison to the healthy group. Despite the lack of significant differences in PTA between the two groups of patients, the differences in transient evoked otoacoustic emission amplitudes were significant. PTA thresholds and otoacoustic emission showed improvement after 1 month. Dizziness was the most common symptom that was reduced after 1 month. CONCLUSION: Slight hearing loss was seen in patients with COVID-19 with or without HCQ. Also, hearing thresholds in the HCQ+ group did not show a significant difference compared with the HCQ- group. Nevertheless, it seems that more damage is done to the hair cells of patients with HCQ intake than in other patients. Hence, the ototoxicity effect of high doses of HCQ use in the COVID-19 patients should be considered. A relative improvement in the hearing was seen over time in both patient groups.

Evaluation of the efferent auditory system in COVID-19 adult patients.

BACKGROUND: The short- and long-term effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the medial olivocochlear reflex and outer hair cells in the cochlea remain largely unclear. AIMS: The aim of this study was to investigate the efferent auditory system effects in adult patients with COVID-19. MATERIALS AND METHODS: The study included 18-50 years old 44 volunteers: 26 individuals (52 ears) with COVID-19 in the study group and 18 healthy individuals (36 ears) in the control group. Otolaryngological examination, immitancemetric evaluation, distortion product otoacoustic emission (DPOAE), contralateral acoustic stimulation with DPOAE, audiometric evaluation, and high frequency audiometric evaluation were performed in all individuals participating in the study. RESULTS: In our study, patients with COVID-19 had significantly lower DPOAE results with or without broadband noise at only 6 kHz frequency and contralateral suppression results at all frequencies compared to healthy individuals. A statistically significant difference was found between the study and control groups according to whether the participants had a response in the high frequency audiometry at 12 and 16 kHz frequencies. CONCLUSIONS: COVID-19 affects many systems in the body. As a result of the findings obtained in the present study, it is shown that the auditory efferent system may also be affected.

COVID-19 during pregnancy and its impact on the developing auditory system.

BACKGROUND: This study compared distortion product otoacoustic emissions (DPOAEs) and click-evoked auditory brainstem responses (ABRs) recorded from infants whose mother had Covid-19 during pregnancy (Covid-19 group) to infants whose mother did not have Covid-19 (Control group) during pregnancy. METHODS: This study retrospectively examined records of infants in the Covid-19 group (n = 15) and control group (n = 46) who had distortion product otoacoustic emissions (DPOAEs) and click-evoked auditory brainstem responses (ABRs) recorded as part of their clinical assessment. DPOAE amplitudes, absolute latencies (I, III, and V), and I-V interpeak intervals were examined. RESULTS: DPOAE amplitudes were similar between the Covid-19 group and the control group. The absolute latency of wave I was similar between groups. But absolute latencies III and V and I-V interpeak intervals of the Covid-19 group were significantly prolonged compared to the control group. CONCLUSION: Covid-19 infection and its complications during pregnancy may not affect the cochlear function but may affect the functioning of the auditory brainstem.

Audiological findings in individuals diagnosed with COVID-19.

PURPOSE: It is thought that COVID-19 may cause hearing loss, but its effects on the hearing system are not clear. This study aimed to reveal the effects of COVID-19 on the auditory system by using various audiological measurement methods in individuals diagnosed with COVID-19. METHODS: Thirty individuals between the ages of 18-45, who were diagnosed with COVID-19 by PCR at least one month ago, and had no pre-COVID-19 hearing loss complaints, constituted the test group. Thirty individuals aged between 18 and 30 years and who had no history of hearing loss constituted the control group. Audiological evaluations of all participants were made with pure-tone audiometry, high-frequency audiometry, transient-evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE), and auditory brainstem response (ABR) measurements. RESULTS: A significant difference was found between the groups at all high frequencies between 4 and 14 kHz (p < 0.05). TEOAE amplitudes at 1500 Hz, 2000 Hz and 4000 Hz frequencies and DPOAE amplitudes at 4003 Hz and higher frequencies were significantly lower in the test group (p < 0.05). While there was a significant difference between the I, III and V absolute latencies between the groups (p < 0.05), there was no significant difference between the I-III, III-V and I-V interpeak latencies (p > 0.05) as a result of the ABR test. CONCLUSION: This study showed that COVID-19 can cause cochlear damage, especially at high frequencies. More studies are needed to determine the effects of COVID-19 on the auditory system.

Does SARS-CoV-2 affect cochlear functions in children?

OBJECTIVES: To determine the influence of coronavirus disease-19 (COVID-19) on cochlear tasks of children who had COVID-19 previously, and the relevance among disease seriousness and cochlear involvement by otoacoustic emissions (OAEs). METHODS: The study included 24 hospitalized children after COVID-19 diagnosis, 23 pediatrics that received outpatient treatment, and 21 children who were without COVID-19 diagnosis as the control group between June 2021 and July 2021. Transient evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission, and contrlateral suppression of otoacoustic emission measurements were carried out for each child. Symptoms of patients, the treatments they received, and the duration of hospitalization of the children in the hospitalized group were recorded. RESULTS: The comparison of TEOAE test results under masking showed a considerable difference between 3 groups at 1 kHz (p=0.033) and 4 kHz (p=0.021) frequencies (p<0.05). Distortion product otoacoustic emission test results of hospitalized outpatient and control group showed a statistically significant difference at 2 kHz among themselves (p=0.009). CONCLUSION: Our results suggest that severe acute respiratory syndrome coronavirus-2 may influence the medial olivocochlear system of children and have irreversible effects on the cochlear functions. Early detection of problems that may affect cochlear functions is a special critical task, especially in children, who are a particularly vulnerable group in terms of hearing and related speech problems.

Auditory evaluation of infants born to COVID19 positive mothers.

COVID-19 infection can cause a wide spectrum of symptoms. The audio-vestibular system can also be involved, but there is still debate about this so findings need to be considered carefully. Furthermore, mother to fetus intrauterine transmission of COVID-19 infection in pregnant women is controversial. Few studies are available about the audio-vestibular symptomatology of newborns with intrauterine COVID19 exposure. OBJECTIVES: This study investigates the possible correlation between the COVID19 gestational infection and hearing impairment onset in newborns. The involvement of hearing in COVID19 is verified so the timing and methodology of audiological evaluation of children can be planned. METHODS: Children were subject to newborn hearing screening and audiological evaluation. Newborn hearing screening is carried out prior to hospital discharge using the Automatic Transient Evoked Otoacoustic Emissions test. Audiological evaluation is performed within the child age of 4 months by using maternal, pregnancy, and perinatal case history, COVID19 case history, otoscopy, acoustic immittance test, Distortion Product Otoacoustic Emissions test, and the Auditory Brainstem Response test. RESULTS: 63 children were included in the study. 82.5% of these children were subjects of the newborn hearing screening program. The remaining 11 newborns were not subjected to hearing screening due to isolation measures and their audiological evaluation was carried out directly. Only one of 52 screened neonates showed a bilateral REFER test result but hearing threshold was normal at audiological evaluation. Audiological evaluation showed normal bilateral ABR thresholds in 59/63 children. Four children (6.3% of the total) had ABR threshold alterations but two showed normal threshold at ABR retest performed within 1 month of the first. The other two infants showed monolateral ABR alterations but one of these had a concomitant middle ear effusion. In conclusion, only one child (1.6% of the sample) had an altered ABR. This child had shown one positive SARS-CoV-2 swab in the absence of risk factors for hearing loss. CONCLUSION: This study finds no evidence that maternal COVID19 infection is a risk factor in the development of congenital hearing loss in newborns.

Comparison of pure tone audiometry thresholds and transient evoked otoacoustic emissions (TEOAE) of patients with and without Covid-19 pneumonia.

OBJECTIVE: COVID-19 is an infectious disease caused by the new coronavirus that starts similar to an upper respiratory tract infection and causes death by causing pneumonia and vasculopathy. Many viral infections are known to cause hearing loss. In this study, pure-tone audiometry (PTA) thresholds and Transient Evoked Otoacoustic Emissions (TEOAE) results were compared across patients with COVID-19 disease and COVID-19 pneumonia, and control group patients. METHODS: The study included 240 patients in the age range of 18-50 years. The patients were divided into three groups of 80 patients as the control (no disease), COVID-19 (nonpneumonia), Covid-19 (pneumonia) groups. PTA and TEOAE tests were performed on the control group patients and the results were recorded. PTA and TEOAE tests were performed in the COVID-19 groups in the first and third months after the infection ended. Each test was performed twice; the results were recorded, and the mean of the two results was calculated. RESULTS: PTA results and TEOAE amplitudes in the first and third months were not significantly different between the COVID-19 non-pneumonia group and the control group (p > 0.05), between the COVID-19 pneumonia group and the control group (p > 0.05), and between the COVID-19 non-pneumonia group and the COVID-19 pneumonia group (p > 0.05). CONCLUSIONS: Despite minimal impairment and minimal amplitude decreases in patients, who recovered from COVID-19, such changes were found to become restored in the third month. Furthermore, no significant changes were observed to indicate COVID-19- associated hearing loss.

Does COVID-19 have an impact on hearing?

BACKGROUNDS: SARS-CoV-2 is known to be a neurotrophic virus. However, the effect of this virus on the hearing system is still uncertain. OBJECTIVES: We aimed to investigate the possible effect of COVID-19 on hearing. MATERIALS AND METHODS: Thirty healthcare workers who had COVID-19 after hearing evaluation with pure tone audiometry (PTA) for any reason in the last 1 year were included in the study. PTA and transient evoked otoacoustic emissions (TEOAE) tests were performed in 15 of 30 patients during the active infection period. For all 30 patients, otoscopic examination plus PTA and TEOAE tests were performed at the end of the first month after their treatment. RESULTS: When the PTA results of 30 patients (60 ears) before and after COVID-19 were compared, a significant decrease in hearing level was found only at 1000 Hz (p < .05). There were no significant differences at other frequencies. When the PTA and TEAOE test results of 15 patients (30 ears) that were performed during and after COVID-19 were compared, no significant differences were found. CONCLUSION AND SIGNIFICANCE: We conclude that COVID-19 may cause hearing loss. However, this result needs to be confirmed with comprehensive studies to be conducted in larger patient groups.

Newborn Hearing Screening Results of Infants Born To Mothers Who Had COVID-19 Disease During Pregnancy: A Retrospective Cohort Study.

OBJECTIVE: Viral infections are known to be a risk factor for neonatal hearing loss. COVID-19 infection has been reported to affect hearing test results in one small sample sized study. We aimed to investigate the incidence the risk of neonatal hearing loss in infants of mothers who had COVID-19 infection during pregnancy, regarding their trimesters, by evaluating the neonatal hearing screening results. DESIGN: In this retrospective case-control study, neonatal hearing test results of 458 women with a history of COVID-19 infection in pregnancy were compared with 339 women who gave birth before the pandemic. Data of pregnant women who attended the COVID-19 outpatient clinic of the emergency service of a tertiary pandemic hospital and who had confirmed infection with a reverse transcriptase-polymerase chain reaction (RT-PCR) test were determined from the hospital's records and their neonatal hearing screening results were analyzed from the national database. Neonates born before <34 weeks, and with reported risk factors in the database such as congenital anomaly or known TORCH infection during pregnancy were excluded. The screening tests, Automated Auditory Brainstem Response or Transient Evoked Otoacoustic Emission (TEOAE), were used for screening, and patients who failed the first screening were reevaluated at least 2 weeks apart with a second screening. RESULTS: The incidence of failed second screening was 1.3% in the COVID-19 group and 2.9% in controls, and no significant difference was observed between the two groups according to the final screening results on the second test. Among the 458 mothers, 8 were infected in first trimester, 126 in second trimester, 127 in third trimester but did not deliver within 15 days after infection and 197 were positive at birth. Six neonates in the infected group failed the second screening (3 [2.4%] in the second trimester, 1 [0.8%] third trimester, and 2 [1.0%] positive at birth). CONCLUSIONS: COVID-19 infection during pregnancy was not found to be a risk factor for hearing loss, according to the newborn hearing screening results.

Auditory Performance in Recovered SARS-COV-2 Patients.

OBJECTIVE: While COVID-19 symptoms impact rhinology (anosmia) and laryngology (airways), two major disciplines of the otolaryngology armamentarium, the virus has seemed to spare the auditory system. A recent study, however, reported changes in otoacoustic emission (OAE) signals measured in SARS-COV-2 positive patients. We sought to assess the effect of COVID-19 infection on auditory performance in a cohort of recovered SARS-COV-2 patients and controls. To avoid a potential bias of previous audiological dysfunction not related to SARS-COV-2 infection, the study encompasses patients with normal auditory history. We hypothesized that if SARS-COV-2 infection predisposes to hearing loss, we would observe subtle and early audiometric deficits in our cohort in the form of subclinical auditory changes. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary referral center. PATIENTS: The Institutional Review Board approved the study and we recruited participants who had been positive for SARS-COV-2 infection, according to an Reverse Transcription Polymerase Chain Reaction (RT-PCR) test on two nasopharyngeal swabs. The patients included in this study were asymptomatic for the SARS-COV-2 infection and were evaluated following recovery, confirmed by repeated swab testing. The control group comprised healthy individuals matched for age and sex, and with a normal auditory and otologic history. INTERVENTIONS: The eligibility to participate in this study included a normal audiogram, no previous auditory symptoms, normal otoscopy examination with an intact tympanic membrane, and bilateral tympanometry type A. None of our volunteers reported any new auditory symptoms following SARS-COV-2 infection. Ototacoustic emissions (OAE) and auditory brainstem response (ABR) measurements were used to evaluate the auditory function. MAIN OUTCOME MEASURES: OAE and ABR measurements. RESULTS: We have found no significant differences between recovered asymptomatic SARS-COV-2 patients and controls in any of transitory evoked otoacoustic emission (TEOAE), distortion product otoacoustic emissions (DPOAE), or ABR responses. CONCLUSIONS: There is no cochlear dysfunction represented by ABR, TEOAE, and DPOAE responses in recovered COVID-19 asymptomatic patients. Retrocochlear function was also preserved as evident by the ABR responses. A long-term evaluation of a larger cohort of SARS-COV-2 patients will help to identify a possible contribution of SARS-COV-2 infection to recently published anecdotal auditory symptoms associated with COVID-19.

Evaluation of cochlear functions in infants exposed to SARS-CoV-2 intrauterine.

PURPOSE: The novel coronavirus (SARS-CoV-2) caused an acute respiratory illness named COVID-19 and the disease spread all over the World. Fever, cough, fatigue, gastrointestinal infection symptoms form the main clinical symptoms. Pregnants and newborns form a vulnerable population and urgent measures must be addressed. Studies about the effect of COVID-19 on pregnant women, developing fetuses, and infants are limited. Various viral diseases can cause congenital or acquired, unilateral or bilateral hearing loss. METHODS: 37 infants whose mother was pregnant between March 2020 and December 2020 and were born after the diagnosis of COVID- 19 during pregnancy and 36 healthy infants were included in the study. Transient evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE) and contralateral suppression of OAE (CLS OAE) tests were performed on all infants. RESULTS: According to the TEOAE results of patients and controls in the silent a statistically significant difference was observed between the two groups at 3 kHz and 4 kHz (p < 0.05). Contralateral suppression of OAE test results of patients and controls a statistically significant difference was found in all frequencies (p< 0.05). Suppression was much more effective at all frequencies in the normal group than patient group. This difference was found to be more significant at higher frequencies (2,3 and 4 kHz) (p < 0.001). CONCLUSIONS: Our results suggest an insufficiency in medial olivocochlear efferent system in infants exposed to SARS-CoV-2 intrauterine. Cochlear functions should be examined in infants whose mothers had COVID-19.

COVID-19 and Tinnitus.

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by the severe acute respiratory syndrome coronavirus 2, brings with it a plethora of health concerns. Although most people have mild symptoms, which are respiratory in nature, some experience neurological symptoms, central nervous system manifestations, peripheral nervous manifestations, and skeletal muscle manifestations. But the damaging impact of COVID-19 virus on the hearing organs in the inner ear is a new finding yet to be explored. Currently, there is little evidence published connecting novel coronavirus and tinnitus directly. But according to the American Tinnitus Association, preexisting behavioral conditions make it more likely for patients to experience tinnitus due to the stress and depression associated with social isolation and infection avoidance. Hearing loss and Tinnitus is a common pathology seen in otolaryngology and there are numerous papers in literature describing its associations with other infections. However, this is the first reported case of hearing loss and tinnitus in a COVID-19 patient, in the State of Qatar, and this case report strives to contribute to the ocean of literature highlighting the need for otorhinolaryngologists to be aware of its correlation with COVID-19 virus.

Telemedicine in Audiology. Best practice recommendations from the French Society of Audiology (SFA) and the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL).

OBJECTIVES: Access to diagnosis and treatments for auditory disorders and related pathologies has regressed in France during the COVID-19 pandemic, posing a risk to the patient's chance of recovery. This best practice recommendations guide aims to list the existing technological solutions for the remote examination of a patient with hearing complaint, and to outline their benefits and, where applicable, their limitations. METHODS: The recommendations were developed both from the clinical experience of the medical experts who drafted the guide, and from an extensive review of the literature dealing with clinical practice recommendations for tele-audiology. Tele-audiometry solutions were identified on the basis of a search engine query carried out in April 2020, prior to verification of their availability on the European market. RESULTS: Video otoscopy solutions allow for the teletransmission of images compatible with a high-quality diagnosis, either by connecting via internet to a tele-health platform or using a smartphone or a tablet with an iOS or Android operating system. Using the same telecommunication methods, it is possible to remotely conduct a pure-tone audiometry test in accordance with standard practice, a speech-in-quiet or a speech-in-noise audiometry test, as well as objective measures of hearing. Clinical and paraclinical examinations can be accessed by the physician to be interpreted on a deferred basis (asynchronous tele-audiology). Examinations can also be conducted in real time in a patient, at any age of life, as long as a caregiver can be present during the installation of the transducers or the acoumetry. Tele-audiology solutions also find application in the remote training of future healthcare professionals involved in the management of deafness and hearing impairment. CONCLUSION: Under French law, tele-otoscopy is a medical procedure that is either a tele-expertise (asynchronous adive) or a teleconsultation act (synchronous advice). Subjective and objective evaluation of the patient's hearing functions can be done remotely provided that the listed precautions are respected.