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Healio interview
Disclosure:
Le Prell reports on current support from 3M, the Emilie and Phil Schepps Professorship in Hearing Science, JPC-8 / SRMRP W81XWH1820014, NIH-NIDCD 1R01DC014088 and USAMRAA W81XWH-19-C-0054; and prior contract funding and / or clinical trial material from Edison Pharmaceuticals, Hearing Health Science, and Sound Pharmaceuticals.
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Growing body of evidence, albeit in strength, suggests that auditory and vestibular effects should be added to the list of symptoms associated with COVID-19, according to an expert.
Colleen The Bounce, PhD, a professor and chair of the division of language, speech and hearing at the University of Texas at Dallas said the inflammatory effects of COVID-19 in neurological tissues could be to blame.
“Inflammation can damage the auditory and equilibrium pathways in the peripheral and central nervous system, just as it can damage the olfactory and taste pathways and other neural systems,” she said in a press release.
Le Prell warned that undetected treatments for COVID-19, such as chloroquine and hydroxychloroquine, can also have adverse hearing effects, especially in those with kidney problems.
“If the kidneys are not working properly, the drug may not” [be] so rapidly metabolized and excreted from the body, which can increase physiological drug concentrations and the risk of side effects, ”Le Prell said in the press release. “Age is often associated with decreased kidney function, and COVID-19 can cause kidney dysfunction, increasing the risk that a patient receiving experimental therapy for COVID-19 is at risk for ototoxicity.”
In an interview with Healio Primary Care, she discussed the limits of the evidence surrounding the link between COVID-19 and hearing and balance disorders, the duration of those symptoms that may be more prone to these effects, and much more.
Healio Primary Care: What? There is evidence to suggest that hearing is and imbalance are symptoms of COVID-19? How strong is the evidence?
the Bounce: Most of the evidence that hearing and balance disorders are symptoms of COVID-19 comes from case reports and retrospective reviews using patient databases. Therefore, much of the data is descriptive in nature and provides statistical information about the percentage of patients admitted to hospital with COVID-19 who also have specific symptoms such as hearing loss, tinnitus or balance disorders documented. Some studies specify new hearing loss, tinnitus, or imbalance, but some studies could identify people with pre-existing symptoms if their methodology is not limited to new symptoms. These studies also generally did not include a control population to examine the prevalence of symptoms in age- or otherwise-matched individuals who did not test positive for COVID-19. Therefore, the evidence for causal relationships is relatively weak, suggesting possible relationships, but not confirmed.
Healio basic care: How long does it take? Hearing and balance disorders related to COVID-19 last?
the Bounce: I am not aware of any data on the duration of hearing and balance disorders after COVID-19. Recovery may or may not be possible depending on the specific pathology underlying the condition. Many of the cells in the cochlea do not have a regeneration process and when these cells die, new cell growth does not replace them.
Healio Primary Care: Does COVID-19 Severity Affect Your Chances of Developing These Symptoms?
the Bounce: Most of the research published comes from severe COVID-19 cases that require hospitalization for other severe and potentially life-threatening symptoms. One study looked at people identified as asymptomatic cases and the asymptomatic group had poorer hearing outcomes compared to a control group that was specifically recruited as a control group with normal hearing. The small differences observed should be interpreted with caution as it is possible that the experimental group (identified as asymptomatic) may have had hearing loss prior to COVID-19 infection. Prospective longitudinal data are needed in which hearing changes are observed within the same group of people. This data can be used to determine the extent of hearing change over time in people with and without COVID-19 infection.
Healio basic care: What pre-existing medical conditions can make a person more susceptible to hearing and balance disorders than a symptom of COVID-19?
the Bounce: There are no published data on this. Since COVID 19 attacks many neurological systems throughout the body, one could speculate that pre-existing nerve damage could increase the risk of hearing and balance disorders, as the loss of additional neurons or other vulnerable cells could lead to measurable deficits more quickly. Another option to consider is the potential for ototoxic side effects from COVID-19 therapeutics. A number of the drugs that are being investigated as potential therapeutics have resulted in either temporary or permanent hearing loss when those drugs have been used for other disease states. Increased doses in COVID-19 patients and the combination of multiple drug treatments in COVID-19 patients could increase these risks.
Healio Primary Care: What Are the Possible Reasons for the Link Between These Conditions and COVID-19?
the Bounce: It’s well documented that COVID-19 causes a cytokine storm – essentially a condition where the body’s defense mechanisms act against its own tissues. When the immune system is activated, white blood cells release inflammatory cytokines, and these cytokines recruit additional immune cells to the site of injury. With COVID-19, this process can be increased to such an extent that it becomes pathological rather than beneficial. It is believed that this is the cause of damage to the hearing and balance systems, as well as other tissues.
Healio basic care: Should PCPs be screened for hearing and balance disorders in patients with COVID-19? When should patients with these symptoms be referred to a specialist?
the Bounce: Outside of COVID-19, too, there has been significant discussion among public health officials, scientists, and clinicians about the benefits of hearing and balance screenings, including whether early detection leads to early intervention.
If a patient reports difficulty communicating with others in silence or in noise, has balance deficits that put them at risk of falls and injuries, or other hearing or balance problems, a referral is certainly justified so that rehabilitation options can be discussed.
In the absence of symptoms or discomfort, there is no consensus among stakeholders about routine hearing and / or balance screening. There are tests that are sensitive to preclinical pathologies, such as: B. otoacoustic emission tests, which measure the health of a certain type of sensory cell (the outer hair cell). If decreased emissions are detected during screening, patients can be advised on the need to protect their ears from additional injury and advised on hearing protection options that best meet their hearing needs. Reduced emissions were reported in asymptomatic COVID-19 cases, although the evidence is still weak due to the lack of prospective longitudinal data.
Relation:
Acoustic Society of America. COVID-19 causes hearing and balance disorders, aggravates tinnitus symptoms. https://www.eurekalert.org/pub_releases/2021-06/asoa-cch060721.php. Accessed July 22, 2021.
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