Hearing Loss in COVID-19 Patients: An Audiological Profile of Symptomatic and Asymptomatic COVID-19 Patients in Qatar.

Background and objective Viral infections caused by cytomegalovirus, lymphocytic choriomeningitis virus, varicella-zoster virus, herpes simplex type 1 and type 2, rubella, measles, rubeola, HIV, West Nile virus, Lassa virus, and mumps are known to be associated with hearing loss. There have been reports of inner ear involvement in coronavirus disease 2019 (COVID-19) patients but the extent and variations in cochlear involvement of symptomatic and asymptomatic patients has not been adequately described. This study aimed to evaluate the hearing status among symptomatic and asymptomatic COVID-19 patients to address the prospects for routine screening for hearing loss in COVID-19 patients. Methods Patients testing positive for COVID-19 between March 2020 and May 2020 and August 2020 and October 2020 in Qatar were screened. A total of 110 patients aged 15-50 years were enrolled and grouped into symptomatic and asymptomatic COVID-19 after telephonic screening. Of them, seven were excluded for various reasons. A questionnaire was administered in person to all included participants. Audiological testing results of symptomatic and asymptomatic patients were analyzed. Results Of the 103 patients included in the study, 49 were symptomatic and 54 asymptomatic; 15 (14.6 %) had high-frequency sensorineural hearing loss (SNHL) in one or both ears. Mean thresholds in extended high frequencies 10K-20K were higher in symptomatic patients. Abnormal distortion product otoacoustic emissions (DPOAEs) were seen in 40 (38.8%) patients; 63.3% (31/49) were symptomatic and 16.7% (9/54) were asymptomatic in 3K-8K frequencies (p=0.0001).  Conclusions Symptomatic COVID-19 patients had significant involvement of the inner ears with abnormal pure tone audiometry (PTA), extended high-frequency audiometry (EHFA), and DPOAEs compared to asymptomatic COVID-19 patients. The extent of inner-ear involvement suggests the severity of the infection. The lack of audiovestibular symptoms does not rule out normal hearing in such patients. Screening for hearing loss should be routinely considered in post-COVID-19 patients.