Hearing problems related to Coronavirus 2 (SARS-CoV-2), the Covid viral infection, have been reported since the disease started spreading worldwide in early 2020. Viral infections, now including Covid, can cause inner ear infection (otitis interna), temporarily or permanently affecting cochlear and vestibular function responsible for hearing and balance.
Tinnitus related to Covid has also been widely reported. Research indicates Covid may worsen symptoms of pre-existing chronic tinnitus, and Covid infection may initiate tinnitus. However, Covid-related tinnitus doesn’t seem to be different from tinnitus that arises without Covid infection. [1]
Clinical evidence indicates Covid infection can damage cochlear and vestibular function.
COVID-19 can damage the inner ear as well as the auditory pathway. Hearing loss may be the only symptom of COVID-19 or be a late complication of the disease due to postinfectious inflammation of the nerve tissue as a symptom of long COVID-19. [2]
This finding is consistent with research indicating that Covid infection can damage the central nervous system (CNS), a larger and more complex problem. The damage can be acute (short term) or chronic (long term).
Covid-19 contributes to neurological disease
The mechanisms of actions are under continual investigation by the National Institute of Neurological Disorders and Stroke and others.
Understanding the mechanisms behind COVID-19-mediated neurological disease is a pressing matter for the scientific community, as current data estimates that 30–60% of individuals infected with SARS-CoV-2 develop at least one post-acute symptom. As over 500 million people are already infected, and [with] the continuing high rate of infection, understanding the mechanisms behind COVID-19-induced neurological disease is a public health emergency. [3]
The current findings are a bit frightening. The virus may invade the CNS by crossing the blood-brain barrier or using neurologic pathways like the olfactory system.
Long COVID affects different people in different ways-- studies have reported up to 200 symptoms associated with Long COVID, and individuals with the condition experience clusters of symptoms. Some people develop gastrointestinal problems while others suffer with shortness of breath and chronic cough. Fatigue and “brain fog” are the most commonly reported symptoms. In some people, these changes were so severe that they were not able to function at their pre-infection level in their jobs or at school. Many people are still dealing with these symptoms years after being infected with SARS-CoV-2. [4]
Patients with COVID-19 frequently report neurological symptoms, such as headaches, dizziness, impaired consciousness, and delirium. In more severe cases, COVID-19 can lead to conditions like encephalopathy, strokes, and neuroinflammation. Studies have found that approximately 22-36% of patients experience neurological symptoms, with headaches being one of the most common manifestations. [ibid 4]
COVID-19 has also been associated with more serious neurological outcomes, such as cerebrovascular complications (e.g., strokes) and microvascular damage, including microthrombi and hemorrhages in the brain. These issues may be due to systemic inflammation and immune responses triggered by the virus, which can also affect the brain's blood vessels. [5]
What can be done about Covid-associated hearing loss?
The scientific consensus that Covid initiates neuroinflammation indicates treatment with anti-inflammatory agents as a potential starting point. Patients with Covid-associated hearing loss have reported receiving prescriptions for Anakinra, for treating rheumatoid arthritis; Prednisone, a steroid used to treat many diseases and conditions, especially those associated with inflammation; Mycophenolate, an immunosuppressive used to prevent transplant organ rejection; and Methotrexate, an antimetabolite that decreases immune system activity, used to treat rheumatoid arthritis, psoriasis, and certain cancers. To our knowledge and with the possible exception of steroids, successful treatment of Covid-associated hearing loss with pharmaceuticals has not been reported.
Specifically with respect to sensorineural hearing loss (SNHL), cochlear damage leading to acute or chronic inner ear hearing loss, recent basic research points to elevated F2 alpha isoprostane levels leading to cochlear oxidative stress, a significant contributing SNHL trigger, which ACEMg has been demonstrated to reduce or eliminate. [6]
Oxidant damage was measured as plasma concentrations of F2-isoprostanes (F2-I). Compared to uninfected controls, plasma concentrations of F2-I were 115% higher in COVID-19 infected patients (Table 1). When these outcomes were analyzed in discrete age groups, compared to uninfected controls, COVID-19 infected patients had 257%, 294% and 37% higher concentrations of F2I in the young (21–40 year), middle-aged (41–60 year) and OA (≥60 year) respectively, suggesting that young and middle-aged COVID-19 patients had severely elevated markers of oxidant damage, and this was also more severe in OA with COVID-19 infection than uninfected OA. Within the COVID-19 group, there was an age effect with a progressive increase in F2-I concentrations with increasing age. [7]
Thus, in theory, the antioxidant and anti-inflammatory properties of ACEMg could contribute to managing COVID-19 associated hearing loss with a non-drug intervention by reducing cochlear oxidative stress and promoting inner ear blood flow. Further research is needed.
Individual real-world evidence (RWE) tests are possible. If you or someone close to you is experiencing Covid-related hearing conditions, you can conduct your own test as an adjunct to standard treatment, preferably under physician supervision in a clinical setting offering otoacoustic emissions hearing tests that objectively measure and monitor potential biological function recovery of the inner ear auditory transduction cells impacted by Covid-19. To be clear, there is no guarantee ACEMg will help. No claims or promises are possible.
Clinical studies are also possible. In concept, for example, some patients presenting with Covid-related hearing loss or vestibular conditions would receive ACEMg in addition to standard treatment. Principal Investigators interested in a clinical study of ACEMg for Covid-associated hearing conditions please contact research@soundbites.com or research@keephearing.org.
References
-
Figueiredo RR, Penido NO, de Azevedo AA, de Oliveira PM, de Siqueira AG, Figueiredo GMR, Schlee W, Langguth B. Tinnitus emerging in the context of a COVID-19 infection seems not to differ in its characteristics from tinnitus unrelated to COVID-19. Front Neurol. 2022 Sep 9;13:974179. https://doi.org/10.3389/fneur.2022.974179 PMID: 36158941; PMCID: PMC9505692.
-
Dorobisz K, Pazdro-Zastawny K, Misiak P, Kruk-Krzemień A, Zatoński T. Sensorineural Hearing Loss in Patients with Long-COVID-19: Objective and Behavioral Audiometric Findings. Infect Drug Resist. 2023 Mar 31;16:1931-1939. https://doi.org/10.2147/IDR.S398126. PMID: 37025195; PMCID: PMC10072149.
-
Vanderheiden A, Klein RS. Neuroinflammation and COVID-19. Curr Opin Neurobiol. 2022 Oct;76:102608. https://doi.org/10.1016/j.conb.2022.102608. Epub 2022 Jun 29. PMID: 35863101; PMCID: PMC9239981.
-
Understanding neurological complications of COVID-19, https://www.ninds.nih.gov/news-events/directors-messages/all-directors-messages/understanding-neurological-complications-covid-19
-
[Paywall] Maliha, S.T., Fatemi, R. & Araf, Y. COVID-19 and the brain: understanding the pathogenesis and consequences of neurological damage. Mol Biol Rep 51, 318 (2024). https://doi.org/10.1007/s11033-024-09279-x
-
Le Prell CG, Yamashita D, Minami SB, Yamasoba T, Miller JM. Mechanisms of noise-induced hearing loss indicate multiple methods of prevention. Hear Res. 2007 Apr;226(1-2):22-43. https://doi.org/10.1016/j.heares.2006.10.006 2006 Dec 4. PMID: 17141991; PMCID: PMC1995566.
-
Kumar P, Osahon O, Vides DB, Hanania N, Minard CG, Sekhar RV. Severe Glutathione Deficiency, Oxidative Stress and Oxidant Damage in Adults Hospitalized with COVID-19: Implications for GlyNAC (Glycine and N-Acetylcysteine) Supplementation. Antioxidants. 2022; 11(1):50. https://doi.org/10.3390/antiox11010050
