Pathogenetic mechanisms of sensorineural hearing loss in patients with COVID-19 and methods for their correction


  • M.A. Trishinska Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
  • O.Ye. Kononov Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine



COVID-19, SARS-CoV-2, acute sensorineural hea-ring loss, choline alfoscerate (L-alpha-glycerylphosphorylcholine), Medotilin


The article describes the main pathogenetic mechanisms of acute sensorineural hearing loss, including that caused by infection. Possible risk factors and mechanisms of development of sensorineural hearing loss against the background of coronavirus infection caused by SARS-CoV-2 virus are consi-dered. Cases of hearing loss in patients with COVID-19 have been described. The pathogenetically substantiated therapeutic approach to the treatment of such patients is presented, it is based on the optimization of acetylcholine neurotransmission in the brain structures involved in the conduction and perception of the auditory impulse.


Download data is not yet available.


Abramovich S., Prasher D.K. Electrocochleography and brain-stem potentials in Ramsay Hunt syndrome. Arch. Otolaryngol. Head Neck Surg. 1986. 112(9). 925-8.

Adler S.P. Congenital cytomegalovirus screening. Pediatr. Infect. Dis. J. 2005. 24(12). 1105-6.

Al Muhaimeed H., Zakzouk S.M. Hearing loss and herpes simplex. J. Trop. Pediatr. 1997. 43(1). 20-4.

Almufarrij I., Uus К., Munro K.J. Does Coronavirus Affect the Audio-Vestibular System? A Rapid Systematic Review. International Journal of Audiology. 2020. 59(7). 487-491. doi: 10.1080/14992027.2020.1776406.

Arabi Y.M., Balkhy H.H., Hayden F.G., Bouchama A., Luke T., Baillie J.K. et al. Middle East respiratory syndrome. N. Engl. J. Med. 2017. 37. 584-94.

Budzilovich G.N., Lieberman A.N. Herpes zoster oticus and facial paralysis (Ramsay Hunt syndrome). Clinicopathologic study and review of literature. J. Neurol. Sci. 1973. 20(2). 149-59.

Byl F.M. Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope. 1984. 94. 647-61.

Cao Y., Liu X., Xiong L., Cai K. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis. J. Med. Virol. 2020. doi:

Cao Q.-D., Hong Z.-S., Tan Y.-Y., Chen S.-D., Jin H.-J., Tan K.-S., Wang D.-Y. et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak — an update on the status. Mil. Med. Res. 2020. 7. 11. on the status, Accessed date: 3 April 2020.

Carfi A., Bernabei R., Landi F. Persistent Symptoms in Patients after Acute COVID-19. Journal of the American Medical Association. 2020. 9. doi: 10.1001/jama.2020.12603.

Carlos W.G., Dela Cruz C.S., Cao B., Pasnick S., Jamil S. Novel Wuhan (2019-nCoV) coronavirus. Am. J. Respir. Crit. Care Med. 2020. 201. P7-8. doi:

Cashman K.A., Wilkinson E.R., Zeng X., Cardile A.P., Facemire P.R., Bell T.M. et al. Immunemediated systemic vasculitis as the proposed cause of sudden-onset sensorineural hearing loss following lassa virus exposure in cynomolgus macaques. mBio. 2018. 9. e01896-e1918.

Chandrasekhar S.S., Connelly P.E., Brahmbhatt S.S., Shah C.S., Kloser P.C., Baredes S. Otologic and audiologic evaluation of human immunodeficiency virus infected patients. Am. J. Otolaryngol. 2000. 21(1). 1-9.

Chandrasekhar S.S., Tsai Do B.S., Schwartz S.R. et al. Clinical practice guideline: sudden hearing loss (update) executive summary. Otolaryngol. Head Neck Surg. 2019. 161. 195-210.

Lowenstein C.J., Solomon S.D. Severe COVID-19 is a Microvascular Disease. Circulation. 2020. 142. 1609-1611. DOI: 10.1161/CIRCULATIONAHA.120.050354.

Chen X., Fu Y.-Y., Zhang T.-Y. Role of viral infection in sudden hearing loss. J. Int. Med. Res. 2019. 47. 2865-72.

Ciorba A., Corazzi V., Skarzynski P.H., Skarzynska M.B., Bianchini C., Pelucchi S., Hatzopoulos S. Don’t Forget Ototoxicity During the SARS-CoV-2 (Covid-19) Pandemic. International Journal of Immunopathology and Pharmacology. 2020. 34. 1-3. doi: 10.1177/2058738420941754.

Cohen B.E., Durstenfeld A., Roehm P.C. Viral causes of hearing loss: a review for hearing health professionals. Trends Hear. 2014. 18. doi: 10.1177/2331216514541361.

Coronavirus disease 2019 (COVID-19) pandemic: Increased transmission in the EU/ EEA and the UK — seventh update, 25 March 2020. Stockholm: ECDC, 2020. Stockholm: European Centre for Disease Prevention and Control, 2020.

de Haro-Licer J., Roura-Moreno J., Vizitiu A., González-Fernández A., González-Ares J.A. Long term serious olfactory loss in colds and/or flu. Acta Otorrinolaringol. Esp. 2013. 64. 331-8.

Degen C., Lenarz T., Willenborg K. Acute profound sensorineural hearing loss after COVID-19 pneumonia. Mayo Clin. Proc. 2020. 95. 1801-3.

Desforges M., Favreau D.J., Brison E., Desjardins J., Meessen-Pinard M., Jacomy H. et al. Human coronavirus: respiratory pathogens revisited as infectious neuroinvasive, neurotropic, and neurovirulent agents. CRC Press, 2013. Р. 93-122.

Duarte R., Furtado I., Sousa L., Carvalho C.F.A. The 2019 novel coronavirus (2019-nCoV): novel virus. old challenges. Acta Med Port 2020. doi:

Esaki S., Goshima F., Kimura H., Ikeda S., Katsumi S., Kabaya K., et al. Auditory and vestibular defects induced by experimental labyrinthitis following herpes simplex virus in mice. Acta Otolaryngol 2011. 131. 684-91.

Escher R., Breakey N., Lämmle B. Severe COVID-19 infection associated with endothelial activation. Thromb Res. 2020. 190. 62. doi: 10.1016/j. thromres.2020.04.014.

Koumpa F.S., Forde C.T., Manjaly J.G. Sudden irreversible hearing loss post COVID-19. BMJ Case Rep. 2020. 13. e238419. doi: 10.1136/bcr-2020-238419.

Goshua G., Pine A.B., Meizlish M.L., Chang C.H., Zhang H., Bahel P., Baluha A., Bar N., Bona R.D., Burns A.J. et al. Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study. Lancet Haematol. 2020. 7. e575-e582. doi: 10.1016/S2352-3026(20)30216-7.

Gralinski L.E., Menachery V.D. Return of the coronavirus: 2019-nCoV. Viruses. 2020. 12. 135.

Hara J.H., Zhang J.A., Gandhi K.R., Flaherty A., Barber W., Leung M.A. et al. Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss. Laryngoscope Investig. Otolaryngol. 2018. 3. 73-7.

Hopkins C., Surda P., Whitehead Е., Kumar B.N. Early Recovery following New Onset Anosmia during the COVID-19 Pandemic — An Observational Cohort Study. Journal of Otolaryngology-Head & Neck Surgery. 2020. 49. 1-6. doi: 10.1186/s40463-020-00423-8.

Karosi T., Konya J., Petko M., Sziklai I. Histologic otosclerosis is associated with the presence of measles virus in the stapes footplate. Otol. Neurotol. 2005. 26(6). 1128-33.

Kennedy P.G. Herpes simplex virus type 1 and Bell’s palsy — a current assessment of the controversy. J. Neurovirol. 2010. 16. 1-5.

Munro K.J., Uus К., Almufarrij І., Chaudhuri N., Yioe V. Persistent self-reported changes in hearing and tinnitus in post-hospitalisation COVID-19 cases. International Journal of Audiology. 2020. DOI: 10.1080/14992027.2020.1798519.

Kilic O., Kalcioglu M.T., Cag Y. et al. Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss. Int. J. Infect. Dis. 2020. 97. 208-11.

Klok F.A., Kruip M.J.H.A., van der Meer N.J.M., Arbous M.S., Gommers D., Kant K.M., Kaptein F.H.J., van Paassen J., Stals M.A.M., Huisman M.V. et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb. Res. 2020. 191. 148-150. doi: 10.1016/j.thromres.2020.04.041.

Lai C.C., Shih T.P., Ko W.C., Tang H.J., Hsueh P.R. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int. J. Antimicrob. Agents. 2020. 55. 105924.

Mao L., Jin H., Wang M., Hu Y., Chen S., He Q. et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020. e201127.

Mateer E.J., Huang C., Shehu N.Y., Paessler S. Lassa fever-induced sensorineural hearing loss: a neglected public health and social burden. PLoS Negl. Trop. Dis. 2018. 12. e0006187.

Merchant S.N., Adams J.C., Nadol J.B. Pathology and pathophysiology of idiopathic sudden sensorineural hearing loss. Otol. Neurotol. 2005. 26. 151-60.

Morse J.S., Lalonde T., Xu S., Liu W.R. Learning from the past: possible urgent prevention and treatment options for severe acute respiratory infections caused by 2019-nCoV. ChemBioChem. 2020. 21. 730-8.

Munro K.J. Coronavirus: Why We’re Investigating the Long-term Impact on Hearing. 2020.

Mustafa M.W.M. Audiological Profile of Asymptomatic COVID-19 PCR-Positive Cases. American Journal of Otolaryngology. 2020. 41(3). 102483. doi: 10.1016/j.amjoto.2020.102483.

National Health Commission of the People’s Republic of China. Diagnosis and treatment of the novel coronavirus pneumonia (Trial version 7). 2020. [Accessed 03 March 2020].

Nomura Y., Kurata T., Saito K. Cochlear changes after herpes simplex virus infection. Acta Otolaryngol. 1985. 99. 419-27.

O’Sullivan J.M., Gonagle D.M., Ward S.E., Preston R.J.S., O’Donnell J.S. Endothelial cells orchestrate COVID-19 coagulopathy. Lancet Haematol. 2020. 7. e553-e555. doi: 10.1016/S2352-3026(20)30215-5.

Kilica О., Kalcioglua M.T., Cagb Y., Tuysuza О., Pektasc Е., Caskurlub Н., Cetind F. Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss. International Journal of Infectious Diseases. 2020. 97. 208-211.

Rhman S.A., Wahid A.A. COVID-19 and sudden sensorineural hearing loss: a case report. Otolaryngol Case Reports. 2020. 16. 100198.

Rubin E.J., Baden L.R., Morrissey S., Campion E.W. Medical journals and the 2019-nCoV outbreak. N. Engl. J. Med. 2020. 382. 866.

Sedaghat Z., Karimi N. Guillain Barre syndrome associated with COVID-19 infection: A case report. Journal of Clinical Neuroscience: official Journal of the Neurosurgical Society of Australasia. 2020. 76. 233-235. doi: 10. 1016/j.jocn.2020.04.062.

Sriwijitalai W., Wiwanitkit V. Hearing loss and COVID-19: a note. Am. J. Otolaryngol. 2020. 41. 102473.

Suzuki M., Saito K., Min W.P., Vladau C., Toida K., Itoh H. et al. Identification of viruses in patients with postviral olfactory dysfunction. Laryngoscope. 2007. 117. 272-7.

Uranaka T., Kashio A., Ueha R. et al. Expression of ACE2, TMPRSS2, and furin in mouse ear tissue. bioRxiv. 2020.

Vaira L.A., Salzano G., Deiana G., De Riu G. Anosmia and ageusia: common findings in COVID-19 patients. Laryngoscope. 2020. doi:

Vallamkondu J., John A., Wani W.Y. et al. SARS-CoV-2 pathophysiology and assessment of coronaviruses in CNS diseases with a focus on therapeutic targets. Biochim. Biophys Acta Mol. Basis Dis. 2020. 1866. 165889.

Varga Z., Flammer A.J., Steiger P., Haberecker M., Andermatt R., Zinkernagel A.S., Mehra M.R., Schuepbach R.A., Ruschitzka F., Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020. 395. 1417-1418. doi: 10.1016/S0140-6736(20)30937-5.

Watson J., Whiting P.F., Brush J.E. Interpreting a COVID-19 test result. BMJ. 2020. 369. m1808.

Wilson W.R. The relationship of the herpesvirus family to sudden hearing loss: a prospective clinical study and literature review. Laryngoscope. 1989. 96. 870-7.

World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance V 1.2.13 March 2020, WHO reference number: WHO/2019-nCoV/clinical/2020.4. 2020.

Wu D., Wu T., Liu Q., Yang Z. The SARS-CoV-2 outbreak: what we know [published online ahead of print, 2020 Mar 12]. Int. J. Infect. Dis. 2020. 94. 44-8. doi:

Xia et al. Impact of anxiety associated with COVID-19 on tinnitus.

Yamasoba T., Kikuchi S., Higo R. et al. Sudden sensorineural hearing loss associated with slow blood flow of the vertebrobasilar system. Ann. Otol. Rhinol. Laryngol. 1993. 102. 873-7.

Yun N.E., Ronca S., Tamura A., Koma T., Seregin A.V., Dineley K.T. et al. Animal model of sensorineural hearing loss associated with lassa virus infection. J. Virol. 2015. 90. 2920-7.

Zayet S., Kadiane-Oussou N’dri J., Lepiller Q. et al. Clinical features of COVID-19 and influenza: a comparative study on Nord Franche-Comte cluster. Microbes Infect. 2020. doi: 10.1016/j.micinf.2020.05.016. [Epub ahead of print: 16 Jun 2020].

Zhu N., Zhang D., Wang W., Li X., Yang B., Song J. et al. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020. 382. 727-33.

Na G., Kwak S.H., Jang S.H., Noh H.E., Kim J., Yang Sand Jung J. Supplementary Effect of Choline Alfoscerate on Speech Recognition in Patients with Age-Related Hearing Loss: A Prospective Study in 34 Patients (57 Ears). Front. Aging Neurosci. 2021. 13. 684519. doi: 10.3389/fnagi.2021.684519.



How to Cite

Trishinska, M., & Kononov, O. (2022). Pathogenetic mechanisms of sensorineural hearing loss in patients with COVID-19 and methods for their correction. INTERNATIONAL NEUROLOGICAL JOURNAL, 17(7), 20–26.



To practicing Neurologist