Can Lyme Disease Cause Tinnitus? Hearing Loss, Vertigo, and Sleep Problems
Can Lyme disease cause tinnitus? Yes. Tinnitus, hearing loss, vertigo, and other ear-related symptoms have been reported in patients with Lyme disease and other tick-borne illnesses. These symptoms may occur alongside neurologic Lyme disease and, in some patients, improve with appropriate antibiotic treatment. Because tinnitus and hearing loss have many potential causes, clinicians should consider Lyme disease as part of a careful differential diagnosis when compatible symptoms and tick exposure are present.
Welcome to another selection from my book An Expert’s Guide on Navigating Lyme Disease. The book highlights findings from my first 600 Lyme disease Science blogs. In this episode, I discuss tinnitus, hearing loss, vertigo, sleep disturbances, and other neurologic manifestations of Lyme disease.
Lyme disease can affect the nervous system in many ways. In addition to headaches, facial nerve palsy, and cognitive symptoms, some patients report tinnitus, hearing loss, dizziness, vertigo, and abnormalities involving sound perception. These symptoms can significantly affect daily functioning and quality of life.
Lyme Disease and Tinnitus
The majority of patients with tick-borne diseases admitted to an outpatient otolaryngologic clinic in Poland experienced hearing loss and tinnitus.
The most common complaint was tinnitus accompanied by vertigo, dizziness, headaches, and unilateral sensorineural hearing loss. Patients also reported trigeminal neuralgia, hearing hypersensitivity, facial nerve paralysis, toothaches, tongue paresthesias, and other neurologic symptoms.
These findings suggest that tinnitus may occur as part of broader neurologic involvement rather than as an isolated ear disorder.
In a study of chronic neurologic Lyme disease, 4 of 27 patients between 35 and 67 years of age presented with hearing loss and tinnitus.
Read more about hearing loss and tinnitus in Lyme disease.
Can Lyme Disease Cause Hearing Loss?
Yes. Lyme disease has been associated with both gradual and sudden sensorineural hearing loss.
An article published in the Journal of Clinical Medicine described 86 patients hospitalized with sudden sensorineural hearing loss. Nine patients had positive antibodies to Borrelia burgdorferi. Following antibiotic treatment, patients experienced partial or complete improvement in hearing.
Although hearing improved in many individuals, two patients continued to experience persistent high-frequency tinnitus.
The investigators concluded that infection with Borrelia burgdorferi may contribute to inflammatory and angiopathic changes that could play a role in sudden sensorineural hearing loss.
A 2023 case report described a 23-year-old woman with headache, tinnitus, instability, and sudden bilateral hearing loss as a presentation of Lyme neuroborreliosis. Despite doxycycline treatment, her hearing did not recover, highlighting that delayed or severe hearing loss may be difficult to reverse in some patients.
Read more about sudden hearing loss in Lyme disease.
Vertigo and Balance Problems in Lyme Disease
Vertigo frequently accompanies tinnitus and hearing loss in Lyme disease patients.
In another Polish study, vertigo was reported by 38 of 50 patients with Lyme disease. Hearing loss and tinnitus commonly occurred in these patients, and tinnitus was reported in 29 of 38 patients, most commonly as high-frequency tinnitus.
The authors found that vestibular dysfunction on video electronystagmography was associated with hearing loss on auditory brainstem response testing, especially high-frequency hearing loss. They concluded that vertigo can be a symptom of Lyme disease and may reflect inner ear or eighth cranial nerve involvement.
The authors emphasized that tick-borne illnesses should be considered among the potential causes of neurologic symptoms such as hearing loss, tinnitus, vertigo, dizziness, and ataxia.
Read more about vertigo and hearing loss in Lyme disease.
Hyperacusis and Sound Sensitivity
Some Lyme disease patients develop hyperacusis, an abnormal sensitivity to everyday sounds. Ordinary conversations, running water, household appliances, or environmental noise may become uncomfortable or even painful.
Hyperacusis has been described as part of the broader sensory hyperarousal reported in patients with neurologic Lyme disease and post-treatment Lyme disease syndrome. This heightened auditory sensitivity can interfere with work, sleep, and social activities.
Read more about sensory hyperarousal and Lyme disease.
Lyme Disease and Sleep Problems
Sleep disturbances are common among patients with Lyme disease and may contribute to fatigue, cognitive dysfunction, mood changes, and impaired quality of life. Sleep problems may occur during early infection and, in some individuals, persist despite treatment.
A prospective study by Weinstein and colleagues found that 41% of patients with early Lyme disease reported new-onset difficulty sleeping. Most participants experienced improvement after antibiotic treatment, but a small group continued to have persistent sleep disturbances.
Among patients with post-treatment Lyme disease syndrome (PTLDS), four of six individuals reported moderate to severe sleep disruption that they attributed primarily to pain. Five of the six also experienced disturbing dreams that interfered with restorative sleep.
Patients with persistent sleep problems also had higher fatigue scores, greater cognitive-affective depressive symptoms, and more significant functional impairment than those whose sleep returned to normal.
Read more about poor sleep quality in Lyme disease patients.
Sleep Disorders Reported in Lyme Disease
According to Bransfield, Lyme disease patients may experience a broad spectrum of sleep disorders. Non-restorative sleep and chronic physiologic stress may contribute to fatigue, impaired cognition, decreased regenerative function, immune dysfunction, and reduced resilience during recovery.
Reported sleep disorders include:
- Non-restorative sleep
- Difficulty falling asleep
- Middle-of-the-night insomnia
- Early morning awakening
- Excessive daytime sleepiness
- Circadian rhythm disruption
- Restless legs syndrome
- Periodic limb movements during sleep
- Obstructive or central sleep apnea
- Sleep paralysis
- Hypnagogic hallucinations
- Sleep attacks
- Cataplexy
- Narcolepsy
Although these disorders are not specific to Lyme disease, they may complicate recovery and deserve careful evaluation because many are treatable.
Read more about sleep disorders in Lyme disease.
[bctt tweet=”Lyme disease may be associated with tinnitus, hearing loss, vertigo, hyperacusis, and a broad range of sleep disorders.” username=”DrDanielCameron”]
Tullio Phenomenon and Lyme Disease
Tullio phenomenon is an uncommon disorder in which loud sounds trigger dizziness, vertigo, imbalance, nausea, or abnormal eye movements. Although rare, it has been reported in association with Lyme disease.
Kaski and colleagues described Tullio phenomenon as recurrent episodes of disequilibrium accompanied by auditory and visual symptoms that are provoked by loud noises or changes in middle-ear pressure, such as during a Valsalva maneuver.
Nields and colleagues reported the case of a 35-year-old woman with Lyme disease who developed severe vertigo, imbalance, nausea, and vomiting triggered by sound. Her symptoms became so pronounced that even the sound of running tap water caused her to fall or retch.
An otolaryngologist recognized the Tullio phenomenon and initially recommended testing for syphilis because similar symptoms may occur with otosyphilis. After syphilis testing was negative, the patient received two courses of intravenous ceftriaxone, and her Tullio phenomenon resolved.
Although uncommon, this case illustrates that unusual vestibular symptoms may occasionally occur in neurologic Lyme disease and should prompt a comprehensive neurologic and otologic evaluation.
These reports highlight the wide range of auditory and vestibular manifestations described in Lyme disease. While tinnitus, hearing loss, vertigo, and hyperacusis are not unique to Lyme disease, they should be considered in patients with compatible neurologic symptoms and a history of tick exposure.
Frequently Asked Questions
Can Lyme disease cause tinnitus?
Yes. Tinnitus has been reported in patients with Lyme disease, particularly those with neurologic involvement. Ringing in the ears may occur together with hearing loss, vertigo, hyperacusis, or other neurologic symptoms. Because tinnitus has many possible causes, clinicians should evaluate alternative explanations while considering Lyme disease in the appropriate clinical setting.
Can Lyme disease cause hearing loss?
Yes. Both gradual and sudden sensorineural hearing loss have been described in Lyme disease. Several reports describe partial or complete improvement following antibiotic treatment, although some patients continue to experience residual tinnitus or persistent hearing loss.
Can Lyme disease cause vertigo?
Yes. Vertigo, dizziness, imbalance, and ataxia have been reported in patients with Lyme disease. These symptoms often accompany tinnitus or hearing loss and may reflect vestibular or neurologic involvement.
Can Lyme disease cause hyperacusis?
Some patients report hyperacusis, an increased sensitivity to everyday sounds. This may occur as part of sensory hyperarousal associated with neurologic Lyme disease or post-treatment Lyme disease syndrome.
Can Lyme disease cause insomnia?
Yes. Difficulty falling asleep, non-restorative sleep, excessive daytime sleepiness, and other sleep disorders have been reported in Lyme disease. Pain, autonomic dysfunction, neurologic symptoms, mood disorders, and other medical conditions may all contribute to poor sleep.
Clinical Takeaway
Tinnitus, hearing loss, vertigo, hyperacusis, and sleep disturbances are among the neurologic and sensory symptoms reported in patients with Lyme disease. Although none of these findings is specific to Lyme disease, their combination—particularly in individuals with compatible tick exposure or other neurologic manifestations—should prompt consideration of Lyme disease in the differential diagnosis.
Recognizing auditory and vestibular symptoms early may shorten delays in diagnosis and improve opportunities for appropriate treatment.
Related Articles
Learn more about neurologic, sleep, and sensory manifestations of Lyme disease:
Neurologic Lyme disease
Lyme disease symptoms guide
Brain fog and Lyme disease
Autonomic dysfunction and Lyme disease
Lyme disease fatigue
References
- Sowula K, Szaleniec J, Dworak M, Przeklasa M, Maraj M, Ceranowicz P, Tomik J. Vertigo as one of the symptoms of Lyme disease. J Clin Med. 2021;10(13):2814.
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
- Sowula K, Szaleniec J, Stolcman K, Ceranowicz P, Kocoń S, Tomik J. Association between sudden sensorineural hearing loss and Lyme disease. J Clin Med. 2021;10(5):1130.
- Rochd S, Benhoummad O, Salhi S, Lakhdar Y, Rochdi Y, Raji A, Oualhadj H, El Kamouni Y, Zouhair S. Isolated sudden bilateral neurosensory hearing loss as a presentation of Lyme neuroborreliosis: A case study. J Audiol Otol. 2023;28(1):72-75.
- Weinstein ER, Rebman AW, Aucott JN, Johnson-Greene D, Bechtold KT. Sleep quality in well-defined Lyme disease: A clinical cohort study in Maryland. Sleep. 2018.
- Bransfield RC. Neuropsychiatric Lyme borreliosis: An overview with a focus on a specialty psychiatrist’s clinical practice. Healthcare (Basel). 2018;6(3):104.
- Batheja S, Nields JA, Landa A, Fallon BA. Post-treatment Lyme syndrome and central sensitization. J Neuropsychiatry Clin Neurosci. 2013;25(3):176-186.
- Kaski D, Davies R, Luxon L, Bronstein AM. The Tullio phenomenon: A neurologically neglected presentation. J Neurol. 2012.
- Nields JA, Kveton JF. Tullio phenomenon and seronegative Lyme borreliosis. 1991.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
This disease leaves me hopeless…
I have patients who felt hopeless and still improved.
Dr Sam Bailey of New Zealand has made a short film entitled “The Lyme Disease Lie”. She claims, using what sound like reasonable rationales, that the Lyme entity is too diverse in symptomatology and fails on all the 4 basic tenets of Koch’s postulates. Dr Cameron, what are you thoughts on the subject, have you seen the film?
You seem to be referring to a 18 minute video rather than the movie. She discards much of the science behind Lyme and tick borne diseases The voices concerns we all have of never enough information. Her url address included the-Lyme-disease-lie https://drsambailey.com/resources/videos/germ-theory/the-lyme-disease-lie/
The “film” was more of a video post. I did not find post helpful.
Thank you for posting. This describes a lot of problems that I’ve been working through.
My patients have found it helpful to understand their condition as they prepare for treatment.
I have conductive hearing loss and a long long history with chronic Lyme. Everything I read refers to sensory neural hearing loss. Can Lyme also cause conductive hearing loss?
I have not looked at the issue.