Can Lyme Disease Cause Bilateral Hearing Loss? A Case Report
Sudden bilateral hearing loss is an uncommon presentation of Lyme disease
A young woman developed tinnitus, instability, and profound hearing loss
Her hearing did not improve following corticosteroids and doxycycline
Can Lyme disease cause bilateral hearing loss? Lyme disease has been associated with sudden sensorineural hearing loss affecting one or both ears, although this is an uncommon manifestation. In one case, a 23-year-old woman developed tinnitus, instability, and sudden profound hearing loss in both ears in association with Lyme neuroborreliosis.
Sudden sensorineural hearing loss requires prompt medical evaluation. Although Lyme disease may be considered in an appropriate clinical setting, hearing loss has numerous possible causes and should not automatically be attributed to a tick-borne infection.
In their article, “Isolated Sudden Bilateral Neurosensory Hearing Loss as a Presentation of Lyme Neuroborreliosis: A Case Study,” Rochd and colleagues described a 23-year-old woman who presented with a two-month history of temporal headache, tinnitus, and instability.1
These symptoms were followed by sudden bilateral hearing loss without other associated symptoms. Audiometry demonstrated profound sensorineural hearing loss affecting both ears.
Testing identifies possible Lyme neuroborreliosis
The woman underwent testing for several infectious causes of hearing loss. Serologic testing was negative except for Borrelia burgdorferi IgM antibodies, which were confirmed by Western blot.
The authors considered the findings consistent with Lyme neuroborreliosis presenting as isolated sudden bilateral sensorineural hearing loss. However, because this was a single case report, it cannot establish how frequently Lyme disease causes hearing loss or prove the mechanism in every patient.
The diagnosis was reported by the authors as Lyme neuroborreliosis. However, the case report did not describe cerebrospinal fluid confirmation, and a positive antibody test must be interpreted together with the patient’s clinical presentation and exposure history.
Hearing did not improve after treatment
The woman was initially treated with corticosteroids according to Stennert’s protocol for sudden hearing loss. After the Lyme disease test results became available, she received a 21-day course of doxycycline.
Despite treatment, the patient did not experience improvement in her hearing. The authors reported that she was subsequently being considered for a cochlear implant.
[Note by Dr. Daniel Cameron: This case illustrates that delayed recognition of Lyme neuroborreliosis may be associated with poorer hearing outcomes. However, it is not possible to determine from a single case whether earlier treatment, a different antibiotic regimen, or a longer course would have changed the outcome.]
How might Lyme disease affect hearing?
The precise mechanism connecting Lyme disease with sensorineural hearing loss remains uncertain. The authors discussed several possible explanations:
- An inflammatory response in the inner ear may damage the hair cells or nerve fibers responsible for hearing.
- The infection may directly affect structures involved in hearing.
- The immune response triggered by the infection may contribute to injury involving otherwise healthy tissue.
Inflammation involving the inner ear, auditory pathways, or cranial nerves may help explain why hearing loss can occur alongside tinnitus, dizziness, vertigo, or balance problems.
When should Lyme disease be considered?
Lyme disease is not a common cause of sudden sensorineural hearing loss. Nevertheless, the authors suggested considering Lyme disease when hearing loss occurs in a patient who lives in or has traveled to a Lyme-endemic region, has possible tick exposure, or has compatible neurologic symptoms.
A recognized tick bite or characteristic rash may strengthen suspicion, but their absence does not necessarily exclude Lyme disease. The patient in this report did not present with the more familiar manifestations typically associated with Lyme disease.
Evaluation should also consider other infectious, autoimmune, vascular, medication-related, neurologic, and inner-ear causes of hearing loss.
Sudden hearing loss requires urgent evaluation
Sudden sensorineural hearing loss—particularly when it affects both ears—is a medical emergency. Anyone experiencing an abrupt change in hearing should seek prompt evaluation from an appropriate medical professional, such as an ear, nose, and throat specialist.
Early audiologic testing and medical assessment may help identify treatable causes and reduce the risk of persistent hearing impairment. Patients should not delay urgent hearing evaluation while waiting for Lyme disease test results.
Frequently Asked Questions
Can Lyme disease cause hearing loss in both ears?
Lyme disease has been associated with bilateral sensorineural hearing loss, but this presentation appears to be uncommon. Hearing loss may occur suddenly or progressively and may affect one or both ears.
Can Lyme disease cause tinnitus?
Tinnitus has been reported in patients with Lyme disease and may occur with hearing loss, dizziness, vertigo, ear fullness, or balance problems. However, tinnitus has many other possible causes.
Can hearing loss associated with Lyme disease be reversed?
The outcome varies and cannot be predicted from this case alone. The woman described in this report did not regain her hearing after corticosteroids and doxycycline. Other outcomes may depend on the cause, severity, timing of diagnosis, and individual response to treatment.
Should everyone with sudden hearing loss be tested for Lyme disease?
Not necessarily. Lyme disease testing may be appropriate when sudden hearing loss occurs with compatible symptoms, possible tick exposure, residence or travel in an endemic region, or findings suggestive of neurologic Lyme disease. Other causes must also be evaluated.
Is sudden bilateral hearing loss an emergency?
Yes. Sudden sensorineural hearing loss requires urgent medical and audiologic evaluation. Treatment opportunities may be time-sensitive, so patients should not wait to see whether their hearing improves on its own.
Clinical Takeaway
This case describes an uncommon presentation in which Lyme neuroborreliosis was associated with sudden profound hearing loss affecting both ears. Tinnitus, headache, instability, dizziness, vertigo, facial weakness, or other neurologic symptoms may provide additional diagnostic context.
Lyme disease should not be presumed to be the cause of every unexplained hearing problem. Nevertheless, it may warrant consideration when the clinical history, geographic exposure, accompanying symptoms, and laboratory findings are compatible.
Sudden hearing loss requires prompt evaluation, and clinicians should consider Lyme disease among the possible explanations in appropriately selected patients.
Related Articles
Hearing loss and vertigo in Lyme disease
Lyme disease, tinnitus, and hearing loss
Can Lyme disease cause sudden hearing loss?
References
- 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. 2024;28(1):72–75.
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
