Sudden Hearing Loss as a Sign of Lyme Neuroborreliosis

Hearing loss may be the first symptom
Often treated initially as idiopathic
Delayed recognition can affect recovery

In their article, “Isolated Sudden Bilateral Neurosensory Hearing Loss as a Presentation of Lyme Neuroborreliosis,” Rochd and colleagues describe a patient whose primary symptom of Lyme disease was sudden hearing loss.

A 23-year-old woman presented with a 2-month history of headache, tinnitus, and imbalance, followed by abrupt bilateral hearing loss. :contentReference[oaicite:0]{index=0}

Initial Treatment Did Not Address the Cause

The patient was initially treated with corticosteroids under a standard protocol for sudden hearing loss.

However, further evaluation revealed Lyme disease by Western blot testing, and she was treated with a 21-day course of doxycycline.

Clinical insight: Sudden hearing loss may be misdiagnosed when Lyme disease is not considered early in the evaluation.

Limited Recovery Despite Treatment

Despite antibiotic therapy, the patient did not experience improvement in her hearing.

She was ultimately referred for consideration of a cochlear implant.

Clinical perspective: Earlier recognition—or a longer duration of treatment—may influence outcomes in some cases.

Lyme Disease and Hearing Loss

Although uncommon, Lyme disease can present with sudden or progressive hearing loss as the primary symptom.

These presentations are part of the broader spectrum of Lyme disease symptoms, particularly when the nervous system is involved.

Related symptoms may include tinnitus, vertigo, and imbalance, as described in Lyme-related vertigo and hearing loss.

How Can Lyme Disease Affect Hearing?

The exact mechanism is not fully understood, but several possibilities have been proposed:

Inflammation of inner ear structures damaging hair cells
Direct infection affecting auditory nerve pathways
Immune-mediated damage to healthy tissue

These mechanisms are consistent with patterns seen in neurologic Lyme disease, where inflammation affects sensory and neural function.

Why This Matters

Sudden hearing loss is often treated as idiopathic or viral.

However, this case highlights the importance of considering Lyme disease—particularly in endemic areas or when symptoms are accompanied by neurologic features.

Early recognition and appropriate treatment may improve outcomes and prevent permanent complications.

Start here: Lyme disease symptoms guide