Hearing loss – a complication of Lyme disease

There have been reported cases of sudden onset or progressive hearing loss as the primary or sole symptom of Lyme disease. In this case report, investigators describe a patient who suddenly lost hearing in both ears and later tested positive for Lyme disease.

In their article “Isolated Sudden Bilateral Neurosensory Hearing Loss as a Presentation of Lyme Neuroborreliosis: A Case Study,” Rochd et al. discuss the case of a 23-year-old woman who “presented with a 2-month history of temporal headache, tinnitus, and instability, which was followed by sudden bilateral hearing loss without any other associated symptoms.”¹

The woman was initially treated with corticosteroids following Stennert’s protocol for sudden hearing loss. However, testing for Lyme disease was positive by Western blot, and the patient was prescribed a 21-day course of doxycycline.

“However, despite treatment, the patient did not experience any improvement in her hearing loss,” the authors state. “As a result, she is now being considered for a cochlear implant.”

[Note by Dr. Daniel Cameron: The patient may have recovered her hearing loss had she received a longer course of antibiotic treatment for Lyme disease.]

“Some studies reported cases of Lyme disease presenting with sudden onset or progressive hearing loss as the primary or sole symptom.”

The authors suggest that clinicians consider Lyme disease in patients with sudden hearing loss, particularly when patients reside in Lyme endemic regions or have a history of a tick bite “and even when no clinical history is present and paraclinical examinations are inconclusive.” Prompt diagnosis and treatment, they point out, can prevent potential complications.

How can hearing loss occur?

• “It is thought that the bacteria may cause an inflammatory response in the tissues of the inner ear, leading to damage to the hair cells or nerve fibers responsible for hearing.”
• “… the bacteria may directly invade and damage these structures.”
• “It is also possible that the hearing loss is a result of the body’s immune response to the bacteria, which can cause damage to healthy tissues as well.”

The exact mechanism by which Lyme disease leads to neurosensory hearing loss is not fully understood, but it is believed to be related to the inflammatory response triggered by the infection.