A 46-year-old farmer with Lyme disease developed permanent tinnitus and hearing loss after receiving only 3 weeks of oral antibiotics. This case raises an important question: when Lyme disease involves the auditory nerve, is a short course of treatment enough?
The Case: Sudden Tinnitus and Hearing Loss
A 46-year-old male farmer was hospitalized with sudden onset of tinnitus and hearing loss in the left ear, dizziness, severe balance instability, and gait ataxia, as described by Jozefowicz-Korczynska and colleagues in Frontiers in Neurology.
Doctors initially suspected vestibular schwannoma — a benign tumor of cranial nerve VIII that affects hearing and balance. But diagnostic testing was normal.
A Western blot test and spinal tap revealed the patient was positive for Lyme disease. He was treated with a 3-week course of oral doxycycline.
Three Weeks of Treatment Was Not Enough
After completing antibiotics, the patient’s dizziness and gait problems persisted. He did not receive any additional oral or intravenous antibiotics. Instead, he was referred to a Balance Disorders Unit for vestibular evaluation.
Upon examination, the patient presented with severe gait disturbance and imbalance. Audiology tests indicated mild to moderate sensorineural hearing loss in both ears.
He underwent vestibular rehabilitation therapy for 10 consecutive days, which significantly improved his balance. But his hearing loss and tinnitus remained.
The authors concluded that the antibiotic therapy was not successful in decreasing hearing loss or tinnitus, suggesting permanent damage to the hearing nerve and cochlea.
Could More Treatment Have Prevented Permanent Damage?
This case raises a critical question. When Lyme disease involves the auditory nerve and cochlea, is 3 weeks of oral antibiotics sufficient to prevent lasting damage?
The patient’s tinnitus and hearing loss began before treatment and persisted afterward. More aggressive or prolonged antibiotic therapy — or intravenous antibiotics — may have offered a better chance of preserving hearing function.
This pattern is consistent with other neurologic presentations of Lyme disease where undertreatment leads to persistent symptoms. For a broader look at how Lyme affects the nervous system, see Lyme Disease Neuropathy: Symptoms and What Causes It.
How Common Are Tinnitus and Hearing Loss in Lyme Disease?
This case is not isolated. A study of 216 patients with tick-borne diseases found that the most common complaint was tinnitus (76.5%), accompanied by vertigo and dizziness (53.7%), headache (39%), and unilateral sensorineural hearing loss (16.7%).
A study from Tufts University found that 4 out of 27 patients with chronic neurologic Lyme disease presented with hearing loss and tinnitus.
For more on tinnitus, ear fullness, and why standard ENT tests often miss the Lyme connection, see Lyme Tinnitus and Ear Fullness.
Why Early and Adequate Treatment Matters
This case underscores the risk of undertreating neurologic Lyme disease. When Lyme involves the auditory nerve, a short course of oral antibiotics may not be enough to prevent lasting damage.
Patients who develop tinnitus and hearing loss during or after Lyme disease should be evaluated for the possibility that the underlying infection was not fully addressed — and that further treatment may be warranted.
Frequently Asked Questions
Can Lyme disease cause permanent tinnitus?
Yes. In this case, tinnitus and hearing loss persisted after treatment, suggesting permanent damage to the auditory nerve and cochlea from Lyme disease.
Can Lyme disease cause hearing loss?
Yes. Sensorineural hearing loss has been documented in multiple studies of Lyme disease patients. It is typically mild to moderate and affects high frequencies.
Was 3 weeks of antibiotics enough for this patient?
The outcome suggests it was not. The patient’s neurologic symptoms persisted, and no additional antibiotic therapy was offered — raising the question of whether more aggressive treatment could have prevented permanent hearing damage.
How common is tinnitus in Lyme disease?
In one study, 76.5% of patients with tick-borne diseases reported tinnitus. It is one of the most frequently reported otolaryngological symptoms in Lyme patients.
Can tinnitus from Lyme disease improve with treatment?
In many patients, tinnitus improves with appropriate antibiotic treatment. However, delayed or insufficient treatment may result in permanent hearing damage, as this case demonstrates.
References
- Jozefowicz-Korczynska M, Zamyslowska-Szmytke E, Piekarska A, Rosiak O. Vertigo and Severe Balance Instability as Symptoms of Lyme Disease. Front Neurol. 2019;10:1172.
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
- Sowula K, Skladzien J, Szaleniec J, Gawlik J. Otolaryngological symptoms in patients treated for tick-borne diseases. Otolaryngol Pol. 2018;72(1):30-34.
the first time I got lyme years ago I had decreased hearing in my left ear,,,, It still remains …