Lyme Disease Tinnitus and Hearing Loss: A Case Report

Lyme disease can affect hearing and balance.
Tinnitus, vertigo, and hearing loss may occur in some patients.
Early diagnosis and treatment may improve the chance of recovery.

Lyme disease tinnitus may occur along with hearing loss, vertigo, dizziness, and balance problems in some patients. Although these complications are uncommon, they can become permanent despite treatment. In this Inside Lyme Podcast, I discuss a published case involving a 46-year-old man whose Lyme disease led to persistent tinnitus and hearing loss.

Vertigo, dizziness, imbalance, and hearing loss are uncommon neurologic manifestations of Lyme disease but have been described in published case reports and clinical studies.

Jozefowicz-Korczynska and colleagues first described this case in Frontiers in Neurology in 2019.

A case of Lyme disease with tinnitus, hearing loss, and vertigo

A 46-year-old male farmer was hospitalized with a “sudden onset of tinnitus and hearing loss in the left ear, dizziness, severe balance instability, and gait ataxia,” the authors write. (Gait ataxia refers to impaired coordination that affects walking and balance.)

Doctors initially suspected vestibular schwannoma, a benign tumor involving the eighth cranial nerve that can affect hearing and balance. However, diagnostic imaging was normal.

Because the patient’s symptoms suggested possible neurologic involvement, additional neurologic testing was performed. A Western blot test and spinal tap supported the diagnosis of Lyme disease.

He was treated with a three-week course of oral doxycycline, but his dizziness and gait instability persisted.

The patient did not receive additional oral or intravenous antibiotics. Instead, he was referred to a Balance Disorders Unit for vestibular evaluation.

“Upon his examination, the patient presented with severe gait disturbance and imbalance,” the authors write.

Audiology testing demonstrated mild-to-moderate bilateral sensorineural hearing loss.

He completed 10 consecutive days of vestibular rehabilitation therapy, which significantly improved his balance. Unfortunately, his hearing loss and tinnitus remained.

Can Lyme disease cause tinnitus?

Although tinnitus is not among the most common symptoms of Lyme disease, published reports show that infection can occasionally affect the nervous system, inner ear, or vestibulocochlear (eighth cranial) nerve. Patients may experience ringing in the ears, hearing loss, dizziness, vertigo, or balance problems.

Not every patient with Lyme disease develops these complications, and other causes of tinnitus and hearing loss—including age-related hearing loss, noise exposure, viral infections, Ménière disease, medications, and vestibular schwannoma—should also be considered.

“Unfortunately, the antibiotic therapy was not successful in decreasing hearing loss or tinnitus, suggesting permanent damage to the hearing nerve and cochlea,” the authors write.

How common are Lyme disease hearing loss and tinnitus?

Another study by Logigian and colleagues at Tufts University School of Medicine found that 4 of 27 patients with chronic neurologic Lyme disease had hearing loss and tinnitus.²

Meanwhile, a study from Poland evaluated 216 patients with tick-borne diseases and found that 162 experienced otolaryngologic (ear, nose, and throat) symptoms.

“The most common complaint was tinnitus (76.5%) accompanied by vertigo and dizziness (53.7%), headache (39%), and unilateral sensorineural hearing loss (16.7%).”³

Questions discussed in this podcast

1. Why did physicians initially suspect vestibular schwannoma?
2. Why was Lyme disease testing ordered despite the patient’s atypical presentation?
3. Would treatment beyond three weeks of doxycycline have improved the patient’s hearing loss or tinnitus?
4. How common are tinnitus, vertigo, hearing loss, and gait impairment in Lyme disease?
5. What other conditions can cause tinnitus and hearing loss?
6. Why was vestibular rehabilitation recommended, and how successful was it?
7. What do the Tufts University and Polish studies tell us about hearing problems in Lyme disease?

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and throughout my website at DanielCameronMD.com. As always, your likes, comments, reviews, and shares help spread awareness about Lyme disease.

Frequently Asked Questions

Can Lyme disease cause tinnitus?

Yes. Although uncommon, Lyme disease has been associated with tinnitus in published case reports and clinical studies, particularly when the nervous system or inner ear is affected.

Can Lyme disease cause hearing loss?

Yes. Lyme disease can occasionally lead to sensorineural hearing loss. Prompt diagnosis and treatment may improve outcomes, although some patients have persistent symptoms.

Can Lyme disease cause vertigo and dizziness?

Yes. Lyme disease can occasionally cause vertigo, dizziness, imbalance, and gait instability, particularly when the vestibular system or nervous system is involved.

Can tinnitus from Lyme disease become permanent?

Some patients improve after treatment, while others continue to experience persistent tinnitus or hearing loss despite antibiotics. Recovery varies depending on the extent of inner ear or nerve involvement.

Clinical Takeaway

Tinnitus, hearing loss, vertigo, and balance problems are uncommon but recognized neurologic manifestations of Lyme disease. Because these symptoms have many possible causes, clinicians should consider Lyme disease alongside other neurologic and inner ear disorders when evaluating patients with compatible exposures and clinical findings.

Prompt evaluation and treatment may improve outcomes, but some patients can experience permanent hearing loss or tinnitus despite appropriate therapy.

Related Articles

Learn more about neurologic and vestibular complications of Lyme disease:

Brain fog in Lyme disease
Lyme disease symptoms guide
Persistent Lyme disease overview
Lyme disease misdiagnosis

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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