Lyme Disease Vertigo and Hearing Loss: Study Findings

Lyme disease can affect hearing and balance.
Some patients develop vertigo, tinnitus, or gait instability.
In severe cases, symptoms may persist despite treatment.

Lyme disease vertigo and hearing loss can be frightening symptoms, especially when they appear suddenly and mimic serious neurologic or inner ear disorders.

In one published case, a 46-year-old farmer developed abrupt tinnitus, hearing loss, dizziness, severe imbalance, and gait ataxia that were ultimately linked to Lyme disease. [1]

The case highlights how tick-borne illness may occasionally affect the vestibular and auditory systems in ways that are difficult to recognize early. :contentReference[oaicite:0]{index=0}

A Lyme Disease Patient With Sudden Hearing and Balance Symptoms

Jozefowicz-Korczynska and colleagues first described this case in Frontiers in Neurology in 2019. [1]

The patient, a 46-year-old farmer, was hospitalized with:

• Sudden tinnitus in the left ear
• Hearing loss
• Dizziness
• Severe balance instability
• Gait ataxia

Gait ataxia refers to impaired coordination affecting walking and balance.

Doctors Initially Suspected a Vestibular Tumor

Because the symptoms strongly resembled a vestibular schwannoma (acoustic neuroma), physicians initially suspected a benign tumor affecting the eighth cranial nerve.

Vestibular schwannomas commonly produce:

• Hearing loss
• Tinnitus
• Balance problems
• Dizziness

However, diagnostic imaging and testing failed to confirm a tumor.

Testing Eventually Revealed Lyme Disease

A Western blot test and spinal tap later revealed evidence of Lyme disease. [1]

The patient received a three-week course of oral doxycycline.

Unfortunately, his dizziness and gait instability persisted despite treatment.

He was subsequently referred to a Balance Disorders Unit for specialized vestibular rehabilitation.

Vestibular Rehabilitation Improved Balance But Not Hearing

Audiology testing demonstrated mild to moderate sensorineural hearing loss in both ears.

The patient underwent 10 consecutive days of vestibular rehabilitation therapy, which significantly improved his balance symptoms.

However, his tinnitus and hearing loss remained.

“Unfortunately, the antibiotic therapy was not successful in decreasing hearing loss or tinnitus, suggesting permanent damage to the hearing nerve and cochlea,” the authors concluded. [1]

How Common Are Hearing and Balance Symptoms in Lyme Disease?

Although not among the most common Lyme disease symptoms, auditory and vestibular complications have been reported in several studies.

Logigian and colleagues from Tufts University found that 4 of 27 patients with chronic neurologic Lyme disease experienced hearing loss and tinnitus. [2]

Another study from Poland involving 216 patients with tick-borne disease reported frequent ear and balance symptoms. [3]

The investigators found:

• Tinnitus in 76.5%
• Vertigo and dizziness in 53.7%
• Headache in 39%
• Unilateral sensorineural hearing loss in 16.7%

Why Lyme Disease May Affect Hearing and Balance

Lyme disease may affect the nervous system, cranial nerves, inner ear structures, or inflammatory pathways involved in balance and hearing.

Possible mechanisms include:

• Inflammation affecting the vestibulocochlear nerve
• Inner ear inflammation
• Immune-mediated injury
• Neurologic Lyme disease affecting balance pathways

In some patients, delayed diagnosis or severe inflammation may increase the risk of long-term complications.

Learn more about neurologic Lyme disease, Lyme disease symptoms, and dizziness and autonomic dysfunction in Lyme disease.

Questions Raised by This Case

This case raises several important clinical questions:

1. Could earlier diagnosis have reduced the risk of permanent hearing damage?
2. Would longer treatment have changed the outcome?
3. How often are vestibular symptoms overlooked in Lyme disease patients?
4. When should Lyme disease be considered in patients with unexplained hearing loss or vertigo?

These questions remain difficult because vestibular and auditory Lyme disease presentations can resemble many other neurologic and ear disorders.

Frequently Asked Questions

Can Lyme disease cause vertigo and dizziness?

Yes. Lyme disease may affect neurologic and vestibular pathways involved in balance and spatial orientation.

Can Lyme disease lead to hearing loss?

Some patients develop sensorineural hearing loss associated with neurologic Lyme disease or inner ear involvement.

Is tinnitus reported in Lyme disease?

Yes. Tinnitus has been described in multiple Lyme disease and tick-borne illness studies.

Can hearing loss become permanent?

In some severe or delayed cases, hearing loss or tinnitus may persist despite treatment.

What is vestibular rehabilitation?

Vestibular rehabilitation is specialized therapy designed to improve balance, gait instability, dizziness, and coordination problems.

Clinical Takeaway

Lyme disease vertigo and hearing loss may reflect vestibular or neurologic involvement that can resemble tumors, inner ear disease, or other neurologic conditions.

Although some patients improve with antibiotics and vestibular therapy, others may experience persistent tinnitus or hearing loss despite treatment.

Clinicians should consider Lyme disease in patients with unexplained dizziness, tinnitus, gait instability, or sudden hearing changes—particularly in endemic regions.

Related Articles

Study Finds Hearing Loss and Tinnitus Common in Lyme Disease
Neurologic Lyme Disease
Autonomic Dysfunction in Lyme Disease
Lyme Disease Symptoms Guide
Vertigo and Lyme Disease

References

1. Jozefowicz-Korczynska M, Zamyslowska-Szmytke E, Piekarska A, Rosiak O. Vertigo and Severe Balance Instability as Symptoms of Lyme Disease-Literature Review and Case Report. Front Neurol. 2019;10:1172.
2. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
3. Sowula K, Skladzien J, Szaleniec J, Gawlik J. Otolaryngological symptoms in patients treated for tick-borne diseases. Otolaryngol Pol. 2018;72(1):30-34.

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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