Can Lyme Disease Cause Sudden Hearing Loss?

Sudden hearing loss is an uncommon but recognized complication of Lyme disease
Tinnitus, ear fullness, dizziness, and vertigo may accompany hearing loss
Prompt evaluation and treatment may improve the chance of recovery

Sudden sensorineural hearing loss (SSNHL) is considered an otologic emergency because hearing can decline rapidly over hours to days. Although most cases have no identifiable cause, infections—including Lyme disease—have been proposed as one possible explanation in a small percentage of patients.

Patients who experience sudden hearing loss should seek same-day medical evaluation, as prompt diagnosis and treatment offer the best opportunity for hearing recovery regardless of the underlying cause.

Hearing loss has been reported in patients with early disseminated Lyme disease as well as Lyme neuroborreliosis. While sudden sensorineural hearing loss remains an uncommon manifestation, clinicians should consider Lyme disease in patients with compatible symptoms, recent tick exposure, or residence in an endemic area.

Several studies have examined whether Borrelia burgdorferi, the bacterium responsible for Lyme disease, contributes to sudden hearing loss. Although the available evidence does not suggest Lyme disease is a common cause of SSNHL, it supports including Lyme disease in the differential diagnosis of selected patients.

A 2021 study by Sowula and colleagues, together with an earlier systematic review and more recent prospective research, provides additional insight into the relationship between Lyme disease and sudden hearing loss.

What is sudden sensorineural hearing loss?

Sudden sensorineural hearing loss (SSNHL) is defined as a hearing loss of at least 30 dB affecting three consecutive audiometric frequencies that develops within 72 hours. It usually affects one ear, although bilateral cases have been reported.

Patients commonly experience:

• sudden hearing loss, usually in one ear,
• ringing in the ear (tinnitus),
• a feeling of ear fullness or pressure,
• dizziness or imbalance, and
• vertigo.

Because hearing recovery is often greatest when treatment begins promptly, SSNHL should always be evaluated urgently.

Most cases of sudden hearing loss remain unexplained

Approximately 90% of patients with sudden sensorineural hearing loss have no clearly identifiable cause. Proposed mechanisms include viral infections, vascular insufficiency, autoimmune disorders, metabolic disease, tumors, stroke, and other neurologic conditions.

Researchers have also proposed Lyme disease as a possible cause because Borrelia burgdorferi may trigger inflammatory and vascular injury involving the cochlea or auditory nerve.

In a systematic review published in 2013, Peeters and colleagues concluded that confirmed Lyme disease was identified in 0% to 21.3% of patients with sudden sensorineural hearing loss, depending on geographic location and diagnostic methods. They concluded that Lyme disease should be considered in selected patients rather than assumed to be the cause of every case of sudden hearing loss.

Study evaluated 86 patients with sudden hearing loss

Sowula and colleagues evaluated 86 consecutive patients hospitalized between 2017 and 2018 because of sudden sensorineural hearing loss. Every patient underwent a detailed otolaryngologic evaluation together with Lyme disease testing using ELISA followed by confirmatory Western blot testing.

Among the 86 patients, 71 (82.5%) had no identifiable explanation for their hearing loss, highlighting why SSNHL remains one of the more challenging disorders encountered in clinical otology.

Nine patients (10.5%) were diagnosed with Lyme disease based on positive serologic testing confirmed according to the study protocol.

2025 review examined Lyme infection in hearing loss

A 2025 systematic review by Bhattarai and colleagues examined nine studies involving 964 patients with sensorineural hearing loss. Overall, 71 patients (7.3%) had laboratory evidence interpreted by the investigators as past or active B. burgdorferi infection. Tinnitus was reported in 53% and vertigo in 47% of the Lyme-positive patients for whom symptom data were available.

The proportion testing positive varied from 0% to 31.6% across the studies. Most of the research was conducted in Europe, and the studies differed in geography, testing methods, and patient selection.

The 7.3% finding does not mean Lyme disease caused 7.3% of all sensorineural hearing loss. A positive antibody test may reflect past exposure, and the studies could not consistently establish that active infection was responsible for the hearing loss. The review nevertheless supports considering Lyme disease when hearing loss is unexplained and the clinical and exposure history is compatible.

How Lyme disease may affect hearing

The exact mechanism remains uncertain, but several biologically plausible explanations have been proposed.

Borrelia burgdorferi may contribute to inflammatory and angiopathic injury involving the cochlea, the tiny blood vessels supplying the inner ear, or the auditory nerve. Immune-mediated inflammation and vascular compromise may interfere with normal cochlear function, resulting in sudden hearing loss, tinnitus, or balance symptoms.

Supporting this theory, a 2024 prospective study of patients with Lyme neuroborreliosis demonstrated objective evidence of cochlear dysfunction using distortion-product otoacoustic emission testing. Many patients experienced improvement during treatment, while others had persistent high-frequency sensorineural hearing loss, suggesting that Lyme neuroborreliosis can affect cochlear function in some individuals.

Although these findings strengthen the biologic plausibility of Lyme-associated hearing loss, additional prospective studies are needed to better define how often Lyme disease causes SSNHL and which patients are most likely to benefit from treatment.

How were the Lyme disease patients treated?

Patients initially received standard therapy for sudden sensorineural hearing loss, including corticosteroids and medications intended to improve inner-ear circulation.

The nine patients with confirmed Lyme disease did not improve with corticosteroids alone and were referred for treatment directed at Lyme disease.

Seven patients returned for follow-up after antibiotic therapy.

• Four patients received oral doxycycline.
• Three patients received intravenous ceftriaxone.

Hearing improved after antibiotic treatment

The four patients treated with doxycycline experienced an average improvement of approximately 10 dB in hearing thresholds, although none had complete recovery.

The remaining three patients were treated with intravenous ceftriaxone. According to the investigators, all three experienced complete hearing recovery following treatment.

Despite recovery of hearing, two of these patients continued to experience persistent high-frequency tinnitus. Their tinnitus had been present from the onset of hearing loss.

Because only three patients received ceftriaxone, these findings should be interpreted cautiously. The study was observational and was not designed to compare antibiotic regimens. Larger prospective studies are needed before conclusions can be drawn regarding the optimal treatment for Lyme-associated sudden hearing loss.

Early diagnosis may influence recovery

The investigators concluded that Borrelia burgdorferi infection may contribute to inflammatory and angiopathic injury involving the cochlea or auditory nerve. They also cautioned that prolonged infection may increase the likelihood of permanent injury to these structures.

For patients living in Lyme-endemic regions—or for those with recent tick exposure, erythema migrans, facial nerve palsy, meningitis, radicular pain, tinnitus, vertigo, or other neurologic symptoms—Lyme disease should be considered during the evaluation of unexplained sudden sensorineural hearing loss.

However, Lyme disease serology should always be interpreted within the clinical context. Positive Lyme serology alone does not establish that Lyme disease caused a patient’s hearing loss, particularly in endemic regions where background seropositivity is relatively common.

Clinical Perspective

Most patients with sudden sensorineural hearing loss do not have Lyme disease. Viral infections, vascular disorders, autoimmune disease, neurologic conditions, and idiopathic cases remain more common explanations.

Nevertheless, Lyme disease deserves consideration in patients with compatible clinical features, particularly those living in endemic regions or those with a history of tick exposure, erythema migrans, facial nerve palsy, radicular pain, meningitis, tinnitus, vertigo, or other neurologic symptoms. Clinical suspicion should be supported by epidemiologic risk and compatible neurologic findings.

The evidence linking Lyme disease and sudden hearing loss continues to evolve. The 2013 systematic review by Peeters and colleagues found confirmed Lyme disease in 0% to 21.3% of patients with sudden hearing loss, depending on geography and diagnostic methods. The 2021 Sowula study reported Lyme disease in 10.5% of hospitalized patients with sudden sensorineural hearing loss. The 2025 systematic review found evidence of past or active B. burgdorferi infection in 7.3% of 964 patients with sensorineural hearing loss.

A 2024 prospective study found objective evidence of cochlear dysfunction in patients with Lyme neuroborreliosis using otoacoustic emission testing.

These studies support considering Lyme disease in selected patients with sudden hearing loss, but they do not prove that Lyme disease is responsible for every case of sensorineural hearing loss. Testing should be guided by the patient’s history, examination, epidemiologic risk, and the presence of other Lyme disease features.

Because delayed treatment of sudden sensorineural hearing loss may reduce the likelihood of recovery, patients should seek urgent medical evaluation rather than waiting to see whether hearing returns on its own.

Frequently Asked Questions

Can Lyme disease cause sudden hearing loss?

Yes. Lyme disease has been associated with sudden sensorineural hearing loss in case reports, observational studies, and prospective research involving Lyme neuroborreliosis. However, it remains an uncommon cause, and most cases of sudden hearing loss are due to other conditions or remain unexplained.

Can Lyme disease cause tinnitus?

Yes. Tinnitus, or ringing in the ears, has been reported in patients with Lyme disease and may accompany sudden sensorineural hearing loss. In some cases, tinnitus can persist even after hearing improves.

Can Lyme disease cause hearing loss in one ear?

Yes. Sudden sensorineural hearing loss usually affects one ear, although bilateral cases have been reported. Lyme disease should be considered when one-sided hearing loss occurs with compatible risk factors, such as tick exposure, facial palsy, meningitis, radicular pain, or other neurologic symptoms.

Is Lyme disease hearing loss permanent?

Recovery varies. Some patients experience partial or complete improvement after treatment, while others have persistent hearing loss or tinnitus. Earlier evaluation may improve the chance of identifying treatable causes.

Should everyone with sudden hearing loss be tested for Lyme disease?

Not necessarily. Lyme disease testing is most appropriate when the patient has compatible symptoms, tick exposure, residence or travel in an endemic region, or neurologic findings suggestive of Lyme disease.

Clinical Takeaway

Sudden sensorineural hearing loss is an otologic emergency that requires prompt medical evaluation. Although Lyme disease is an uncommon cause, several studies suggest it should be considered in selected patients, especially those with tick exposure, neurologic symptoms, or residence in a Lyme-endemic region.

Prompt evaluation of sudden hearing loss offers the best opportunity to identify treatable causes and reduce the risk of persistent hearing loss or tinnitus.

Related Articles

These related articles provide additional context on ear symptoms, balance disorders, facial nerve involvement, and persistent illness.

Lyme Disease Patient with Permanent Tinnitus and Hearing Loss
Can Lyme Disease Cause Vertigo?
Bell’s Palsy and Lyme Disease
Persistent Lyme Disease Overview

References

1. Sowula K, Szaleniec J, Stolcman K, et al. Association between sudden sensorineural hearing loss and Lyme disease. J Clin Med. 2021;10(5):1130.
2. Peeters N, van der Kolk BYM, Thijsen SFT, Colnot DR. Lyme disease associated with sudden sensorineural hearing loss: Case report and literature review. Otol Neurotol. 2013;34(5):832–837.
3. Jensen ES, Cayé-Thomasen P, Bodilsen J, et al. Sensorineural hearing loss in Lyme neuroborreliosis. Ann Med. 2024;56(1):2411014.
4. Bhattarai A, Shah S, Bhattarai M, et al. Borrelia burgdorferi infection is worth screening to investigate sensorineural hearing loss etiology: A systematic review. Health Sci Rep. 2025;8(7):e70974.
5. Rochd S, Benhoummad O, Salhi S, et al. Isolated sudden bilateral neurosensory hearing loss as a presentation of Lyme neuroborreliosis: A case study. J Audiol Otol. 2024;28(1):72–75.
6. Peltomaa M, Pyykkö I, Seppälä I, Viitanen L, Viljanen M. Lyme borreliosis, an etiological factor in sensorineural hearing loss? Eur Arch Otorhinolaryngol. 2000;257(6):317–322.

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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