Sudden sensorineural hearing loss and viral association: serological evidence of herpesviruses and SARS-CoV-2.

OBJECTIVE

To investigate the association between Herpesviruses (HSV-1, HSV-2, VZV, EBV, CMV) and SARS-CoV-2 in the acute phase of Sudden Sensorineural Hearing Loss (SSNHL), correlating serological and PCR findings with clinical and audiometric outcomes.

METHODS

Prospective cohort study including 53 patients evaluated between March 2020 and February 2024. Audiological assessment, serological testing (IgM and IgG), PCR for herpesviruses and SARS-CoV-2, and magnetic resonance imaging were performed.

RESULTS

Most patients (90.6%) presented with unilateral hearing loss. Serological evidence of viral exposure was observed in 43.4% of cases, including SARS-CoV-2 (26.4%), HSV (22.6%), and CMV (5.6%). Coinfection with two viruses occurred in 11.3% of patients and was associated with poorer hearing outcomes (p = 0.0032). Bilateral hearing loss (9.4%) was also associated with no improvement (p = 0.0368). In multivariate analysis, COVID-19 infection remained independently associated with poorer outcomes.

CONCLUSION

SSNHL was associated with a high frequency of viral serological markers. Viral coinfection may be associated with poorer prognosis, although causality cannot be established. Initial hearing loss severity and bilateral involvement remained important prognostic factors. Serological findings may serve as complementary tools for clinical characterization and prognostic assessment, although their etiological role remains uncertain.