Otological and vestibular symptoms in Lyme disease – especially in the late stage of Borrelia burgdorferi infection or in the phase of neurological complications – are now better documented, but remain less known to many physicians. In addition to the classic skin symptoms of Lyme disease, such as erythema migrans and early systemic symptoms, in many cases there are symptoms that are common in ENT practice but are non-specific: tinnitus, hearing loss, sudden sensorineural hearing loss, dizziness/vertigo, balance disorders and symptoms of inner ear inflammation. These audiological and vestibular symptoms may indicate involvement of both the peripheral (inner ear, vestibular system) and central nervous system in the course of Lyme disease.
The occurrence of dizziness and vertigo in connection with Lyme disease was discussed in detail in a 2021 study. In this study, 38 patients diagnosed with Lyme disease underwent otoneurological testing, in which more than half of the patients tested positive on the Romberg test or showed vestibular dysfunction. Vestibular problems were also associated with high-frequency hearing loss. The authors note that Lyme disease often affects the inner ear or the VIII cranial nerve (vestibulocochlear nerve), which can lead to the co-occurrence of dizziness and hearing problems. With antibiotic treatment, especially if started early, otoneurological symptoms may be reduced or even resolved, significantly improving the patient’s quality of life.
Another retrospective study involving more than 200 patients showed that otolaryngological symptoms are common in Lyme disease: the most common symptom was tinnitus (76.5%), followed by dizziness and balance disorders (53.7%) and unilateral sensorineural hearing loss (16.7%). These epidemiological data emphasise that although these symptoms are not specific, they occur more frequently in Lyme disease than in the control population.
Hearing loss is a particularly interesting symptom, as many clinical cases and studies confirm that sensorineural hearing loss can occur in Lyme disease. In one known case, a 23-year-old woman’s illness began with very severe hearing loss and tinnitus, followed by sudden bilateral sensorineural hearing loss, which was confirmed by serological tests showing the presence of IgM antibodies against Borrelia burgdorferi. In this case, unfortunately, hearing did not return despite appropriate antibiotic treatment, suggesting that early diagnosis and therapy are crucial in preventing permanent damage.
Clinical studies have also shown that Lyme disease affecting the nervous system alone can lead to hearing and vestibular disorders. In a prospective study, audiological and vestibular tests were performed on patients with Lyme disease who had already developed neurological complications. Almost half of these patients showed audiometrically detectable sensorineural hearing loss both at admission and after treatment. This indicates that the Borrelia bacterium itself or the inflammatory process may directly damage the outer hair cells of the cochlea and other structures of the inner ear.
The prevalence of tinnitus is confirmed not only by epidemiological studies, but also by self-assessment studies, according to which tinnitus is a serious disruptive factor in a significant proportion of people suffering from Lyme disease. It affects sleep and concentration and is often accompanied by hyperacusis (hypersensitivity to sound) and difficulty understanding speech, especially in noisy environments. These audiological complaints are important not only from a physical point of view, but also in terms of quality of life.
In terms of mechanism, in the case of neurological complications of Lyme disease, inflammation and vascular changes caused by Borrelia burgdorferi may contribute to damage to peripheral nerves, including the vestibulocochlear nerve. The mechanism of inflammation and possible demyelination may damage the nerves in a similar way to other neurological symptoms of Lyme disease, which can cause hearing and balance disorders.
Some case studies also point out that sensorineural hearing loss or sudden hearing loss may be the main or only symptom of Lyme disease infection, even without skin rash, joint pain or other classic symptoms. This is particularly important from a diagnostic point of view, as such forms of Lyme disease can easily be confused with other inner ear diseases, such as idiopathic sudden hearing loss or vestibular neuritis, if a comprehensive medical history and serological tests are not performed. Therefore, it is important for the examining physician to suspect Lyme disease even if it is the only symptom.
In summary, the symptoms of Lyme disease affecting hearing and balance cover a wide spectrum, including tinnitus, hearing loss (including sudden hearing loss), dizziness/vertigo, balance disorders, auditory hypersensitivity and difficulties in auditory processing. These symptoms can not only be common, but also, especially in the case of neurological Lyme disease, associated with significant morbidity that affects patients’ daily lives and quality of life. Clinical diagnosis, targeted diagnostics and early antibiotic treatment are crucial in preventing permanent damage and alleviating symptoms. Where possible, direct diagnostic tests should be performed to obtain more accurate results.
https://pubmed.ncbi.nlm.nih.gov/34202339/
https://pubmed.ncbi.nlm.nih.gov/38052526/
https://pubmed.ncbi.nlm.nih.gov/12567088/
https://pubmed.ncbi.nlm.nih.gov/29513260/
(C) Lyme Disease Foundation
