Shedding light on SARS-CoV-2, COVID-19, COVID-19 vaccination, and auditory symptoms: causality or spurious conjunction?

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Eldré Beukes
  • Christopher J. Armitage


There are reports of associations between SARS-CoV2, COVID-19, COVID-19 vaccines,
and auditory symptoms (hearing difficulty, tinnitus). However, most studies have relied on
self-report and lack baseline and/or non-COVID control groups. This makes it problematic to
differentiate if symptoms are associated with SARS-CoV2, COVID-19, the vaccine, psychosocial factors or recall bias. In this study, we differentiate these by comparing hearing and tinnitus data collected pre- and during the pandemic.
The survey conducted during the pandemic asked about the onset and change in three types of symptom. Type One - known association (loss of smell, memory/concentration issues, persistent fatigue), Type 2 - indeterminate association (auditory symptoms), and Type 3 - no established association with COVID-19 (toothache). We hypothesized that if auditory symptoms are directly associated with COVID-19, their onset and change would be similar to Type One symptoms, but if indirectly associated (reflecting psychosocial factors and/or recall bias) would be more similar to Type Three symptoms.
Of the 6,881 individuals who responded, 6% reported confirmed COVID-19 (positive test),
11% probably had COVID-19, and 83% reported no COVID-19. Those with confirmed or
probable COVID-19 more commonly reported new and/or worsened auditory symptoms
than those not reporting COVID-19. However, this does not imply causality because: (1)
new auditory symptoms coincided with COVID-19 illness among just 1/3 of those with
confirmed or probable COVID-19, and another 1/3 said their symptoms started before the
pandemic – despite reporting no symptoms in the pre-pandemic survey. (2) >60% of
individuals who had COVID-19 said it had affected their Type 3 symptoms, despite a lack of
evidence linking the two. (3) Those with confirmed COVID-19 reported more Type 1
symptoms, but reporting of Type 2 and Type 3 symptoms did not differ between those with
confirmed COVID-19 and those without COVID-19, and those who probably had COVID-19
most commonly reported these symptom types.
Despite more reports of auditory symptoms in confirmed of suspected COVID-19, there is
inconsistent reporting, recall bias, and possible nocebo effects. Studies that include
appropriate control groups and use audiometric measures in addition to self-report to
investigate change in auditory symptoms relative to pre-COVID-19 are urgently needed.

Bibliographical metadata

Original languageEnglish
JournalFrontiers in Public Health
Publication statusAccepted/In press - 25 Jan 2022

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