Skip to main content
Download PDF

Hearing loss and the COVID-19 pandemic

BMC Research Notes volume 15, Article number: 228 (2022) Cite this article

Abstract

Objective

Hearing loss is an important public health problem. Its causes vary, including infections, noise, and aging. The first wave of the COVID-19 pandemic occurred in April 2020 in Japan. During the pandemic, people were urged to stay at home and drastically changed their lifestyles. This study aimed to examine hearing loss before and during the pandemic. The prevalence during the pandemic after April 2020 was compared for the period in 2019. Study subjects were those who received health checkups in both periods. Hearing loss was defined as a hearing threshold of > 30 dB at 1 kHz and > 40 dB at 4 kHz in either ear using pure-tone audiometry.

Results

A total of 2367 persons presented in both 2019 and 2020. The overall rates of hearing loss were 9.5% and 13.2% before and after the pandemic, respectively. After controlling for age, sex, current smoking, regular exercise and alcohol consumption, the rate of hearing loss showed a significant increase in 2020 (p =  < 0.0001). With age stratification, an increase was observed in the participants aged < 40 years (1.3% vs. 3.1%, p < 0.001) and 40–59 years (7.2% vs. 12.6%, p < 0.001). Further studies are needed to confirm the impact of the COVID-19 pandemic on hearing loss.

Introduction

Hearing loss is a major public health issue. It is caused by infections, exposure to loud sounds, chronic diseases, and aging. Recently, the overuse of earphones has been associated with the development of hearing loss [1]. A worldwide study revealed that the prevalence of hearing loss varied among the 212 participating countries, ranging from < 11% to > 28% [2]. The COVID-19 pandemic, which began in 2020, dramatically changed people’s lifestyles.

There are reports of substantial lifestyle changes during the COVID-19 pandemic. The Government of Japan has been promoting remote work, and many workers changed to remote work during the emergency declaration [3]. A study from the U.S. reported that 72% of the general population changed to remote work, and remote workers had increases in on-working day sedentary behavior and stress, with a greater decline in physical functioning [4]. Lifestyle changes during the pandemic affected workers’ stress due to strict regulations to avoid infection [5]. A Japanese survey among workers revealed longer sedentary behaviors, such as sitting, for those who worked from home compared to those who worked at workplaces [3]. The frequency and duration of earphone and headphone use have been increasing as remote work increases. The association between hearing loss and personal listening devices has also been reported [6]. A large-scale cohort study showed that users listening to high sound levels increased their hearing thresholds [7].

There have been emerging publications on sudden sensorineural hearing loss after COVID-19 infection [8,9,10,11,12]. All these investigations were based on COVID-19 patients, and systematic reviews and meta-analyses were conducted to report the association between sudden sensorineural hearing loss and COVID-19 infection [13,14,15,16,17]. A meta-analysis showed that the rate of hearing loss was 3.1%, which was statistically significant in patients with COVID-19 [16]. A study involving young and middle-aged health care workers showed that mild and moderate COVID-19 disease did not permanently affect hearing function [18]. Further studies with follow-up assessments are needed. Regarding the use of face masks during the pandemic, sound attenuation and the inability to read lips were reported as the main concerns [19, 20].

The current study aimed to examine hearing loss before and during the COVID-19 pandemic by comparing the prevalence among participants in regional health checkup centers in Japan. Furthermore, this study aimed to clarify any subgroups whose hearing ability may have been affected, e.g., different age groups show different situations of hearing loss before and during the pandemic. Lifestyle-related information was also examined to determine its association with hearing loss.

Main text

Study population and study subjects

Persons who received health checkups conducted in a regional health care center in Mito, Japan, were invited to participate in the study. All persons with hearing ability measurements were included in the study. Health information for the pandemic period came from the period of April 2020–March 2021 (we denote as “2020”) and for the prepandemic period of April 2019–March 2020 (we denote as “2019”). Study subjects were those who received health checkups in both periods.

Information collected and used in the current study

The information used for the analysis included the date of health examination, age, sex, body mass index (BMI), and medical history, which included medication use for hypertension, diabetes, and dyslipidemia, and history of stroke and heart disease. Self-reported information on current smoking, alcohol consumption, and regular exercise were also collected and analyzed. Regular exercise was defined as > 30 min/day and > 2 times/week based on a standardized questionnaire for lifestyle-related diseases by the Ministry of Health, Labour and Welfare, Japan.

Measurement of hearing ability

Pure-tone audiometry was conducted by trained medical staff using an AA-57 or AA-58 audiometer (Rion Co, Ltd., Tokyo, Japan). Hearing loss was defined as a hearing threshold of > 30 dB at 1 kHz and > 40 dB at 4 kHz in either ear, according to the National Health Examination Guidelines (Industrial Safety and Health Act, Ordinance on Industrial Safety and Health, Articles 43, 44, 45).

Statistical analysis

For the characteristics of the study participants, McNemar’s test and paired t test for continuous variables were used for categorical variables and continuous variables, respectively, to examine the differences between the two periods. The analysis was further conducted with the stratification of age groups (< 40, 40–59, 60 + years), and the differences in the prevalence between the two periods were examined. Lifestyle changes were examined for current smoking, alcohol consumption, and regular exercise and compared between the two periods using McNemar’s test. To compare the rate of hearing loss between the periods, a generalized estimating equation (GEE) with repeated measures by examination year was used, and showed parameter estimates with 95% confidence intervals (95% CIs). The final model included variables of examination period (2020 vs. 2019), age (continuous), sex, current smoking, alcohol consumption, and regular exercise. Statistical analyses were performed using IBM SPSS Statistics version 27. Statistical significance was defined as a two-sided p value < 0.05.

Results

Table 1 shows the characteristics of the study subjects in 2019 and 2020. The number of study subjects was 2367. The mean age in 2019 was 46.4 years (SD 13.8, range 18–86 years). Males accounted for 58.8% of the sample. Current medication use for hypertension and dyslipidemia and a medical history of stroke were significantly different between the two periods (Table 1). The prevalence of hearing loss in 2020 was significantly higher than that in 2019 (9.5% (225/2367) and 13.2% (313/2367), respectively; p < 0.0001).

Table 1 Characteristics of study subjects
Full size table

By age stratification analysis, the rates of hearing loss in 2020 for participants aged under 40 years (1.3% (10/799) vs. 3.1% (25/799), respectively, p < 0.001) and participants aged 40 to 59 years (7.2% (78/1087) vs. 12.6% (137/1087), respectively, p < 0.001) were significantly higher than those in 2019 (Fig. 1).

Fig. 1
figure 1

Prevalence of hearing loss in 2019 and 2020, n = 2367. P value was calculated using McNemar's test. Asterisks (*) denote a significant difference (***p < 0.001) in the prevalence of hearing loss in 2020 compared to 2019 by age group.

Full size image

Current smoking decreased in 2020 (23.4% (523/2234) in 2019 vs. 22.4% (501/2234) in 2020, p = 0.032) and there were no significant differences in regular exercise and alcohol consumption between the two periods (Additional file 1: Table S1). With the stratification of age groups, current smoking only showed a significant difference between the years for the group of participants aged 60 years and older (16.5% (74/449) vs. 14.5% (65/449), p = 0.035).

In a GEE univariable analysis, the period of the COVID-19 pandemic in 2020 showed a significantly higher rate of hearing loss (beta estimate [95% CI] = 0.372 [0.260–0.484], p < 0.0001; Additional file 1: Table S2). Males had a higher rate of hearing loss (beta estimate [95%CI] = 0.668 [0.389–0.947], p < 0.0001). Participants with regular exercise and alcohol consumption showed a significant increase in hearing loss in 2020 (beta estimate [95% CI] = 0.310 [0.102–0.517], p = 0.003 and 0.540 [0.311–0.768], p < 0.0001, respectively).

The final GEE multivariable model with the variables of age, sex, regular exercise, current smoking, and alcohol consumption, a significantly higher rate of hearing loss was observed during the pandemic period (beta estimate [95% CI] = 0.339 [0.208–0.471], adjusted odds ratio (aOR) = 1.404, p < 0.0001). Male sex was associated with a higher rate of hearing loss (beta estimate [95% CI] = 0.668 [0.389–0.947], p < 0.0001, aOR = 1.950) (Table 2). The effect modification of the variables included in the model was examined, and the interactions were assessed. There were no significant interactions.

Table 2 Generalized Estimating Equations (GEE) with repeated measures of hearing loss, n = 2345 (multivariable analysis)
Full size table

Discussion

This study showed that the prevalence of hearing loss among people < 60 years of age significantly increased during the COVID-19 pandemic compared to the prepandemic period. Surprisingly, people under 40 years of age were also significantly affected. This is the first study to report an association between hearing loss and the COVID-19 pandemic in the general population.

This study used a definition of hearing loss with a hearing threshold of > 30 dB at 1 kHz and > 40 dB at 4 kHz in either ear. This was adopted according to national health examination guidelines in Japan. The World Health Organization recently published a report on hearing loss, which was defined as “a person is said to have hearing loss if their hearing capacity is reduced, and they are not able to hear as well as someone with normal hearing. “Normal” hearing typically refers to hearing thresholds of 20 dB or better in both ears” [1]. According to the grading system stated in this report, the thresholds used in the current study were those for moderate hearing loss. A systematic review showed that mild COVID-19 disease causes audio-vestibular damage [16]. There would be an increase in the number of cases if milder cases were included. The standard health examination procedure in this study followed the national guideline definition, and health checkup records frequently lack a threshold level, that is, hearing loss is reported as yes or no. Therefore, sensitivity analysis could not be conducted. This limits the comparability with other international studies. Although age-related hearing loss progresses slowly, it would be possible that some study subjects were in the early stages of “hearing loss”, and they may have progressed after a year.

Systematic reviews have described possible neuroinvasive actions for hearing loss with SARS-CoV-2 infection [14, 16, 17]. The current study lacked information on infection. We cannot deny the influence of the direct action of the virus, and it is uncertain whether asymptomatic infections also cause hearing loss. According to the periodical updates on COVID-19 by the National Institute of Infectious Diseases, the number of new infections had continued to increase, with infections just below 90 per 100,000 persons in the Tokyo metropolitan area at the beginning of 2021 [21].

Rather, this might be affected by other factors such as lifestyle changes, for example, the long-term use of earphones for online communication during the pandemic in 2020. Many people changed to remote work and stayed home for longer periods [3, 4]. Personal communication and entertainment devices with earphone or headphone use have increased recently [1], and it would have been further facilitated by the COVID-19 pandemic. Although the study did not include information on earphone use, the study subjects in the current study might have been exposed to earphone use for a longer duration. Further information is required to monitor inappropriate earphone use.

Tobacco smoking has been reported to influence hearing ability [13, 22]. This study did not show this effect on hearing loss. Fortunately, remote work shifts and stay-at-home policies seem to influence smoking behavior. This study showed that the prevalence of current smoking decreased during the pandemic. A study conducted in Italy on lifestyle changes during the COVID-19 pandemic also showed a decreasing trend in smoking [24].

Physical exercise and alcohol consumption have been shown to be associated with hearing loss [25,26,27]. However, this study found that there was no significant association when adjusting for age, sex, and smoking. In this study, the prevalence of regular exercise and alcohol consumption did not change after the pandemic. The study used the definition of regular exercise as “ > 30 min/day and > 2 times/week.” This may not have been sensitive enough to capture the association with hearing loss. In addition, self-reported information with simple yes or no options may limit the conclusion due to these factors, e.g., no dose–response relationship was assessed.

Limitations

This study could not assess causality between hearing loss and the COVID-19 pandemic due to its cross-sectional design. In addition, the health checkup data used in this study did not include information on SARS-CoV-2 infection status, ontological history or inappropriate earphone use. Further studies are required to confirm the direct and indirect impacts of the COVID-19 pandemic on hearing loss.

Availability of data and materials

The data used and/or analyzed during the study are available from corresponding author on reasonable request.

References

  1. World Health Organization. World report on hearing. Geneva: World Health Organization; 2021.

    Google Scholar 

  2. Masalski M, Morawski K. Worldwide prevalence of hearing loss among smartphone users: cross-sectional study using a mobile-based app. J Med Internet Res. 2020;22: e17238.

    Article  Google Scholar 

  3. Fukushima N, Machida M, Kikuchi H, Amagasa S, Hayashi T, Odagiri Y, Takamiya T, Inoue S. Associations of working from home with occupational physical activity and sedentary behavior under the COVID-19 pandemic. J Occup Health. 2021;63: e12212.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Barone Gibbs B, Kline CE, Huber KA, Paley JL, Perera S. Covid-19 shelter-at-home and work, lifestyle and well-being in desk workers. Occup Med (Lond). 2021;71:86–94.

    Article  CAS  Google Scholar 

  5. Spinato G, Gaudioso P, Boscolo Rizzo P, Fabbris C, Menegaldo A, Mularoni F, Singh B, Maniaci A, Cocuzza S, Frezza D. Risk management during COVID-19: safety procedures for otolaryngologists. Acta Biomed. 2021;92: e2021105.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Rhee J, Lee D, Lim HJ, Park MK, Suh MW, Lee JH, Hong YC, Oh SH. Hearing loss in Korean adolescents: the prevalence thereof and its association with leisure noise exposure. PLoS ONE. 2019;14: e0209254.

    Article  CAS  Google Scholar 

  7. Engdahl B, Aarhus L. Personal music players and hearing loss: the HUNT cohort study. Trends Hear. 2021;25:23312165211015880.

    PubMed  PubMed Central  Google Scholar 

  8. Koumpa FS, Forde CT, Manjaly JG. Sudden irreversible hearing loss post COVID-19. BMJ Case Rep. 2020;13: e238419.

    Article  Google Scholar 

  9. Kilic O, Kalcioglu MT, Cag Y, Tuysuz O, Pektas E, Caskurlu H, Cetın F. Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss. Int J Infect Dis. 2020;97:208–11.

    Article  CAS  Google Scholar 

  10. Freni F, Meduri A, Gazia F, Nicastro V, Galletti C, Aragona P, Galletti C, Galletti B, Galletti F. Symptomatology in head and neck district in coronavirus disease (COVID-19): A possible neuroinvasive action of SARS-CoV-2. Am J Otolaryngol. 2020;41: 102612.

    Article  CAS  Google Scholar 

  11. Mustafa MWM. Audiological profile of asymptomatic Covid-19 PCR-positive cases. Am J Otolaryngol. 2020;41: 102483.

    Article  CAS  Google Scholar 

  12. Özçelik Korkmaz M, Eğilmez OK, Özçelik MA, Güven M. Otolaryngological manifestations of hospitalised patients with confirmed COVID-19 infection. Eur Arch Otorhinolaryngol. 2021;278:1675–85.

    Article  Google Scholar 

  13. Hajikhani B, Calcagno T, Nasiri MJ, Jamshidi P, Dadashi M, Goudarzi M, Eshraghi AA, FACS, Mirsaeidi M. Olfactory and gustatory dysfunction in COVID-19 patients: a meta-analysis study. Physiol Rep. 2020;8:e14578.

    Article  CAS  Google Scholar 

  14. Maharaj S, Bello Alvarez M, Mungul S, Hari K. Otologic dysfunction in patients with COVID-19: a systematic review. Laryngoscope Investig Otolaryngol. 2020;5:1192–6.

    Article  Google Scholar 

  15. Almufarrij I, Uus K, Munro KJ. Does coronavirus affect the audio-vestibular system? A rapid systematic review. Int J Audiol. 2020;59:487–91.

    Article  Google Scholar 

  16. Jafari Z, Kolb BE, Mohajerani MH. Hearing loss, tinnitus, and dizziness in COVID-19: a systematic review and meta-analysis. Can J Neurol Sci. 2022;49:184–95.

    Article  Google Scholar 

  17. Almufarrij I, Munro KJ. One year on: an updated systematic review of SARS-CoV-2, COVID-19 and audio-vestibular symptoms. Int J Audiol. 2021;60:935-45.

    Article  Google Scholar 

  18. Kökoğlu K, Tektaş N, Baktir-Okcesiz FE, Şahin Mİ. Mild and moderate COVID-19 disease does not affect hearing function permanently: a cross-sectional study involving young and middle-aged healthcare givers. Eur Arch Otorhinolaryngol. 2021;278:3299–305.

    Article  Google Scholar 

  19. Trecca EMC, Gelardi M, Cassano M. COVID-19 and hearing difficulties. Am J Otolaryngol. 2020;41: 102496.

    Article  CAS  Google Scholar 

  20. Ten Hulzen RD, Fabry DA. Impact of hearing loss and Universal face masking in the COVID-19 Era. Mayo Clin Proc. 2020;95:2069–72.

    Article  Google Scholar 

  21. National Institute of Infectious Diseases. Japan. COVID-19 updates. Current situation of infection. https://www.niid.go.jp/niid/en/2019-ncov-e/10138-covid19-ab21th-en.html. Accessed 10 Mar 2022.

  22. Hu H, Sasaki N, Ogasawara T, Nagahama S, Akter S, Kuwahara K, Kochi T, Eguchi M, Kashino I, Murakami T, et al. Smoking, Smoking cessation, and the risk of hearing loss: Japan epidemiology collaboration on occupational health study. Nicotine Tob Res. 2019;21:481–8.

    Article  Google Scholar 

  23. Lin BM, Wang M, Stankovic KM, Eavey R, McKenna MJ, Curhan GC, Curhan SG. Cigarette smoking, smoking cessation, and risk of hearing loss in women. Am J Med. 2020;133:1180–6.

    Article  Google Scholar 

  24. Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attinà A, Cinelli G, Leggeri C, Caparello G, Barrea L, Scerbo F, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18:229.

    Article  Google Scholar 

  25. Kuo PL, Di J, Ferrucci L, Lin FR. Analysis of hearing loss and physical activity among US adults aged 60–69 years. JAMA Netw Open. 2021;4: e215484.

    Article  Google Scholar 

  26. Fransen E, Topsakal V, Hendrickx JJ, Van Laer L, Huyghe JR, Van Eyken E, Lemkens N, Hannula S, Mäki-Torkko E, Jensen M, et al. Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: a European population-based multicenter study. J Assoc Res Otolaryngol. 2008;9:264–76.

    Article  Google Scholar 

  27. Lin YY, Chen HC, Lai WS, Wu LW, Wang CH, Lee JC, Kao TW, Chen WL. Gender differences in the association between moderate alcohol consumption and hearing threshold shifts. Sci Rep. 2017;7:2201.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the participants who participated in the study, the Japan Agricultural Cooperative Ibaraki Kouseiren for their cooperation, and the doctors, nurses, and staff of Mito-Kyodo Hospital.

Funding

This work was supported by the Japan Science and Technology Agency (JST), grant number JPMJCE1301.

Author information

Authors and Affiliations

  1. Department of Clinical Trials and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Yukiko Wagatsuma

  2. Department of Clinical Trials and Clinical Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Kaori Daimaru, Shiqi Deng & Jou-Yin Chen

Authors
  1. Yukiko Wagatsuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaori Daimaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiqi Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jou-Yin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YW and KD: Idea and conceptualization. YW: Planning and first draft. KD, SD, and JC: revisions. YW, KD, and SD: Literature research. YW, KD, and JC: Data analysis. All authors contributed to the manuscript and approved the submitted version. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yukiko Wagatsuma.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Ethics Review Committee of the Faculty of Medicine, University of Tsukuba. Informed written consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1: Table S1.

Lifestyle changes between 2019 and 2020. Table S2. Generalized estimating equations (GEE) with repeated measures of hearing loss, n=2345 (univariable analysis).

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wagatsuma, Y., Daimaru, K., Deng, S. et al. Hearing loss and the COVID-19 pandemic. BMC Res Notes 15, 228 (2022). https://doi.org/10.1186/s13104-022-06120-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13104-022-06120-1

Keywords

BMC Research Notes

ISSN: 1756-0500

Contact us