LM318 - COVID-19 Audiology Update 2024

Abstract:
This program will update the participants on COVID-19’s impact on hearing, balance, auditory processing and cognitive function. Diagnostic tests for all four areas will be reviewed and recommendations will be made for selecting the most effective tests when a COVID-19 survivor is scheduled for testing. There will be detailed information about “brain fog” and auditory processing – a case study will also be presented. Finally, there is a section on cognitive screenings.

Summary:
It has been three years since the COVID-19 pandemic started in the United States. Each of us has dealt with the impact of COVID-19 personally and professionally. In 2019, there were vast unknowns about the virus’s effect on the many aspects of the auditory system: hearing, balance and tinnitus. Although it was tempting to make early declarations regarding the impact of COVID-19 on hearing, balance and tinnitus, the aggregated peer-reviewed literature in 2023 paints a more realistic picture.

What emerged over the past three years for audiologists includes:

1. There has been evidence of the COVID-19 virus in cerumen, thus resulting in the recommendation of increased use of personal protective equipment (PPE); cerumen disposal does not have to be handled any differently, as long as one is flowing Universal Precautions per the CDC.

2.  Middle ear pathology has been reported but the incidence is no different than with the general population.

3.  The probable associated sensorineural hearing loss (SNHL) is usually high frequency ( >4kHz) and often above 8kHz.

4. Sudden SNHL has been reported but the incidence has not been shown to be greater than pre-COVID-19 with the general population.

5. Word Recognitions Scores (WRS) remain a dubious test at best, but do appear to be essentially as expected based on the degree of SNHL.

6. Tinnitus remains a case-by-case situation based on the patient’s medical history/co-morbidities medication use. No changes have been suggested in the current tinnitus assessment or management protocols.

7. Vestibular complaints can be evaluated and managed using recognized balance assessment tests that would be used for a non-COVID patient. There are no changes in management strategies either

8. There is objective, clinical evidence that the virus affects the size of several brain structures along the auditory pathway (including brainstem and cortical regions) from pre-COVID normal MRI findings and post-COVID abnormal MRI findings on the same patients. "Shrinkage" sheds light on the inaccurate use of the term “brain fog” when the behaviors associated with this subjective, non-medical term fall in direct line with the behaviors associated with an auditory processing disorder.

9. Middle Latency Response (MLR) testing can support the MRI findings; Specifically, changes in latency are a better indicator rather than changes in amplitude although morphology could be affected.

10. Cognitive complaints associated with “brain fog” and long haul COVID-19 can be screened via cognitive screening tests by audiologists to determine a normative or non-normative result and make the appropriate referral for additional assessment, diagnosis and management.

11. To assess the auditory processing skills of a ‘brain fog” patient traditional auditory processing protocols are recommended with appropriate aural rehabilitation for appropriate patients.

A recommendation for a new Task Force to propose guidelines for the identification and management of auditory abilities of COVID-19 survivors will be discussed.