Epidemiology and Mechanisms of Auditory Outcomes in Veterans Following COVID-19

Project Background/Rationale: Emerging evidence points towards a potential role of COVID-19 in the development of hearing loss, tinnitus, and vertigo/dizziness, but disagreements remain. Given the longstanding issue of auditory dysfunction among Veterans and the magnitude of the potential impact of COVID-19 on hearing health and quality of life, understanding the risk and the mechanisms underpinning ear and hearing problems resulting from COVID-19 is crucial. The proposed project aims to further investigate the link between COVID-19 and auditory system damage in Veterans. This information is needed to protect, restore and improve auditory function and enhance Veteran quality of life. Project Aims: There is a need to understand the short- and long-term consequences of COVID-19 on auditory function, especially among Veterans who are already at high risk for hearing loss and tinnitus. The specific aims of this research proposal are: (1) In Veterans who have experienced sudden hearing loss following COVID-19, examine and characterize: (a) health history and co-occurring COVID-19 complications and (b) audiometric profiles and treatment outcomes. (2) Quantify the association between: (a) COVID-19 serum antibody concentrations and new onset sudden hearing loss and (b) inflammatory and coagulation biomarkers among Veterans with and without serologic evidence of past COVID-19 and new onset sudden hearing loss. (3) Estimate the average change in hearing, tinnitus, and self-reported dizziness among Veterans recently hospitalized for COVID-19 compared to Veterans hospitalized for other conditions. Project Methods: The approach combines different quantitative study designs. In Aim 1, we will use electronic health records to characterize the clinical phenotype of COVID-19-related sudden hearing loss in Veterans by identifying audiometric profiles, associated symptoms, comorbidities, and past exposure history that may accompany this condition. We will use a case-control study design in Aim 2 to measure COVID-19 antibodies in Veterans with and without sudden hearing loss and investigate biomarkers of inflammation and coagulation, which have the potential to mediate and/or moderate the association between COVID-19 and sudden hearing loss. Aim 3 is a prospective cohort study following hospitalized Veterans with and without COVID-19 over 3 months to provide important insights into the progression and recovery of auditory dysfunction in Veterans affected by COVID-19. This emphasis on epidemiologic quantitative methods provides specific strengths to the research, namely objectivity, replicability, and increase generalizability of the research. This approach ensures a rigorous and reliable analysis of the research question, further strengthening the impact and validity of the research outcomes supported by this project. Anticipated Impact: Through these comprehensive investigations, our research aims to contribute valuable insights into the clinical phenotype, mechanisms, risk factors, and hearing health trajectory of Veterans with COVID-19. This knowledge will enhance our understanding of the condition and lay the foundation for developing effective interventions, improving care, and ultimately optimizing the hearing health outcomes of Veterans affected by COVID-19.