Auditory Rehabilitation Needs in COVID-19 Survivors

Project Background/Rationale: The purpose of this proposal is to quantitatively examine and qualitatively understand the impact of COVID-19 on Veterans' auditory function. Since the pandemic began, over 230,000 Veterans in the VA health care system have tested or been presumed positive for COVID-19. It has been hypothesized that COVID-19 may have adverse effects on the auditory system, although the extent is unknown. Viral induced hearing loss is not a new phenomenon and several case studies and case series have reported new onset and progression of hearing loss and tinnitus, sudden hearing loss (sudden occurrence of acute hearing loss), ear pain, noise sensitivity and otitis media with respect to COVID-19. Moreover, we are lacking an understanding of the auditory rehabilitation needs of COVID-19 survivors. This evidence is required to successfully restore and return Veterans' auditory function to improve their quality of life. Project Aims: There is a need to understand the short- and long-term consequences of COVID-19 on the auditory system, especially among Veterans who are already at risk for underlying auditory complications, and to conceptualize these within a rehabilitation framework. The specific aims of this research proposal are to (1) Quantify the burden and impact of COVID- 19 on Veterans' auditory function; and (2) Describe Veterans' experiences with auditory complications following COVID-19 with respect to timing, onset, clinical course, rehabilitation needs, and quality of life. Project Methods: This 2-year pilot project will be accomplished through a mixed-methods approach with a sequential quantitative-qualitative design. Quantitative data regarding COVID- 19 auditory sequelae will be gathered via patient surveys and review of the electronic medical record (n=1,566). Qualitative data will be gathered via semi-structured interviews with COVID- 19 patients (n=40). By focusing on the personal and lived experiences among Veterans with COVID-19, the qualitative aim will explore emerging issues and contextual nuances otherwise unmeasurable using survey methods. Data will be stratified by hospitalization history so that unique needs of Veterans with more severe disease can be examined. Anticipated Impact: Completion of the proposed study will provide evidence for the impacts of COVID-19 on the auditory system. It is our goal to immediately provide clinicians with a better understanding of this complex patient population, functional limitations, and perceived rehabilitation needs. Observed hearing loss and tinnitus may very well become chronic, so the audiological impact of the pandemic may substantially outlast the current phase. Results of this study will lead to a VA Rehabilitation Research & Development, Merit Award application exploring the longitudinal effects of COVID-19 on the ear, hearing, and tinnitus using more robust and audiometric test measures not feasible in this pilot study.