Introduction

Respiratory syncytial virus (RSV) is one of the most common viruses that cause breathing problems. It can affect anyone, regardless of their age. In the UK between 1995 and 2009, there were an estimated 29,160 hospital admissions and 83 deaths among children and adolescents ages 0 to 17 due to RSV infections.¹ Elderly individuals are also severely impacted; in the UK, it causes 8,000 deaths and 14,000 hospital admissions each year.

Any viral infection carries the risk of multiple health conditions. It has been estimated that viruses can cause up to 40% of all congenital (conditions present at birth) and acquired cases of hearing loss.² 

This article will detail the possibility of developing hearing loss as a result of an RSV infection in adults.

Understanding RSV

What is respiratory syncytial virus?

RSV is a member of the Paramyxoviridae virus family. This family also contains the viruses that cause measles, mumps, and human parainfluenza. 

RSV frequently triggers the start of winter colds and coughing. However, it can also cause serious diseases in adults, especially among the elderly, individuals with chronic lung conditions, and those with weak immune systems.³

Symptoms and signs of RSV in adults

The symptoms of RSV infections are similar to those caused by other respiratory viruses, making it difficult to differentiate them based only on symptoms.

The symptoms differ from person to person, but there are common presentations, such as the following:⁴

• Sore throat
• Runny nose and a blocked nose
• Headache
• Myalgia (pain in the muscles and body)
• Cough (this is one of the landmark symptoms in adults with respiratory tract infections)
• Sputum production: sputum is a mixture of mucus and saliva. Normally, our respiratory tract produces it to keep itself moist and protected from any virus, bacteria, or dust. In response to an RSV infection, the tract produces significantly more sputum as a heightened protective mechanism
• Dyspnea: this is when patients have difficulties with breathing. It is associated with wheezes (a whistling sound in the lungs when breathing, caused by air passing through tight or squeezed air passages)
• Fever
• Exhaustion: feeling very tired

RSV infection has a wide range of presentations, from no symptoms to severe chest conditions and life-threatening respiratory distress, including exacerbations (worsening) of underlying chronic conditions like asthma and chronic obstructive pulmonary disease (COPD).³

Methods of transmission 

The primary means of transmission for a RSV is:^3,5,6

• Direct contact with an infected individual, such as kissing
• Indirect contact, such as touching infected surfaces and objects and then touching your face before washing your hands
• If an infected person sneezes or coughs close to you, virus droplets can enter your nose, eyes, or mouth

It is recommended, when you feel any symptoms, to seek medical attention and proper advice from your doctor.

Hearing loss: an overview

Our ability to hear is a vital part of our everyday communication and plays a significant role in our cognitive functions. A decrease in the ability to perceive sound is described as hearing loss. It can affect one or both ears and impair one's ability to hear loud noises or conversations. Hearing loss is categorised as mild, moderate, severe, or profound.⁶

According to the World Health Organisation (WHO), 30% of adults over 65 years old have profound hearing loss. In addition, over 700 million individuals (or one in ten people) are expected to have severe hearing loss by the year 2050. 

Hearing loss impacts your ability to engage fully in social situations and activities. Also, it has emotional consequences that may require rehabilitation.

The types of hearing loss

There are different types of hearing loss, each affecting individuals in a unique way. These types include:⁷

• Conductive hearing loss: this occurs when the sound waves become obstructed inside the ear canal, eardrum, and/or the middle part of the ear. In turn, this leads to problems in the delivery of sound waves to the inner part of the ear
• Sensorineural hearing loss: this occurs when damage happens to the inner ear or the neuronal pathways that link the inner ear to the brain
• Mixed hearing loss: this is a combination of sensorineural and conductive hearing loss, which results in problems in the inner ear as well as the outer or middle ear⁷

Common causes of hearing loss in adults 

Hearing loss can have many different causes, some of which are irreversible and permanent, whereas others could be a complication to another condition. Examples of causes include the following:

• Ageing: a gradual natural process known as presbycusis
• Loud noises: this is the prolonged exposure to loud noises, which leads to noise-induced hearing loss
• Acute otitis (ear infection): this is an infection of the middle part of the ear (the air-filled space behind the eardrum that houses the ear's tiny vibrating bones)
• Earwax build-up
• Ruptured Eardrum: this can occur from complications of an ear infection
• Labyrinthitis: this is a type of inner ear infection that can affect hearing

Symptoms of hearing loss

The symptoms of hearing loss differ among individuals, and may affect one or both ears. Hearing loss symptoms can include:⁷

• Speech and other sounds becoming muffled
• Difficulty in understanding speech, especially in noisy or crowded environments
• Asking others to talk louder, clearer, and more slowly more frequently
• Needing to adjust the radio or television volume
• Tinnitus, which is when you can hear a ringing in your ears⁷

If you feel like your hearing is gradually getting worse or you are receiving treatment for an ear infection or ear wax accumulation and your hearing has not returned, then you need to talk to your healthcare provider.

Diagnostic approaches for hearing impairment

Diagnosis for hearing loss is done by a medical professional. It includes a combination of history taking, a comprehensive physical examination, and a series of auditory evaluations. The target is to identify the nature and severity of your hearing deficits. It takes place as follows:

• History taking: this is an essential part of assessment as it provides information about the onset, duration, and accompanying severity of signs and symptoms. This assessment also allows the healthcare professional to check whether the patient has any underlying hereditary or chronic disease, as these could be risk factors for developing hearing loss
• Thorough physical examination: this includes general and local physical assessments. The local examination involves examining the ear with a device called an otoscope. It helps the medical practitioner view the condition of the ear canal and eardrum, searching for any signs of inflammation
• Auditory evaluation tests: these include tympanometry (to assess the pressure inside the middle ear) and audiometry (the test typically involves an audiometer that plays a sequence of tones over headphones at different pitches (frequencies) and loudness (intensities))

Potential link between RSV and hearing loss

Connection between RSV and middle ear infections

AOM (acute otitis media) frequently starts by a viral upper respiratory infection, which leads to inflammation and makes it possible for viruses like RSV to easily enter the middle ear.⁸

The inflammation of the middle ear due to an RSV infection can lead to an increase in mucus secretion inside the ear. This build-up can impair hearing.⁸ Additionally, due to RSV infection, Eustachian tube dysfunction can occur. This refers to when the tube between the throat and middle ear is blocked. Therefore, hearing loss from otitis media with effusion will lead to a build-up of fluid inside the middle ear.⁷

The link between RSV and inner ear infections

RSV can also invade the inner ear, thanks to the anatomical connection between the middle and inner parts of the ear. Infection of the inner ear can lead to inflammation, consequently affecting hearing and sometimes resulting in balance problems.⁹

Treatment and prevention

Hearing loss treatment due to RSV infection

Generally, the management of RSV symptoms involves self-care management using OTC (over-the-counter) medications from the pharmacy. The treatment for hearing impairment due to RSV focuses primarily on resolving the underlying ear infection. There are multiple approaches, such as:

• Antiviral medication¹⁰
• Steroids: these medications can decrease middle or inner ear inflammation¹¹
• Antibiotics: these can be used if a bacterial infection happens on top of an RSV infection

Preventing RSV infection

The following general hygiene precautions can stop the transmission of RSV:^12,13

• Washing your hands
• Cover your coughs and sneezes
• Frequent cleaning of household surfaces (such as door handles and kitchen counters)
• Avoiding close contact with sick people
• Staying home when you are sick and taking enough rest

FAQs

Can RSV affect your hearing?

Yes, it can.

Is hearing loss from a virus permanent?

It depends on the severity, but most of the time it is reversible.

Can an upper respiratory infection affect your ears?

Yes, it can.

How do you relieve ear pressure from RSV?

You can use over-the-counter medications. In addition, yawning or swallowing helps to open the eustachian tube and relieve the pressure.

Summary

RSV can cause ear infections in adults, which can lead to transient hearing loss. There are certain factors that increase the risk of hearing loss from RSV, like chronic underlying diseases. Seeking advice from your GP is advisable for diagnosis and treatment.