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Review
May 16, 2019

Association of Ebola Virus Infection With Hearing Loss in Regions Where Ebola Virus Infection Is Endemic: A Systematic Review

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of California San Francisco, San Francisco
JAMA Otolaryngol Head Neck Surg. Published online May 16, 2019. doi:10.1001/jamaoto.2019.0710
Key Points

Question  Do survivors of Ebola virus infection have higher rates of hearing loss than uninfected control individuals in regions where the infection is endemic?

Findings  In this systematic review of 15 studies describing 1775 survivors of Ebola virus infection and 363 uninfected controls, significantly higher rates of hearing loss were observed among survivors of Ebola virus infection compared with controls in countries where the infection is endemic.

Meaning  The current literature suggests a possible association between Ebola virus infection and hearing loss; additional studies with longitudinal, quantitative metrics are needed to better characterize the pathophysiologic features and clinical consequences of this association.

Abstract

Importance  Many survivors of Ebola virus infection describe new-onset hearing loss after infection. The prevalence, severity, and pathophysiologic features of hearing loss in this population have not been well characterized.

Objective  To perform a systematic review of the current literature to characterize hearing loss in survivors of Ebola virus infection.

Evidence Review  This study adhered to the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Searches through PubMed, Embase, and Google Scholar were performed to include publications written in English from January 1, 1965, to October 1, 2018. Relevant vocabulary terms and key terms related to Ebola and hearing loss were used. Two investigators independently screened the eligible studies, extracted data, and assessed quality and risk of bias.

Findings  Of 127 publications reviewed, 15 met the criteria for inclusion; 3 were retrospective case-control studies (level of evidence, 3), and 12 were cross-sectional studies or case reports (level of evidence, 4). Studies included 1775 survivors of Ebola virus infection (993 female [55.9%]) and 363 uninfected controls (186 female [51.2%]) from the Democratic Republic of the Congo, Uganda, Guinea, Liberia, and Sierra Leone. The duration of follow-up ranged from 0 to 29 months (median, 5 months). Hearing loss was reported in 147 survivors of Ebola virus infection (8.3%). Among studies that compared survivors with controls, the reported odds ratios for hearing loss in survivors was 7.50 (95% CI, 3.91-14.39; range, 1.4-12.1). Including all studies, the odds ratio of hearing loss in survivors vs controls in countries where Ebola virus infection is endemic was 1.84 (95% CI, 1.10-3.08).

Conclusions and Relevance  Survivors of Ebola virus infection had higher rates of hearing loss than uninfected controls in regions where the infection is endemic. Further research with consistent objective methods and pure-tone audiometry may be needed to better characterize the hearing loss, understand its pathophysiologic features, and develop treatments.

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