Volume 101, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The neglected tropical diseases Zika, Ebola, and Lassa fever (LF) have all been noted to cause some degree of hearing loss (HL). Hearing loss is a chronic disability that can lead to a variety of detrimental effects, including speech and language delays in children, decreased economic productivity in adults, and accelerated cognitive decline in older adults. The objective of this review is to summarize what is known regarding HL secondary to these viruses. Literature for this review was gathered using the PubMed database. Articles were excluded if there were no data of the respective viruses, postinfectious complications, or conditions related to survivorship. A total of 50 articles were included in this review. Fourteen articles discussing Zika virus and subsequent complications were included. Across these studies, 56 (21.2%) of 264 Zika-infected individuals were found to have HL. Twenty-one articles discussing Ebola virus and subsequent complications were included, with 190 (5.7%) of 3,350 Ebola survivors found to have HL. Fifteen additional articles discussing LF and subsequent complications were included. Of 926 individuals with LF, 79 (8.5%) were found to have HL. These results demonstrate a relationship between HL and infection. The true prevalence is likely underestimated, however, because of lack of standardization of reporting and measurement. Future studies of viral sequelae would benefit from including audiometric evaluation. This information is critical to understanding pathophysiology, preventing future cases of this disability, and improving quality of life after survival of infection.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Hotez PJ, Ferris MT, , 2006. The antipoverty vaccines. Vaccine. 24: 57875799. [Google Scholar]
  2. Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Sachs SE, Sachs JD, Savioli L, , 2007. Control of neglected tropical diseases. N Engl J Med. 357: 10181027. [Google Scholar]
  3. Hotez P, Ottesen E, Fenwick A, Molyneux D, Pollard AJ, Finn A, , 2006. The neglected tropical diseases: the ancient afflictions of stigma and poverty and the prospects for their control and elimination. , eds. Hot Topics in Infection and Immunity in Children III, Vol. 582. New York, NY: Springer, 2333. [Google Scholar]
  4. Hotez PJ, , 2008. Stigma: the stealth weapon of the NTD. PLoS Negl Trop Dis 2: e230. [Google Scholar]
  5. Weiss MG, , 2008. Stigma and the social burden of neglected tropical diseases. PLoS Negl Trop Dis 2: e237. [Google Scholar]
  6. World Health Organization, 2008. Guinea: Life after Ebola Has New Meaning for 2 Survivors Now Helping Others. WHO. Available at: http://www.who.int/features/2014/life-after-ebola/en/. Accessed March 6, 2019.
  7. GBD 2016 DALYs, HALE Collaborator, 2017. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390: 12601344. [Google Scholar]
  8. Mackenzie I, Smith A, , 2009. Deafness—the neglected and hidden disability. Ann Trop Med Parasitol. 103: 565571. [Google Scholar]
  9. Disease and Injury Incidence and Prevalence Collaborators, 2016. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388: 15451602. [Google Scholar]
  10. Mohr PE, Feldman JJ, Dunbar JL, McConkey-Robbins A, Niparko JK, Rittenhouse RK, Skinner MW, , 2000. The societal costs of severe to profound hearing loss in the United States. Int J Technol Assess Health Care 16: 11201135. [Google Scholar]
  11. Davis JM, Elfenbein J, Schum R, Bentler RA, , 1986. Effects of mild and moderate hearing impairments on language, educational, and psychosocial behavior of children. J Speech Hear Disord 51: 53. [Google Scholar]
  12. Bess FH, Dodd-Murphy J, Parker RA, , 1998. Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear Hear 19: 339. [Google Scholar]
  13. Lin FR, , 2011. Hearing loss and cognition among older adults in the United States. J Gerontol A Biol Sci Med Sci 66: 11311136. [Google Scholar]
  14. Lin FR, 2013. Hearing loss and cognitive decline in older adults. JAMA Intern Med 173: 293299. [Google Scholar]
  15. Van Dishoeck HA, Bierman TA, , 1957. Sudden perceptive deafness and viral infection. Ann Otol Rhinol Laryngol 66: 963980. [Google Scholar]
  16. Byl FM, Jr., 1984. Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope. 94: 647661. [Google Scholar]
  17. Jaffe BF, , 1978. Viral causes of sudden inner ear deafness. Otolaryngol Clin North Am 11: 6369. [Google Scholar]
  18. Leal MC, , 2016. Hearing loss in infants with microcephaly and evidence of congenital Zika virus infection—Brazil, November 2015–May 2016. MMWR Morb Mortal Wkly Rep 65: 917919. [Google Scholar]
  19. Rowe AK, 1999. Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the Congo. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis 179 (Suppl 1): S28S35. [Google Scholar]
  20. Cummins D, McCormick JB, Bennett D, Samba JA, Farrar B, Machin SJ, Fisher-Hoch SP, , 1990. Acute sensorineural deafness in Lassa fever. JAMA 264: 20932096. [Google Scholar]
  21. Cohen BE, Durstenfeld A, Roehm PC, , 2014. Viral causes of hearing loss: a review for hearing health professionals. Trends Hear 18: 118. [Google Scholar]
  22. Martins OR, de AL Rodrigues P, dos Santos ACM, Ribeiro EZ, Nery AF, Lima JB, Moreno CC, Silveira ARO, , 2017. Achados otológicos em pacientes pós-infecção pelo Zika vírus: estudos de caso. Audiol Commun Res 22, doi: 10.1590/2317-6431-2017-1850. [Google Scholar]
  23. Tappe D, Nachtigall S, Kapaun A, Schnitzler P, Günther S, Schmidt-Chanasit J, , 2015. Acute Zika virus infection after travel to Malaysian Borneo, September 2014. Emerg Infect Dis 21: 911913. [Google Scholar]
  24. Vinhaes ES, 2017. Transient hearing loss in adults associated with Zika virus infection. Clin Infect Dis 64: 675677. [Google Scholar]
  25. Leal MC, Muniz LF, Caldas Neto SD, van der Linden V, Ramos RC, , 2016. Sensorineural hearing loss in a case of congenital Zika virus. Braz J Otorhinolaryngol 16: 3012630127. [Google Scholar]
  26. Wheeler AC, Ventura CV, Ridenour T, Toth D, Nobrega LL, Silva de Souza Dantas LC, Rocha C, Bailey DB, Jr Ventura LO, , 2018. Skills attained by infants with congenital Zika syndrome: pilot data from Brazil. PLoS One 13: e0201495. [Google Scholar]
  27. Satterfield-Nash A, 2017. Health and development at age 19–24 Months of 19 children who were born with microcephaly and laboratory evidence of congenital Zika virus infection during the 2015 Zika virus outbreak—Brazil, 2017. MMWR Morb Mortal Wkly Rep 66: 13471351. [Google Scholar]
  28. Santos VS, Oliveira SJG, Gurgel RQ, Lima DRR, Dos Santos CA, Martins-Filho PRS, , 2017. Case report: microcephaly in twins due to the Zika virus. Am J Trop Med Hyg 97: 151154. [Google Scholar]
  29. Microcephaly Epidemic Research Group, 2016. Microcephaly in infants, Pernambuco State, Brazil, 2015. Emerg Infect Dis 22: 10901093. [Google Scholar]
  30. de Laval F, 2018. Evolution of symptoms and quality of life during Zika virus infection: a 1-year prospective cohort study. J Clin Virol 109: 5762. [Google Scholar]
  31. Ventura CV, Consortium Investigators , 2018. First locally acquired congenital Zika syndrome case in the United States: neonatal clinical manifestations. Ophthalmic Surg Lasers Imaging Retina 49: e93-e98. [Google Scholar]
  32. França TLB, Medeiros WR, Souza NL, Longo E, Pereira SA, França TBO, Sousa KG, , 2018. Growth and development of children with microcephaly associated with congenital Zika virus syndrome in Brazil. Int J Environ Res Public Health 15: E1990. [Google Scholar]
  33. Vianna RAO, 2019. Children born to mothers with rash during Zika virus epidemic in Brazil: first 18 Months of life. J Trop Pediatr 19: 111. [Google Scholar]
  34. Calle-Giraldo JP, 2019. Outcomes of congenital Zika virus infection during an outbreak in Valle del Cauca, Colombia. Pediatr Infect Dis J 38: 16. [Google Scholar]
  35. Wheeler AC, , 2018. Development of infants with congenital Zika syndrome: what do we know and what can we expect? Pediatrics. 141 (Suppl 2): S154S160. [Google Scholar]
  36. Jacobs M, 2016. Late Ebola virus relapse causing meningoencephalitis: a case report. Lancet 388:498503. [Google Scholar]
  37. Mattia JG, 2016. Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. Lancet Infect Dis 16: 3 31338. [Google Scholar]
  38. Qureshi AI, Chughtai M, Loua TO, Pe Kolie J, Camara HF, Ishfaq MF, N’Dour CT, Beavogui K, , 2015. Study of Ebola virus disease survivors in Guinea. Clin Infect Dis 61: 10351042. [Google Scholar]
  39. Tiffany A, Vetter P, Mattia J, Dayer JA, Bartsch M, Kasztura M, Sterk E, Tijerino AM, Kaiser L, Ciglenecki L, , Ebola virus disease complications as experienced by survivors in Sierra Leone. Clin Infect Dis 62: 13601366. [Google Scholar]
  40. Etard JF, 2017. Multidisciplinary assessment of post-Ebola sequelae in Guinea (Postebogui): an observational cohort study. Lancet Infect Dis 17: 545552. [Google Scholar]
  41. Shantha JG, Crozier I, Hayek BR, Bruce BB, Gargu C, Brown J, Fankhauser J, Yeh S, , 2017. Ophthalmic manifestations and causes of vision impairment in Ebola virus disease survivors in monrovia, Liberia. Ophthalmology 124: 170177. [Google Scholar]
  42. Bwaka MA, 1999. Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients. J Infect Dis 179 (Suppl 1): S1S7. [Google Scholar]
  43. Clark DV, 2015. Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study. Lancet Infect Dis 15: 905912. [Google Scholar]
  44. Jagadesh S, Sevalie S, Fatoma R, Sesay F, Sahr F, Faragher B, Semple MG, Fletcher TE, Weigel R, Scott JT, . 2018. Disability among Ebola survivors and their close contacts in Sierra Leone: a retrospective case-controlled cohort study. Clin Infect Dis 66: 131133. [Google Scholar]
  45. Wilson HW, Amo-Addae M, Kenu E, Ilesanmi OS, Ameme DK, Sackey SO, , 2018. Post-Ebola syndrome among Ebola virus disease survivors in Montserrado County, Liberia 2016. Biomed Res Int 2018: 18. [Google Scholar]
  46. Nanyonga M, Saidu J, Ramsay A, Shindo N, Bausch DG, . 2016. Sequelae of Ebola virus disease, Kenema district, Sierra Leone. Clin Infect Dis 62: 125126. [Google Scholar]
  47. Kelly JD, 2018. Neurological, cognitive, and psychological findings among survivors of Ebola virus disease from the 1995 Ebola outbreak in Kikwit, Democratic Republic of Congo: a cross-sectional study. Clin Infect Dis 68: 13881393. [Google Scholar]
  48. Hereth-Hebert E, 2017. Ocular complications in survivors of the Ebola outbreak in Guinea. Am J Ophthalmol 175: 114121. [Google Scholar]
  49. Fallah MP, Skrip LA, Dahn BT, Nyenswah TG, Flumo H, Glayweon M, Lorseh TL, Kaler SG, Higgs ES, Galvani AP, , 2016. Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease. Lancet Glob Health 4: e678e679. [Google Scholar]
  50. Wing K, 2018. Surviving Ebola: a historical cohort study of Ebola mortality and survival in Sierra Leone 2014–2015. PLoS One 13: e0209655. [Google Scholar]
  51. Overholt L, 2018. Stigma and Ebola survivorship in Liberia: results from a longitudinal cohort study. PLoS One 13: e0206595. [Google Scholar]
  52. Howlett PJ, 2018. Case series of severe neurologic sequelae of Ebola virus disease during epidemic, Sierra Leone. Emerg Infect Dis 24: 14121421. [Google Scholar]
  53. de St Maurice A, 2018. Care of Ebola survivors and factors associated with clinical sequelae—Monrovia, Liberia. Open Forum Infect Dis 5: ofy239. [Google Scholar]
  54. The PREVAIL III Study Group 2019. A longitudinal study of Ebola sequelae in Liberia. N Engl J Med 380: 924934. [Google Scholar]
  55. Kelly JD, 2019. Ebola virus disease-related stigma among survivors declined in Liberia over an 18-month, post-outbreak period: an observational cohort study. PLoS Negl Trop Dis 13: e0007185. [Google Scholar]
  56. Okokhere PO, Ibekwe TS, Akpede GO, , 2009. Sensorineural hearing loss in Lassa fever: two case reports. J Med Case Rep 3: 36. [Google Scholar]
  57. Grundy D, Bowen ETW, Lloyed G, , 1980. Isolated case of Lassa fever in Zaria, Northern Nigeria. Lancet 316: 649650. [Google Scholar]
  58. Choi MJ, 2018. A case of Lassa fever diagnosed at a community hospital—Minnesota 2014. Open Forum Infect Dis 5: ofy131. [Google Scholar]
  59. Grahn A, 2016. Imported case of Lassa fever in Sweden with encephalopathy and sensorineural hearing deficit. Open Forum Infect Dis 3: ofw198. [Google Scholar]
  60. McCormick JB, King IJ, Webb PA, Johnson KM, O’Sullivan R, Smith ES, Trippel S, Tong TC, , 1987. A case-control study of the clinical diagnosis and course of Lassa fever. J Infect Dis 155: 445455. [Google Scholar]
  61. Macher AM, Wolfe MS, , 2006. Historical Lassa fever reports and 30-year clinical update. Emerg Infect Dis 12: 835837. [Google Scholar]
  62. Ibekwe TS, Okokhere PO, Asogun D, Blackie FF, Nwegbu MM, Wahab KW, Omilabu SA, Akpede GO, , 2011. Early-onset sensorineural hearing loss in Lassa fever. Eur Arch Otorhinolaryngol 268: 197201. [Google Scholar]
  63. White HA, , 1972. Lassa fever: a study of 23 hospital cases. Trans R Soc Trop Med Hyg 66: 390401. [Google Scholar]
  64. Mertens PE, Patton R, Baum JJ, Monath TP, , 1973. Clinical presentation of Lassa fever cases during the hospital epidemic at Zorzor, Liberia, March-April 1972. Am J Trop Med Hyg 22:780784. [Google Scholar]
  65. Okokhere P, 2018. Clinical and laboratory predictors of assa fever outcome in a dedicated treatment facility in Nigeria: a retrospective, observational cohort study. Lancet Infect Dis 18: 684695. [Google Scholar]
  66. Günther S, Weisner B, Roth A, Grewing T, Asper M, Drosten C, Emmerich P, Petersen J, Wilczek M, Schmitz H, , 2001. Lassa fever encephalopathy: Lassa virus in cerebrospinal fluid but not in serum. J Infect Dis 184: 345349. [Google Scholar]
  67. Frame JD, , 1989. Clinical features of Lassa fever in Liberia. Rev Infect Dis 11: S783S789. [Google Scholar]
  68. Frame JD, Monson MH, Cole AK, Alexander S, Jahrling PB, Serwint JR, , 1987. Pediatric Lassa fever: a review of 33 Liberian cases. Am J Trop Med Hyg 36: 408415. [Google Scholar]
  69. Hirabayashi Y, Oka S, Goto H, Shimada K, Kurata T, Fisher-Hoch SP, McCormick JB, , 1988. An imported case of Lassa fever with late appearance of polyserositis. J Infect Dis 158: 872875. [Google Scholar]
  70. Arlinger S, , 2003. Negative consequences of uncorrected hearing loss—a review. Int J Audiol 42 (Suppl 2): 1720. [Google Scholar]
  71. Kvam MH, Loeb M, Tambs K, , 2007. Mental health in deaf adults: symptoms of anxiety and depression among hearing and deaf individuals. J Deaf Stud Deaf Educ 12: 17. [Google Scholar]
  72. Tambs K, , 2004. Moderate effects of hearing loss on mental health and subjective well-being: results from the Nord-Trøndelag hearing loss study. Psychosom Med 6: 776782. [Google Scholar]
  73. Shin HY, Hwang HJ, , 2017. Mental health of the people with hearing impairment in Korea: a population-based cross-sectional study. Korean J Fam Med 38: 5763. [Google Scholar]
  74. Li CM, Zhang X, Hoffman HJ, Cotch MF, Themann CL, Wilson MR, , 2014. Hearing impairment associated with depression in us adults, National Health and Nutrition Examination Survey 2005–2010. JAMA Otolaryngol Head Neck Surg 140: 293302. [Google Scholar]
  75. Parra VM, Matas CG, Neves IF, , 2003. Estudo de caso: neuropatia auditiva. Rev. Bras. Otorrinolaringol 69: 283288. [Google Scholar]
  76. Probst R, Lonsbury-Martin BL, Martin GK, , 1991. A review of otoacoustic emissions. J Acoust Soc Am 89: 20272067. [Google Scholar]
  77. Wiwanitkit V, , 2017. Hearing loss in congenital Zika virus. Braz J Otorhinolaryngol 83: 239. [Google Scholar]
  78. Nem de Oliveira Souza I, 2018. Acute and chronic neurological consequences of early-life Zika virus infection in mice. Sci Transl Med 10: eaar2749. [Google Scholar]
  79. Racicot K, VanOeveren S, Alberts A, , 2017. Viral hijacking of formins in neurodevelopmental pathologies. Trends Mol Med 23: 778785. [Google Scholar]
  80. Guevara JG, Agarwal-Sinha S, , 2018. Ocular abnormalities in congenital Zika syndrome: a case report, and review of the literature. J Med Case Rep 12: 161. [Google Scholar]
  81. Vetter P, Kaiser L, Schibler M, Ciglenecki I, Bausch DG, , 2016. Sequelae of Ebola virus disease: the emergency within the emergency. Lancet Infect Dis 16: e82e91. [Google Scholar]
  82. Spengler JR, Prescott J, Feldmann H, Spiropoulou CF, , 2017. Human immune system mouse models of Ebola virus infection. Curr Opin Virol 25: 9096. [Google Scholar]
  83. Younan P, Iampietro M, Bukreyev A, , 2018. Disabling of lymphocyte immune response by Ebola virus. PLoS Pathog 14: e1006932. [Google Scholar]
  84. Yeh S, Shantha JG, Hayek B, Crozier I, Smith JR, , 2018. Clinical manifestations and pathogenesis of uveitis in Ebola virus disease survivors. Ocul Immunol Inflamm 26: 11281134. [Google Scholar]
  85. Cashman KA, Wilkinson ER, Facemire PR, Bell TM, Shaia CI, Schmaljohn CS, , 2018. Autoimmune associated systemic vasculitis as the cause of sudden onset bilateral sensorineural hearing loss following Lassa virus exposure in a cynomolgus macaque deafness model. mBio 9. [Google Scholar]
  86. Cashman KA, 2017. A DNA vaccine delivered by dermal electroporation fully protects cynomolgus macaques against Lassa fever. Hum Vaccin Immunother 13: 29022911. [Google Scholar]
  87. Yun SI, Lee YM, , 2017. Zika virus: an emerging flavivirus. J Microbiol 55: 204219. [Google Scholar]
  88. Yun NE, 2015. Animal model of sensorineural hearing loss associated with Lassa virus infection. J Virol 90: 29202927. [Google Scholar]
  89. Rybak LP, , 1990. Deafness associated with Lassa fever. JAMA 264: 2119. [Google Scholar]

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  • Received : 23 Nov 2018
  • Accepted : 06 Jun 2019
  • Published online : 22 Jul 2019

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