Dissertations, Theses, and Capstone Projects

Date of Degree

6-2025

Document Type

Capstone Project

Degree Name

Au.D.

Program

Audiology

Advisor

Dorothy DiToro

Subject Categories

Bacterial Infections and Mycoses | Communication Sciences and Disorders | Interprofessional Education | Speech and Hearing Science | Speech Pathology and Audiology

Keywords

Tick-borne infections, hearing Loss, tinnitus, hyperacusis, dizziness, auditory processing

Abstract

Background:

Lyme disease, an infectious vector-borne illness, is carried by the deer tick, Ixodes scapularis, which harbor the spirochete, Borrelia burgdorferi, affecting hundreds of thousands of people in the United States annually. Lyme disease has a multitude of clinical presentations and overlaps with other complex illnesses, making diagnosis and treatment a medical challenge. This distinct bacterium can migrate into any organ system through the mediums of soft tissue, the lymphatic system, and the circulatory system. Despite its prevalence and range in symptomatology, minimal research has been conducted to identify distinct audiological and vestibular symptoms associated with a Lyme disease diagnosis. Through the collection of a self-reported questionnaire with targeted questions, this study aims to investigate how Lyme and tick-borne infection correlate with audiological and vestibular manifestations.

Methods:

A literature review was conducted to identify particular audiometric and vestibular symptoms that were reported with a Lyme disease diagnosis. Five audiological symptoms were targeted for a comprehensive survey of Lyme disease patients: tinnitus, hearing difficulties, sound tolerance, dizziness/imbalance, and auditory processing. An online based questionnaire of 24 questions, following a Likert scale of reporting, was created incorporating these symptoms utilizing pre-existing validated surveys that had high internal consistency. Tinnitus, hearing difficulties, and sound tolerance questions were adapted from the Tinnitus and Hearing Survey (THS) (National Center for Rehabilitative Auditory Research, n.d.). Dizziness/imbalance questions were derived from the Pediatric Vestibular Symptom Questionnaire (Pavlou et al., 2016). Auditory processing questions were adapted from the Adult Auditory Performance Scale (AAPS) (Roup et al., 2021) which investigates six listening conditions named Quiet, Ideal, Noise, Multiple Inputs, Auditory Memory, and Auditory Attention. The survey also consisted of general demographic information as well as other factors that might contribute to survey answers: other co-infections, methods of diagnosis, current medications, and pre- and post-hearing aid use. Following the creation of the survey, it was distributed utilizing an online platform, Qualtrics. A total of 561 eligible participants (nine participants were eliminated due to not fulfilling inclusion criteria) ages 18 years of age and older completed the survey.

Results:

The majority of survey participants were female (87.3%), with a median age of 50 years old and the most prevalent age at symptom onset in the range of 35-44 years old (22.6%). Besides Lyme disease, Bartonella (62.2%) was the most prevalent disease. Survey respondents had the ability to select from a limited number of choices for the diagnostic methods and current medications and had the option to select “other” for responses that were not listed. The “other” classifications were selected for the most indicated diagnostic method (e.g. IGeneX) which encompasses blood tests such as ImmunoBlot, ELISA, Western Blot, Lyme dot-blot assay (LDA), Indirect Immunofluorescent Assay (IFA), and IgXSpot. Participants also selected the “other” responses for the medication category (61.4%), with “no current medications” and “Traditional Chinese Medicine” herbs being the most frequent responses. Auditory and vestibular symptoms were calculated by adding the cumulative percentages of the following categories: sometimes, most of the time, and all of the time. Regarding tinnitus, ~50% of respondents indicated tinnitus was affecting their sleep and concentration and acted as a significant distraction over the past week; 75% of participants indicated difficulty hearing in noisy environments and conversations, along with difficulty hearing soft voices. Regarding hyperacusis, ~80% indicated that at least one sound is too loud every day and that a group setting with 5-10 people is often too loud. Additionally, at least one prior episode of dizziness/imbalance and auditory processing symptoms were evaluated in Lyme patients, with 90% of subjects reporting imbalance; 69.1% reporting dizziness; ~80.2% reporting attention deficits and difficulty comprehending language and multi-step instructions; and ~60% reporting difficulty discerning similar sounding speech sounds.

Conclusions:

In summary, there is a high prevalence of self-reported audiological and vestibular symptoms with a confirmed Lyme disease diagnosis. These findings suggest that proper referral from medical professionals and adequate identification of diagnostic markers are crucial to optimizing treatment outcomes and quality of life for patients suffering from tick-borne infections with comorbid hearing loss. Although much has been explored, future research is still warranted to clearly identify other specialty organ systems and the associated symptoms that follow Lyme disease.

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