Pathways and pathogenesis of hearing deficits, tinnitus, and vertigo in COVID-19

COVID-19 has been shown to affect the ear and has led to hearing deficits, tinnitus, and vertigo. Very little is known regarding the mechanisms and targets of SARS-CoV-2 that cause the above symptoms. Anatomical extensions from the areas of viral loads to the middle ear appear to enable the SARS-CoV-2 to cause either an inflammatory response or a direct effect on the lining epithelium leading to temporary hearing and equilibrium-related symptoms in COVID-19. Herein the anatomical continuity from the areas of viral loads to the middle and internal ear is debated to uncover the possible covert routes used by SARS-CoV-2 to affect the hearing and equilibrium in COVID-19