When Mumps Silences an Ear: Audiovestibular Findings in Sudden Unilateral Hearing Loss – A Case Report

When Mumps Silences an Ear: Audiovestibular Findings in Sudden Unilateral Hearing Loss – A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report When Mumps Silences an Ear: Audiovestibular Findings in Sudden Unilateral Hearing Loss – A Case Report ROHITH RAJESH, GOPIKA RAJESH This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9138936/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Mumps is an acute viral infection caused by a paramyxovirus, classically characterised by the swelling of the parotid gland and systemic symptoms (Hviid et al., 2008 ). Mumps is largely controlled through immunisation programs, but sporadic outbreaks continue to occur worldwide. Hearing loss is a rare but well-documented complication of mumps infection, with an incidence ranging from 0.005% to 0.3% (Hashimoto et al., 2009 ; Nomura & Harada, 1981 ). Hearing loss associated with mumps is typically sudden in onset, unilateral, severe to profound in degree, and often irreversible. Because of its rarity, early recognition may be delayed, which may result in long-term communicative and educational consequences in pediatric populations. Case presentation: An 11.2-year-old female presented with a complaint of sudden reduced hearing sensitivity in the right ear post-mumps infection (May 2025). A detailed audiological evaluation was carried out. Pure Tone Audiometry revealed severe to profound hearing loss in the right ear and normal hearing in the left ear. Speech identification scores could not be measured in the right ear, while in the left ear demonstrated a score of 100%. Immittance audiometry revealed an ‘A’ type tympanogram, which ruled out the presence of any middle ear pathology. Otoacoustic emissions were absent in the right ear, suggesting outer hair cell dysfunction, while they were present in the left ear. Auditory brainstem response revealed the absence of wave V at 90 dB nHL using both click and 500 Hz Tone Burst stimuli in the right ear, which supported cochlear pathology, while wave V was obtained till 30 dB nHL using the click stimulus in the left ear, which showed normal hearing. In addition, balance evaluation was also carried out by evaluating the Vestibular evoked myogenic potentials (VEMP) and the functional head impulse test, which revealed right-sided hypo-function of the vestibular system. The management option provided was a hearing aid, in which the aided responses were observed to be within the speech spectrum and a speech perception score of 72%. Conclusion This case highlights the importance of a comprehensive audiovestibular evaluation in the pediatric population presenting with sudden hearing loss after mumps infection. Early identification and timely rehabilitation are essential to minimise long-term communicative and developmental consequences. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Mumps is an acute, contagious viral illness caused by a single-stranded RNA virus belonging to the Paramyxoviridae family, which mainly affects the pediatric and adolescent population (Hviid, A., Rubin, S., & Mühlemann, K., 2008 ). It is characterised by non-specific prodromal symptoms such as fever, malaise, headache, myalgia and a classical presentation of unilateral or bilateral parotid gland enlargement. Although mumps is a self-limiting infection, systemic dissemination of the virus can lead to significant complications that involve the central nervous system, pancreas, gonads and the auditory system. Mumps is a common childhood illness worldwide. The widespread implementation of the MMR vaccine (measles, mumps, rubella) has significantly reduced the global occurrence of mumps. However, outbreaks continue to occur due to incomplete vaccination coverage and viral genotype variations. Apart from the extra salivary complications of mumps, sudden sensorineural hearing loss is one of the most devastating and rare sequelae. The incidence of mumps-associated sensorineural hearing loss varies in the literature, ranging from 0.005% to 0.3% of infected individuals (Hashimoto et al., 2009 ; Nomura & Harada, 1981 ). Importantly, when hearing loss occurs, it is mostly sudden, unilateral, severe to profound in degree, and it is often irreversible. In very rare cases, bilateral hearing loss has been reported. Mumps-associated sensorineural hearing loss is present during or after the acute phase of parotitis. Patients may report sudden hearing loss, tinnitus or imbalance. In the pediatric population, the symptoms may go unnoticed or be attributed to transient ear-related complaints unless specifically investigated. The pathophysiological mechanism that underlies mumps-induced sensorineural hearing loss remains incompletely understood. Many hypotheses have been proposed, most of which implicate the direct viral invasion of the inner ear structures, leading to inflammation and degeneration of the sensory cells of the cochlea and the vestibular organs. Numerous case reports have been documented on mumps-induced sensorineural hearing loss, but all lack detailed electrophysiological correlation. A detailed case documentation is mainly needed in the current scenario, where vaccination has reduced disease incidence, and the clinicians may be less familiar with the complications. Case Presentation An 11.2-year-old female was referred to the department of Audiology with the concern of a sudden onset of reduced hearing sensitivity in the right ear. She was accompanied by her mother, who reported that the auditory difficulty was noticed after diagnosis of mumps in May, 2025. She presented with a slight fever and unilateral parotid gland swelling on the right side. The symptoms resolved with appropriate medical management, and no neurological manifestations, such as encephalitis or meningitis, were reported. There was no prior history of recurrent otitis media, chronic ear discharge, otologic surgery, head trauma, exposure to ototoxic medications or noise exposure. There was no family history of hearing impairment. Her mother reported that she began to develop auditory difficulty within a short period following recovery from the viral illness (mumps). She depended on her left ear during conversation and requested frequent repetition and exhibited difficulty responding when addressed from the right side. Additionally, the child reported difficulty localising sound sources, often turning in the wrong direction when called. She did not report any complaint of tinnitus, vertigo, oscillopsia, imbalance, nausea or gait disturbances. A Comprehensive audiological evaluation was carried out, which includes otoscopic examination, tuning fork test, pure tone audiometry, immittance audiometry, otoacoustic emissions (OAE), auditory brainstem response (ABR), Hearing aid trial (HAT), and vestibular evaluation, including subjective vestibular evaluation, vestibular evoked myogenic potentials (VEMP) and Functional Head Impulse test (FHIT). Otoscopic examination revealed that the tympanic membranes were intact, translucent and displayed normal anatomical landmarks without any sign of perforation, retraction or any middle ear effusion. Tuning fork tests revealed lateralisation of the Weber test to the left ear, and the Rinne test demonstrated false-negative Rinne response in the right ear and positive Rinne response in the left ear. Pure Tone Audiometry was done using Piano Inventis, which revealed severe to profound sensorineural hearing loss in the Right ear and hearing sensitivity within normal limits in the Left ear , which confirmed a unilateral hearing impairment (Fig. 1 ). Immittance audiometry was done using Touch Tymp Maico, which revealed a bilateral ‘A’ type tympanogram , which excluded any middle ear pathology. Acoustic reflex test demonstrated absent ipsilateral reflexes and present contralateral reflexes in the Right ear, while in the left ear, ipsilateral reflexes were present and contralateral reflexes were absent. Distortion product otoacoustic emission (DPOAE) was done using Duet IHS, which revealed that DPOAEs are absent in the right ear, suggesting outer hair cell dysfunction , and DPOAEs are present in the left ear, suggesting normal outer hair cell functioning (Fig. 2 ). Electrophysiological assessment was carried out using IHS Duet Jr. Auditory brainstem response (ABR) was performed using click stimulus and 500 Hz tone burst stimuli at a repetition rate of 19.3 stimuli per second in the right ear, which showed that no replicable wave V was identified even at the maximum stimulus intensity of 90 dB nHL in rarefaction and alternating polarity. This indicated a profound hearing loss in the right ear . In the left ear, wave V was obtained at 30 dB nHL using a click stimulus at the same repetition rate of 19.3 stimuli per second in rarefaction polarity, which indicated normal hearing in the left ear (Fig. 3 ). As the viral infections have the potential to affect the entire membranous labyrinth, assessing the vestibular system is mandatory. Cervical vestibular evoked myogenic potentials (cVEMP) were performed using 500 Hz tone burst stimuli, which were presented at 106 dB nHL at a repetition rate of 5.1 stimuli per second in rarefaction polarity. In both ears, P1 and N1 peaks could be obtained within normal latencies, but there was a significant reduction in the amplitude of the right ear compared to the left ear, which suggested a partial dysfunction of the saccule and inferior vestibular nerve pathway in the right ear (Fig. 4 ). Ocular vestibular evoked myogenic potentials (oVEMP) were obtained using the same parameters used for cVEMP. In both ears, N1 and P1 peaks could be obtained within normal latencies with reduced amplitude in the right ear, which suggests a partial dysfunction of the utricle and superior vestibular nerve pathway (Fig. 5 ). Functional head impulse test (fHIT) was performed using the EQUIfHIT system (Equidor MedTech) to assess the functional integrity of the semicircular canals and vestibulo-ocular reflex (VOR). The test findings revealed reduced VOR performance in the right semicircular canals, which indicated impaired functioning on the Right side (Fig. 6 ). The hearing aid trial was administered using the Rexton M Core Behind-the-Ear (BTE) hearing aid on the right side. Aided audiometry was performed using Piano Inventis. Aided threshold responses were within the speech spectrum in the right ear, and speech discrimination scores were 72% in a quiet environment . The aided thresholds and speech discrimination scores were obtained while presenting contralateral masking noise to the left ear at 65 dBEM through a TDH-39 supra-aural headphone to prevent the better ear's participation (Fig. 7 ). The child demonstrated good adherence to the usage of hearing aid. Discussion Mumps is an acute viral infection caused by the mumps virus, which mainly affects the salivary glands, particularly the parotid glands. Other complications include meningitis, pancreatitis and rarely, sensorineural hearing loss. According to the literature, the reported incidence of mumps-associated hearing loss is approximately 1 in 20,000 cases (Hashimoto et al., 2009 ; Nomura & Harada, 1981 ). The present case demonstrates an 11-year-old child who developed sudden unilateral hearing loss following the recovery of mumps infection. Audiological evaluation revealed severe to profound hearing loss in the right ear and normal hearing in the left ear, which means mumps has caused a unilateral hearing loss in this case and has been widely reported in previous studies (Nomura & Harada, 1981 ). Immittance audiometry revealed a bilateral ‘A’ type tympanogram, which ruled out any middle ear pathology, which supports the possibility of viral involvement of the inner ear structures. Several hypotheses for the pathophysiological mechanisms underlying mumps-induced hearing loss have been proposed, of which the widely accepted one is the direct invasion of the labyrinth, which includes both the organ of hearing (cochlea) and the organ of balance (otolith and semicircular canals). Inflammation and degeneration of the sensory hair cells lead to impaired mechanical and neural transduction of sound, which results in sensorineural hearing loss, and damage the vestibular sensory epithelium that could disrupt the transmission of balance-related information to the central nervous system. In the present case, VEMP and fHIT were carried out to assess the otolith organs, semicircular canals and the vestibular nerve, the VEMP findings suggested that the peak latencies were observed to be within normal limits in both ears and the peak-to-peak amplitudes were observed to be reduced in the right ear, and the fHIT scores were affected in the right-sided semicircular canals, which supported that there is a partial viral involvement to the vestibular system in the right side. A comprehensive audiological and balance evaluation played a major role in identifying the extent of the viral involvement in the labyrinth. The prognosis of hearing recovery in cases of mumps-associated sensorineural hearing is poor, which often results in permanent and irreversible hearing loss, as reported in several studies (Nomura & Harada, 1981 ). Therefore, this case highlights the importance of considering mumps infection as a potential etiological factor for sudden unilateral hearing loss in the pediatric population. The possibility of viral labyrinthitis is emphasised by the vestibular findings. Continued reporting and investigation of such cases may help improve understanding of the disease process and support the development of more efficient management strategies. Early identification was challenging, mainly due to the onset of symptoms and the rarity of mumps-associated hearing loss, especially in the pediatric population. Declarations Funding Declaration The authors declare that no financial support was received for the research, authorship and publication of this article. Author Contribution RR collected the clinical data and performed the audiological and vestibular evaluations for the case. GR conducted the literature review and drafted the manuscript. Both authors reviewed, revised, and approved the final version of the manuscript and agree to be accountable for all aspects of the work. Acknowledgement The author acknowledges the support provided by MERF–ISH, Chennai, in facilitating the audiological and vestibular evaluations for this case documentation. All efforts have been made to protect patient confidentiality, and no identifying information has been disclosed in this report. We confirm that written informed consent was obtained from the patient’s legal guardian for participation and for the publication of the clinical details and associated findings. All identifying information has been anonymised to ensure patient confidentiality. References Bess FH, Tharpe AM (1984) Unilateral hearing impairment in children. Pediatrics 74(2):206–216 Everberg G (1957) Deafness following mumps. Acta Otolaryngol 47(6):540–550. https://doi.org/10.3109/00016485709127060 Fina M, Skinner M, Goebel JA, Piccirillo JF, Neely JG (2003) Vestibular dysfunction after viral infection. Otology Neurotology 24(2):200–206. https://doi.org/10.1097/00129492-200303000-00009 Hashimoto H, Fujioka M, Kinumaki H, Kondo K, Ogawa K (2009) A case of profound sensorineural hearing loss caused by mumps virus. Acta Otolaryngol 129(2):203–206. https://doi.org/10.1080/00016480802195716 Hviid A, Rubin S, Mühlemann K (2008) Mumps. Lancet 371(9616):932–944. https://doi.org/10.1016/S0140-6736(08)60419-5 Iwasaki S, Ozeki H, Nishio SY, Naito Y, Sugiura S, Mizutari K, Ito J (2005) Vestibular dysfunction in patients with sudden sensorineural hearing loss. Otology Neurotology 26(4):722–727. https://doi.org/10.1097/01.mao.0000178124.12091.8b Lieu JEC (2013) Unilateral hearing loss in children: Speech-language and school performance. B-ENT 9(Suppl 21):107–115 McKenna MJ (1996) Pathophysiology of viral inner ear disease. Otolaryngol Clin North Am 29(3):451–463 Nomura Y, Harada T (1981) Mumps deafness. ORL: J Oto-Rhino-Laryngology Its Relat Specialties 43(6):349–355. https://doi.org/10.1159/000276017 Nomura Y, Harada T, Mori S (1975) Sudden deafness associated with mumps. Arch Otolaryngol 101(6):353–357. https://doi.org/10.1001/archotol.1975.00780350047006 Rauch SD (2008) Idiopathic sudden sensorineural hearing loss. N Engl J Med 359(8):833–840. https://doi.org/10.1056/NEJMcp0802129 Rubin S, Eckhaus M, Rennick LJ, Bamford CG, Duprex WP (2015) Molecular biology, pathogenesis and pathology of mumps virus. Clin Microbiol Rev 28(2):546–569. https://doi.org/10.1128/CMR.00106-14 Rubin SA, Plotkin SA (2018) Mumps vaccine. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM (eds) Plotkin’s vaccines, 7th edn. Elsevier, pp 663–688 Rupa V, Job A (1993) Mumps deafness: Clinical and audiological characteristics. J Laryngology Otology 107(5):389–392. https://doi.org/10.1017/S0022215100123186 Takagi A, Miwa T, Saito H (1990) Mumps virus infection and sensorineural hearing loss. Annals Otology Rhinology Laryngology 99(12):973–979. https://doi.org/10.1177/000348949009901210 Welgampola MS, Colebatch JG (2005) Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology 64(10):1682–1688. https://doi.org/10.1212/01.WNL.0000161875.20559.AA World Health Organization (2017) Mumps virus vaccines: WHO position paper. Wkly Epidemiol Rec 92(25):357–368 Additional Declarations No competing interests reported. Supplementary Files CAREChecklist.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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It is characterised by non-specific prodromal symptoms such as fever, malaise, headache, myalgia and a classical presentation of unilateral or bilateral parotid gland enlargement. Although mumps is a self-limiting infection, systemic dissemination of the virus can lead to significant complications that involve the central nervous system, pancreas, gonads and the auditory system. Mumps is a common childhood illness worldwide. The widespread implementation of the MMR vaccine (measles, mumps, rubella) has significantly reduced the global occurrence of mumps. However, outbreaks continue to occur due to incomplete vaccination coverage and viral genotype variations.\u003c/p\u003e \u003cp\u003eApart from the extra salivary complications of mumps, sudden sensorineural hearing loss is one of the most devastating and rare sequelae. The incidence of mumps-associated sensorineural hearing loss varies in the literature, ranging from 0.005% to 0.3% of infected individuals (Hashimoto et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Nomura \u0026amp; Harada, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1981\u003c/span\u003e). Importantly, when hearing loss occurs, it is mostly sudden, unilateral, severe to profound in degree, and it is often irreversible. In very rare cases, bilateral hearing loss has been reported. Mumps-associated sensorineural hearing loss is present during or after the acute phase of parotitis. Patients may report sudden hearing loss, tinnitus or imbalance. In the pediatric population, the symptoms may go unnoticed or be attributed to transient ear-related complaints unless specifically investigated.\u003c/p\u003e \u003cp\u003eThe pathophysiological mechanism that underlies mumps-induced sensorineural hearing loss remains incompletely understood. Many hypotheses have been proposed, most of which implicate the direct viral invasion of the inner ear structures, leading to inflammation and degeneration of the sensory cells of the cochlea and the vestibular organs.\u003c/p\u003e \u003cp\u003eNumerous case reports have been documented on mumps-induced sensorineural hearing loss, but all lack detailed electrophysiological correlation. A detailed case documentation is mainly needed in the current scenario, where vaccination has reduced disease incidence, and the clinicians may be less familiar with the complications.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eAn 11.2-year-old female was referred to the department of Audiology with the concern of a sudden onset of reduced hearing sensitivity in the right ear. She was accompanied by her mother, who reported that the auditory difficulty was noticed after diagnosis of mumps in May, 2025. She presented with a slight fever and unilateral parotid gland swelling on the right side. The symptoms resolved with appropriate medical management, and no neurological manifestations, such as encephalitis or meningitis, were reported. There was no prior history of recurrent otitis media, chronic ear discharge, otologic surgery, head trauma, exposure to ototoxic medications or noise exposure. There was no family history of hearing impairment.\u003c/p\u003e \u003cp\u003eHer mother reported that she began to develop auditory difficulty within a short period following recovery from the viral illness (mumps). She depended on her left ear during conversation and requested frequent repetition and exhibited difficulty responding when addressed from the right side. Additionally, the child reported difficulty localising sound sources, often turning in the wrong direction when called. She did not report any complaint of tinnitus, vertigo, oscillopsia, imbalance, nausea or gait disturbances.\u003c/p\u003e \u003cp\u003eA Comprehensive audiological evaluation was carried out, which includes otoscopic examination, tuning fork test, pure tone audiometry, immittance audiometry, otoacoustic emissions (OAE), auditory brainstem response (ABR), Hearing aid trial (HAT), and vestibular evaluation, including subjective vestibular evaluation, vestibular evoked myogenic potentials (VEMP) and Functional Head Impulse test (FHIT).\u003c/p\u003e \u003cp\u003eOtoscopic examination revealed that the tympanic membranes were intact, translucent and displayed normal anatomical landmarks without any sign of perforation, retraction or any middle ear effusion. Tuning fork tests revealed lateralisation of the Weber test to the left ear, and the Rinne test demonstrated \u003cem\u003efalse-negative Rinne response\u003c/em\u003e in the right ear and \u003cem\u003epositive Rinne response\u003c/em\u003e in the left ear.\u003c/p\u003e \u003cp\u003ePure Tone Audiometry was done using Piano Inventis, which revealed \u003cem\u003esevere to profound sensorineural hearing loss in the Right ear\u003c/em\u003e and \u003cem\u003ehearing sensitivity within normal limits in the Left ear\u003c/em\u003e, which confirmed a unilateral hearing impairment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Immittance audiometry was done using Touch Tymp Maico, which revealed a \u003cem\u003ebilateral \u0026lsquo;A\u0026rsquo; type tympanogram\u003c/em\u003e, which excluded any middle ear pathology. Acoustic reflex test demonstrated \u003cem\u003eabsent ipsilateral reflexes and present contralateral reflexes\u003c/em\u003e in the Right ear, while in the left ear, \u003cem\u003eipsilateral reflexes were present and contralateral reflexes were absent.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDistortion product otoacoustic emission (DPOAE) was done using Duet IHS, which revealed that \u003cem\u003eDPOAEs are absent in the right ear, suggesting outer hair cell dysfunction\u003c/em\u003e, and \u003cem\u003eDPOAEs are present in the left ear, suggesting normal outer hair cell functioning\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eElectrophysiological assessment was carried out using IHS Duet Jr. Auditory brainstem response (ABR) was performed using click stimulus and 500 Hz tone burst stimuli at a repetition rate of 19.3 stimuli per second in the right ear, which showed that no replicable wave V was identified even at the maximum stimulus intensity of 90 dB nHL in rarefaction and alternating polarity. This indicated a \u003cem\u003eprofound hearing loss in the right ear\u003c/em\u003e. In the left ear, wave V was obtained at 30 dB nHL using a click stimulus at the same repetition rate of 19.3 stimuli per second in rarefaction polarity, which indicated \u003cem\u003enormal hearing in the left ear\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs the viral infections have the potential to affect the entire membranous labyrinth, assessing the vestibular system is mandatory. Cervical vestibular evoked myogenic potentials (cVEMP) were performed using 500 Hz tone burst stimuli, which were presented at 106 dB nHL at a repetition rate of 5.1 stimuli per second in rarefaction polarity. In both ears, P1 and N1 peaks could be obtained within normal latencies, but there was a significant reduction in the amplitude of the right ear compared to the left ear, which suggested \u003cem\u003ea partial dysfunction of the saccule and inferior vestibular nerve pathway in the right ear\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOcular vestibular evoked myogenic potentials (oVEMP) were obtained using the same parameters used for cVEMP. In both ears, N1 and P1 peaks could be obtained within normal latencies with reduced amplitude in the right ear, which suggests \u003cem\u003ea partial dysfunction of the utricle and superior vestibular nerve pathway\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFunctional head impulse test (fHIT) was performed using the EQUIfHIT system (Equidor MedTech) to assess the functional integrity of the semicircular canals and vestibulo-ocular reflex (VOR). The test findings revealed \u003cem\u003ereduced VOR performance in the right semicircular canals, which indicated impaired functioning on the Right side\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe hearing aid trial was administered using the Rexton M Core Behind-the-Ear (BTE) hearing aid on the right side. Aided audiometry was performed using Piano Inventis. \u003cem\u003eAided threshold responses were within the speech spectrum in the right ear, and speech discrimination scores were 72% in a quiet environment\u003c/em\u003e. The aided thresholds and speech discrimination scores were obtained while presenting contralateral masking noise to the left ear at 65 dBEM through a TDH-39 supra-aural headphone to prevent the better ear's participation (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). The child demonstrated good adherence to the usage of hearing aid.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMumps is an acute viral infection caused by the mumps virus, which mainly affects the salivary glands, particularly the parotid glands. Other complications include meningitis, pancreatitis and rarely, sensorineural hearing loss. According to the literature, the reported incidence of mumps-associated hearing loss is approximately 1 in 20,000 cases (Hashimoto et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Nomura \u0026amp; Harada, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1981\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe present case demonstrates an 11-year-old child who developed sudden unilateral hearing loss following the recovery of mumps infection. Audiological evaluation revealed severe to profound hearing loss in the right ear and normal hearing in the left ear, which means mumps has caused a unilateral hearing loss in this case and has been widely reported in previous studies (Nomura \u0026amp; Harada, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1981\u003c/span\u003e). Immittance audiometry revealed a bilateral \u0026lsquo;A\u0026rsquo; type tympanogram, which ruled out any middle ear pathology, which supports the possibility of viral involvement of the inner ear structures. Several hypotheses for the pathophysiological mechanisms underlying mumps-induced hearing loss have been proposed, of which the widely accepted one is the direct invasion of the labyrinth, which includes both the organ of hearing (cochlea) and the organ of balance (otolith and semicircular canals). Inflammation and degeneration of the sensory hair cells lead to impaired mechanical and neural transduction of sound, which results in sensorineural hearing loss, and damage the vestibular sensory epithelium that could disrupt the transmission of balance-related information to the central nervous system.\u003c/p\u003e \u003cp\u003eIn the present case, VEMP and fHIT were carried out to assess the otolith organs, semicircular canals and the vestibular nerve, the VEMP findings suggested that the peak latencies were observed to be within normal limits in both ears and the peak-to-peak amplitudes were observed to be reduced in the right ear, and the fHIT scores were affected in the right-sided semicircular canals, which supported that there is a partial viral involvement to the vestibular system in the right side. A comprehensive audiological and balance evaluation played a major role in identifying the extent of the viral involvement in the labyrinth. The prognosis of hearing recovery in cases of mumps-associated sensorineural hearing is poor, which often results in permanent and irreversible hearing loss, as reported in several studies (Nomura \u0026amp; Harada, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1981\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, this case highlights the importance of considering mumps infection as a potential etiological factor for sudden unilateral hearing loss in the pediatric population. The possibility of viral labyrinthitis is emphasised by the vestibular findings. Continued reporting and investigation of such cases may help improve understanding of the disease process and support the development of more efficient management strategies. Early identification was challenging, mainly due to the onset of symptoms and the rarity of mumps-associated hearing loss, especially in the pediatric population.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003cb\u003eFunding Declaration\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe authors declare that no financial support was received for the research, authorship and publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRR collected the clinical data and performed the audiological and vestibular evaluations for the case. GR conducted the literature review and drafted the manuscript. Both authors reviewed, revised, and approved the final version of the manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe author acknowledges the support provided by MERF\u0026ndash;ISH, Chennai, in facilitating the audiological and vestibular evaluations for this case documentation. All efforts have been made to protect patient confidentiality, and no identifying information has been disclosed in this report.\u003c/p\u003e\n\u003cp\u003eWe confirm that written informed consent was obtained from the patient’s legal guardian for participation and for the publication of the clinical details and associated findings. All identifying information has been anonymised to ensure patient confidentiality.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBess FH, Tharpe AM (1984) Unilateral hearing impairment in children. Pediatrics 74(2):206\u0026ndash;216\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEverberg G (1957) Deafness following mumps. Acta Otolaryngol 47(6):540\u0026ndash;550. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3109/00016485709127060\u003c/span\u003e\u003cspan address=\"10.3109/00016485709127060\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFina M, Skinner M, Goebel JA, Piccirillo JF, Neely JG (2003) Vestibular dysfunction after viral infection. Otology Neurotology 24(2):200\u0026ndash;206. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00129492-200303000-00009\u003c/span\u003e\u003cspan address=\"10.1097/00129492-200303000-00009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashimoto H, Fujioka M, Kinumaki H, Kondo K, Ogawa K (2009) A case of profound sensorineural hearing loss caused by mumps virus. Acta Otolaryngol 129(2):203\u0026ndash;206. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00016480802195716\u003c/span\u003e\u003cspan address=\"10.1080/00016480802195716\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHviid A, Rubin S, M\u0026uuml;hlemann K (2008) Mumps. Lancet 371(9616):932\u0026ndash;944. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(08)60419-5\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(08)60419-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIwasaki S, Ozeki H, Nishio SY, Naito Y, Sugiura S, Mizutari K, Ito J (2005) Vestibular dysfunction in patients with sudden sensorineural hearing loss. Otology Neurotology 26(4):722\u0026ndash;727. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/01.mao.0000178124.12091.8b\u003c/span\u003e\u003cspan address=\"10.1097/01.mao.0000178124.12091.8b\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLieu JEC (2013) Unilateral hearing loss in children: Speech-language and school performance. B-ENT 9(Suppl 21):107\u0026ndash;115\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKenna MJ (1996) Pathophysiology of viral inner ear disease. Otolaryngol Clin North Am 29(3):451\u0026ndash;463\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNomura Y, Harada T (1981) Mumps deafness. ORL: J Oto-Rhino-Laryngology Its Relat Specialties 43(6):349\u0026ndash;355. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000276017\u003c/span\u003e\u003cspan address=\"10.1159/000276017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNomura Y, Harada T, Mori S (1975) Sudden deafness associated with mumps. Arch Otolaryngol 101(6):353\u0026ndash;357. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/archotol.1975.00780350047006\u003c/span\u003e\u003cspan address=\"10.1001/archotol.1975.00780350047006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRauch SD (2008) Idiopathic sudden sensorineural hearing loss. N Engl J Med 359(8):833\u0026ndash;840. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMcp0802129\u003c/span\u003e\u003cspan address=\"10.1056/NEJMcp0802129\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubin S, Eckhaus M, Rennick LJ, Bamford CG, Duprex WP (2015) Molecular biology, pathogenesis and pathology of mumps virus. Clin Microbiol Rev 28(2):546\u0026ndash;569. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1128/CMR.00106-14\u003c/span\u003e\u003cspan address=\"10.1128/CMR.00106-14\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubin SA, Plotkin SA (2018) Mumps vaccine. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM (eds) Plotkin\u0026rsquo;s vaccines, 7th edn. Elsevier, pp 663\u0026ndash;688\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRupa V, Job A (1993) Mumps deafness: Clinical and audiological characteristics. J Laryngology Otology 107(5):389\u0026ndash;392. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S0022215100123186\u003c/span\u003e\u003cspan address=\"10.1017/S0022215100123186\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakagi A, Miwa T, Saito H (1990) Mumps virus infection and sensorineural hearing loss. Annals Otology Rhinology Laryngology 99(12):973\u0026ndash;979. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/000348949009901210\u003c/span\u003e\u003cspan address=\"10.1177/000348949009901210\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWelgampola MS, Colebatch JG (2005) Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology 64(10):1682\u0026ndash;1688. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1212/01.WNL.0000161875.20559.AA\u003c/span\u003e\u003cspan address=\"10.1212/01.WNL.0000161875.20559.AA\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2017) Mumps virus vaccines: WHO position paper. Wkly Epidemiol Rec 92(25):357\u0026ndash;368\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9138936/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9138936/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMumps is an acute viral infection caused by a paramyxovirus, classically characterised by the swelling of the parotid gland and systemic symptoms (Hviid et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Mumps is largely controlled through immunisation programs, but sporadic outbreaks continue to occur worldwide. Hearing loss is a rare but well-documented complication of mumps infection, with an incidence ranging from 0.005% to 0.3% (Hashimoto et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Nomura \u0026amp; Harada, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1981\u003c/span\u003e). Hearing loss associated with mumps is typically sudden in onset, unilateral, severe to profound in degree, and often irreversible. Because of its rarity, early recognition may be delayed, which may result in long-term communicative and educational consequences in pediatric populations.\u003c/p\u003e \u003cp\u003eCase presentation:\u003c/p\u003e \u003cp\u003eAn 11.2-year-old female presented with a complaint of sudden reduced hearing sensitivity in the right ear post-mumps infection (May 2025). A detailed audiological evaluation was carried out. Pure Tone Audiometry revealed severe to profound hearing loss in the right ear and normal hearing in the left ear. Speech identification scores could not be measured in the right ear, while in the left ear demonstrated a score of 100%. Immittance audiometry revealed an \u0026lsquo;A\u0026rsquo; type tympanogram, which ruled out the presence of any middle ear pathology. Otoacoustic emissions were absent in the right ear, suggesting outer hair cell dysfunction, while they were present in the left ear. Auditory brainstem response revealed the absence of wave V at 90 dB nHL using both click and 500 Hz Tone Burst stimuli in the right ear, which supported cochlear pathology, while wave V was obtained till 30 dB nHL using the click stimulus in the left ear, which showed normal hearing. In addition, balance evaluation was also carried out by evaluating the Vestibular evoked myogenic potentials (VEMP) and the functional head impulse test, which revealed right-sided hypo-function of the vestibular system. The management option provided was a hearing aid, in which the aided responses were observed to be within the speech spectrum and a speech perception score of 72%.\u003c/p\u003e \u003cp\u003eConclusion\u003c/p\u003e \u003cp\u003eThis case highlights the importance of a comprehensive audiovestibular evaluation in the pediatric population presenting with sudden hearing loss after mumps infection. Early identification and timely rehabilitation are essential to minimise long-term communicative and developmental consequences.\u003c/p\u003e","manuscriptTitle":"When Mumps Silences an Ear: Audiovestibular Findings in Sudden Unilateral Hearing Loss – A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-24 15:01:49","doi":"10.21203/rs.3.rs-9138936/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d9757eb-2bc5-4950-9ae2-c928ca591603","owner":[],"postedDate":"March 24th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-15T13:54:53+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T14:10:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-24 15:01:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9138936","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9138936","identity":"rs-9138936","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}