No—Chest Pain Does Not Cause Hearing Loss
Chest pain and hearing loss are unrelated symptoms that do not share a causal relationship. When these two symptoms occur together, they represent either coincidental separate conditions or are both manifestations of a rare systemic process such as migraine-related vasospasm.
Why These Symptoms Are Unrelated
Chest pain arises from cardiac, pulmonary, gastrointestinal, musculoskeletal, or psychiatric causes—none of which have anatomic or physiologic connections to the auditory system. The most common cardiac cause is acute coronary syndrome (20% of general practice presentations), while musculoskeletal causes account for 43% of chest pain in primary care. 1
The cochlear vasculature and cardiac/thoracic structures operate in completely separate vascular territories with no shared blood supply that would allow chest pathology to directly affect hearing. 2
Life-threatening causes of chest pain—including acute coronary syndrome, aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture—do not produce hearing loss as part of their clinical presentation. 1
The Single Exception: Migraine-Related Vasospasm
Migraine with vasospasm can simultaneously affect both cochlear and coronary circulation, producing sudden hearing loss alongside chest pain as separate manifestations of the same vasospastic episode. In one case series, 13 patients with unexplained sudden hearing loss met diagnostic criteria for migraine and experienced concurrent neurologic phenomena including chest pain, vertigo, amaurosis fugax, and hemiplegia—all attributed to vasospasm. 2
This represents an extremely rare scenario where both symptoms stem from a shared underlying mechanism (vasospasm) rather than one causing the other. 2
Clinical Approach When Both Symptoms Coexist
Immediate Life-Threatening Exclusion (First 10 Minutes)
Obtain a 12-lead ECG within 10 minutes to identify ST-elevation myocardial infarction, new ischemic changes, or other acute cardiac pathology. 1
Measure high-sensitivity cardiac troponin immediately as it is the most sensitive biomarker for myocardial injury. 1
Assess vital signs including heart rate, respiratory rate, oxygen saturation, and bilateral arm blood pressures to detect hemodynamic instability or pulse differentials suggestive of aortic dissection. 1
Evaluate Each Symptom Independently
Chest pain evaluation should follow standard algorithms: rule out acute coronary syndrome, aortic dissection, pulmonary embolism, pneumothorax, and pericarditis before considering benign causes such as costochondritis (43% of non-cardiac chest pain in primary care) or gastroesophageal reflux disease (10-20% of outpatient chest pain). 1, 3
Sudden hearing loss evaluation should assess for viral labyrinthitis, acoustic neuroma, Meniere's disease, or ototoxic medication exposure—none of which are related to chest pathology. 2
Consider Migraine Only After Exclusion of Emergencies
If both cardiac workup is negative AND the patient has a personal or family history of migraine, consider vasospasm as a unifying diagnosis, particularly if other vasospastic phenomena (vertigo, visual aura, transient neurologic deficits) are present. 2
A trial of antispasmodic agents may be considered in this rare scenario after life-threatening causes are excluded. 2
Critical Pitfalls to Avoid
Do not attribute hearing loss to chest pain or vice versa—these symptoms require separate diagnostic pathways unless migraine with vasospasm is strongly suspected based on additional clinical features. 2
Do not delay cardiac evaluation to investigate hearing loss; chest pain mandates immediate exclusion of life-threatening cardiac and thoracic emergencies. 1
Do not assume a normal physical examination excludes acute coronary syndrome—uncomplicated myocardial infarction can present with entirely normal findings. 1, 3