COVID-19 and tinnitus: What’s the connection?Will coronavirus cause ringing in the ears? Some people report ringing in the ears after a COVID-19 infection. But is it the virus or something else? We look into the research. 2021 1168 COVID-19 and tinnitus: What’s the connection? https://www.healthyhearing.com/report/53206-Covid-tinnitus-and-coronavirus
Late in October 2020, Paula Wheeler, who lives in central Kentucky, came down with COVID-19—a severe case that led to high fever, pneumonia, and time in the hospital, and week after week of rolling symptoms. It wasn’t until March, five months after her initial diagnosis, that Wheeler first noticed the tinnitus.
The ringing in her ears is a bit like the buzz of an old-time TV, Wheeler says. It’s unrelenting. “I've got that in my head in both ears all the time,” she says.
Wheeler isn’t alone in experiencing tinnitus after recovering from COVID-19.
In a systematic review of hearing-related symptoms post-coronavirus, nearly 15 percent of patients reported tinnitus, although it’s worth noting that this figure may be an overestimate, per the study authors.
Here, a look at the potential connection between COVID-19 and tinnitus.
What is tinnitus, exactly?
Tinnitus is typically described as ringing in the ears, but as Wheeler notes, it can also present as buzzing or other sounds. This unpleasant sensation is common: About 45 million Americans are affected by tinnitus at some point in their life, per the American Tinnitus Association.
There are many risk factors—from hearing loss to sinus infections to hormonal changes to medications—that can lead to tinnitus. Stress may play a role, too, exacerbating symptoms or potentially even contributing to them, per a study in Clinical Practice & Epidemiology in Mental Health.
And, of particular note given the potential connection to COVID-19, other viral infections can cause tinnitus and hearing loss, such as mumps.
There’s no cure for tinnitus, although treatments, which vary depending on the cause of the symptom, can help.
So, does COVID-19 cause tinnitus?
As with so many things having to do with COVID-19, there’s much that remains to be discovered and understood.
Here’s what we do know: The novel coronavirus affects other organs and systems beyond the respiratory system, says Kevin Munro, Au.D., a professor of audiology at the UK's Manchester Center for Audiology and Deafness. Munro served as senior author of the systematic review on the evidence around COVID-19 and hearing symptoms.
So there’s a logic to SARS-CoV-2 (the virus that causes COVID-19) having a link to tinnitus and other hearing issues. Especially when the virus causes lots of upper respiratory symptoms, putting pressure on the ears. This is more likely with the Delta variant.
Early in the pandemic, Munro and other researchers looked for audio-vestibular symptoms associated with coronaviruses. There were “rare” reports from people with COVID-19 of audio-vestibular symptoms, but none related to severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS). “We never found any literature linking any of the other coronaviruses,” Munro says.
In December 2020, Munro decided to revisit the research, looking again for more literature on COVID-19 and hearing. This led to the systematic review, which found an estimated:
The evidence is better than the original systematic review, which included only seven studies, Munro says. “But it's still not great,” he says. The “confidence interval” for those estimates is high (meaning the true prevalence might be far higher or lower in reality).
The quality of the studies, which lack control groups, is not high, he notes.
Ideally, studies compare two groups, looking for a difference. For example, a study might look at people who were hospitalized for any reason as well as people hospitalized for COVID-19 and see if the patients with coronavirus were more likely to have tinnitus.
Many things can cause tinnitus
Even if there is a connection between COVID-19 and tinnitus, that still doesn’t reveal the precise cause. Tinnitus could be an indirect consequence of the virus, Munro notes.
For example, treatment methods for the coronavirus, time spent in the hospital (which often leads to an array of symptoms, including brain fog), being on oxygen, and other factors might play a role, Munro says.
And don’t discount stress as a factor: Lost loved ones, unemployment, financial difficulties, and strained circumstances have transformed people’s lives during the pandemic.
“We're all a bit stressed and anxious and if you're not sleeping well people will often report tinnitus,” Munro says.
For people who already had tinnitus, getting COVID-19 might make the symptoms worse. A study published in Frontiers in Public Health surveyed more than 3,000 people with pre-existing tinnitus from 48 countries. “Having COVID-19 symptoms exacerbated tinnitus in 40% of respondents,” the study authors write. And for many respondents, pandemic-related issues—such as financial concerns, reduced activity, and poor sleep—worsened tinnitus symptoms.
What about hearing loss?
We've put together a separate report on COVID-19 and hearing loss. Research indicates that the virus is linked to hearing loss, for some people, though it appears rare.
'It's a lonely road'
As Munro notes, more studies, and well-designed ones, are needed to uncover a potential connection.
More insight might lead to evolving treatment tactics. And, if there is a connection, hearing-related services might see an uptick in patients, Munro notes.
Plus, with more studies, people will gain peace of mind, Wheeler says. Munro’s received about 200 emails since his systematic review went live, and many of them are from people with tinnitus. “They're relieved to hear that they're not the only ones,” Munro says.
“It's a lonely road that you walk,” Wheeler says. Connecting with other people experiencing tinnitus and other long-haul symptoms has reassured her the symptoms aren’t in her head, which can be a problem since doctors often dimiss tinnitus.
If you need help
If you have tinnitus or hearing loss, seeing your doctor or a hearing specialist for an evaluation is also a good idea. Find a tinnitus specialist near you by going to our directory of hearing care providers. Please note that not all hearing clinics treat tinnitus, so you may need to browse several clinic pages to find the right provider.
Before your first appointment, take note of your specific tinnitus symptoms, when they occur and what environments make them better or worse. For example, do you experience tinnitus spikes? This work ahead of time will prepare you for questions asked by the practitioner and ensure you get the most out of your evaluation.
More: Browse our full list of articles that discuss COVID-19, hearing loss and tinnitus.