COVID-19 is primarily known for its respiratory effects, but it can also impact various other bodily systems. While symptoms like cough and fever are widely recognized, the virus can manifest in less obvious ways, including affecting the ears.
Common Ear Symptoms
Individuals with COVID-19 have reported various ear-related symptoms. Tinnitus, often described as a ringing, buzzing, or hissing sound in the ears, is a commonly reported auditory symptom. Research indicates that approximately 14.8% of people infected with COVID-19 may experience tinnitus.
Hearing loss is another reported symptom, appearing in various forms. Sudden sensorineural hearing loss (SSNHL), which involves rapid hearing impairment often in one ear, has been observed in some cases. This type of hearing loss can range from mild to profound. While not as common as tinnitus, about 7.6% of COVID-19 patients have reported some form of hearing loss. Some studies suggest hearing loss can also be a long-term effect, appearing months after the initial infection.
Balance issues, such as vertigo and dizziness, are also connected to COVID-19. Vertigo, a sensation of spinning, was reported by about 7.2% of infected individuals. These symptoms can arise from the virus affecting the inner ear or the neurological pathways responsible for balance.
Less common, but reported, are ear pain and a sensation of ear fullness. Ear pain may occur due to inflammation or pressure changes within the ear. Ear fullness can stem from Eustachian tube dysfunction, where the tubes connecting the middle ear to the back of the nose become blocked due to congestion and inflammation.
How the Virus Impacts the Ear
The SARS-CoV-2 virus, which causes COVID-19, can impact the ear through several biological mechanisms. One involves direct viral invasion of ear tissues. The virus uses angiotensin-converting enzyme 2 (ACE2) receptors to enter human cells. These ACE2 receptors are present in various parts of the inner ear, including hair cells and Schwann cells in vestibular tissue. This suggests the virus may directly infect these delicate structures, potentially leading to auditory and vestibular dysfunction.
Another significant factor is the body’s inflammatory response. COVID-19 can trigger a systemic inflammatory response, sometimes leading to an overproduction of inflammatory proteins called cytokines. This heightened inflammation can cause damage to blood vessels and nerve tissues throughout the body, including those in the ear. Such inflammation can affect the cochlea and vestibular organs, which are highly sensitive to changes.
Vascular issues are also implicated in COVID-19-related ear problems. The virus can cause damage to blood vessels and lead to the formation of microclots. If these microclots or blood vessel damage affect the small arteries supplying blood to the inner ear, it can disrupt blood flow to the cochlea (hearing organ) and vestibular organs (balance organs). This reduced blood supply can impair the function of these structures and contribute to hearing loss or balance problems.
The virus can also have neurological effects that extend to the auditory and vestibular nerves. Some research suggests SARS-CoV-2 has neurotropic properties, meaning it can affect the nervous system. Damage or inflammation of the auditory nerve, which transmits sound information to the brain, or the vestibular nerve, which helps with balance, could lead to hearing loss, tinnitus, or vertigo. These mechanisms highlight the complex ways COVID-19 can affect the auditory system.
When to Seek Medical Care
Seek medical attention if you experience new or worsening ear symptoms during or after a COVID-19 infection. Sudden hearing loss, especially if it occurs rapidly in one ear, warrants immediate evaluation by a healthcare professional. Early treatment with corticosteroids can improve outcomes for sudden sensorineural hearing loss.
Consult a doctor if you experience severe vertigo or persistent tinnitus. While some ear symptoms may resolve on their own, those that significantly impact daily life or do not improve should be assessed. A healthcare provider can determine the underlying cause of your symptoms and recommend appropriate management.
Avoid self-diagnosing COVID-related ear issues or attempting self-treatment. A medical professional can rule out other potential causes for your ear problems, including conditions unrelated to COVID-19. They can also provide guidance on specific treatments, such as therapies for tinnitus or interventions for hearing loss. Follow-up care is important to monitor recovery and manage any ongoing effects.