Tinnitus is the perception of sound—often described as ringing, buzzing, or roaring—in the absence of any external source. This common auditory sensation can arise from various underlying causes, including hearing loss or earwax buildup. Since the start of the pandemic, many individuals have reported the onset or worsening of tinnitus following a COVID-19 infection. This article examines the relationship between the SARS-CoV-2 virus and this condition.
The Established Link Between COVID-19 and Tinnitus
Clinical evidence has established an association between COVID-19 infection and the development of tinnitus. The symptom is documented both during the acute phase of illness and as a persistent issue in those with “Long COVID.” Prevalence estimates vary, but a significant number of patients report this auditory change after contracting the virus.
Studies suggest the prevalence of new or worsened tinnitus is around 8% of infected individuals. Among those diagnosed with Long COVID, the link is stronger, with reports indicating that 20% to over 40% of patients experience this symptom. Tinnitus may occur alone or alongside other inner ear issues like dizziness or hearing loss.
Many people with pre-existing tinnitus report that their symptoms became louder or more bothersome following their COVID-19 illness. This suggests the infection can act as a trigger, amplifying a previously manageable condition. For others, the experience of tinnitus is entirely new, emerging weeks or months after the initial respiratory symptoms have cleared.
Potential Biological Mechanisms of Damage
Several theories explain how the SARS-CoV-2 virus might cause or exacerbate tinnitus. These mechanisms generally involve the body’s reaction to the virus rather than a direct attack on the auditory system. Current research suggests three main pathways: systemic inflammation, direct viral invasion, and vascular issues affecting the inner ear.
Systemic Inflammation
Systemic inflammation is a primary hypothesis, involving the release of signaling molecules known as cytokines during the immune response. These inflammatory molecules can travel through the bloodstream and impact the delicate structures of the inner ear, including the nerves and sensory hair cells. Elevated inflammation may disrupt the function of these cells or the central auditory pathway, leading to the perception of sound.
Direct Viral Invasion
The potential for the SARS-CoV-2 virus to directly invade cells within the auditory system is also being investigated. Studies indicate that the virus may infect cells within the cochlea, the part of the inner ear responsible for hearing. Since the virus uses the ACE2 receptor to enter cells, and these receptors are present in the inner ear, this provides a possible route for direct damage.
Vascular Issues
Vascular issues represent a third mechanism, as COVID-19 is known to affect the circulatory system and increase the risk of blood clotting. The cochlea relies on a specialized blood supply to function correctly. Any disruption, such as microclots or reduced blood flow, can quickly damage the sensory cells. This localized oxygen deprivation could trigger the neural hyperactivity perceived as tinnitus.
Managing Acute and Persistent Symptoms
Managing tinnitus involves a combination of coping strategies and therapeutic approaches aimed at reducing the perception of the sound and the distress it causes. The first step often involves sound therapy, which uses external sounds to mask the internal noise or reduce the contrast between silence and the tinnitus. Simple tools like white noise machines, fans, or nature sound apps can provide constant background noise to help the brain tune out the ringing.
Cognitive Behavioral Therapy (CBT) and other habituation techniques are recommended for persistent symptoms. These therapies focus on changing the emotional response to the sound, rather than eliminating the sound itself. By reducing the anxiety and negative attention given to the tinnitus, the brain gradually learns to filter it out, lessening its impact on daily life.
Lifestyle adjustments also play a significant part in management, as stress and poor sleep are known triggers for worsening tinnitus. Moderating the intake of stimulants like caffeine and alcohol can sometimes help. Implementing stress-reduction practices, such as mindfulness or regular exercise, supports overall neural health and can contribute to symptom relief.
Medical interventions may also be necessary, starting with a thorough check for easily treatable physical causes. A healthcare provider can remove any earwax impaction, which can intensify symptoms. If hearing loss is identified alongside the tinnitus, using hearing aids may help by amplifying external sounds, which stimulates the auditory system and can reduce the perception of the internal noise.
When to Seek Medical Attention
While many cases of post-COVID tinnitus improve over time or are manageable with home strategies, certain indicators suggest the need for professional medical evaluation. Any sudden onset of tinnitus, especially if it is accompanied by a noticeable and rapid loss of hearing, requires immediate attention from an ear, nose, and throat specialist (otolaryngologist). Early treatment for sudden hearing loss is time-sensitive, with the best outcomes achieved when intervention begins within the first few days.
Tinnitus that is only perceived in one ear should also be evaluated quickly to rule out less common but serious underlying causes. Similarly, if the ringing sensation is pulsatile, meaning it beats in rhythm with your heart, a medical assessment is necessary to check for a potential vascular issue.
If the tinnitus is severely interfering with your quality of life, causing significant sleep disruption, anxiety, or depression, it is important to seek help. A healthcare provider can offer referrals for audiological evaluations, specialized sound therapy, or mental health support, ensuring that a comprehensive management plan is put in place.