Tinnitus is the medical term for perceiving sound when no external source is present, most commonly described as a ringing, buzzing, hissing, or roaring in the ears. This auditory phenomenon arises from altered neural activity, usually resulting from damage or changes within the auditory system. Since the start of the COVID-19 pandemic, many individuals have reported the onset or worsening of this symptom during or following a SARS-CoV-2 infection. This connection has prompted investigation into whether the virus directly causes this auditory disturbance or if other factors related to the infection are involved.
Establishing the Link and Prevalence
Current research strongly supports an association between COVID-19 infection and the development of tinnitus. Studies show a significant percentage of recovered individuals experience this symptom. Early reviews suggested that up to 14.8% of people infected reported tinnitus.
More recent surveys of former COVID-19 patients found the prevalence of post-infection tinnitus to be around 27.9%. For those dealing with “Long COVID,” where symptoms persist for months, rates are higher, estimated between 20% and 40% in some populations. While tinnitus is less common than respiratory issues, these findings indicate the viral infection can trigger an auditory response in a substantial number of people.
Potential Biological Mechanisms
The scientific community has identified several plausible pathways through which SARS-CoV-2 may trigger or exacerbate tinnitus. One leading theory involves the massive inflammatory response the body mounts against the virus, often called a “cytokine storm.” These elevated inflammatory molecules (cytokines) can travel through the bloodstream and potentially damage the delicate structures of the inner ear.
This systemic inflammation is thought to create neuroinflammation and central sensitization in the brain’s auditory pathways. When the nervous system is hyper-reactive, it can amplify existing tinnitus or trigger its onset, even without ongoing ear damage. Tinnitus, in this context, may result from the brain processing sensory signals differently after an inflammatory event.
Another proposed mechanism centers on the virus’s ability to affect the vascular system. SARS-CoV-2 is known to cause microvascular damage and promote micro-clot formation throughout the body. If these clots or vascular restrictions occur in the blood vessels supplying the cochlea or auditory nerve, restricted blood flow could starve auditory cells of oxygen and nutrients. This leads to cell dysfunction and the resulting phantom sound of tinnitus.
A less common possibility is the direct invasion of inner ear cells by the virus. SARS-CoV-2 exhibits neurotrophic properties, meaning it can affect nervous tissue. Direct viral action or the subsequent inflammatory response within the ear could injure the hair cells or auditory nerve fibers, leading to the perception of ringing.
Differentiating Causes
Not all cases of tinnitus experienced during a COVID-19 infection are necessarily caused by the virus itself. Many patients received medications known to possess ototoxic properties, meaning they can damage the inner ear or auditory nerve. Several antivirals and other drugs used early in the pandemic, such as chloroquine, hydroxychloroquine, azithromycin, and remdesivir, are potentially ototoxic agents.
The toxic effects of these medications can mimic viral-induced tinnitus. For instance, drugs like hydroxychloroquine can interfere with potassium channel function in the outer hair cells of the cochlea, temporarily altering inner ear function and causing auditory symptoms. In these instances, tinnitus is a treatment side effect, not a direct consequence of the infection.
The psychological toll of severe illness, combined with the stress and isolation associated with the pandemic, also plays a significant role. Tinnitus has a well-established link with high levels of anxiety, stress, and emotional distress. The psychological burden of being severely ill could easily trigger the onset or exacerbation of pre-existing tinnitus, without biological action from the virus.
Prognosis and Management
For many individuals, tinnitus related to acute COVID-19 is a transient symptom that resolves as the patient recovers. However, for a subset of patients, the symptom persists, becoming part of the post-COVID conditions often called “Long COVID.” The prognosis is often linked to the initial severity of the auditory complaint.
Patients reporting more severe or intrusive tinnitus immediately following infection tend to have lower rates of spontaneous recovery and may require more involved management. If the tinnitus is sudden in onset or accompanied by a noticeable change in hearing, prompt consultation with an audiologist or an otolaryngologist is recommended. Sudden sensorineural hearing loss often requires urgent intervention to maximize recovery chances.
Management techniques focus primarily on reducing sound perception and helping the brain habituate to the noise. Sound therapy, which involves using low-level background sounds like white noise, nature sounds, or masking devices, can help divert attention from the internal ringing. Addressing underlying factors like stress and anxiety through behavioral therapies is also helpful. For persistent cases linked to neuroinflammation, specialized treatments targeting neurological drivers may be explored.