Tinnitus, the perception of noise like ringing, buzzing, or hissing when no external sound is present, has long been recognized as a common auditory concern. Following the onset of the COVID-19 pandemic, an association emerged between SARS-CoV-2 infection and the development or worsening of this symptom. This auditory disturbance can manifest during the acute infection or appear weeks to months afterward, often as a component of long COVID. A primary concern for those affected is whether the noise will eventually subside.
Prevalence and Typical Resolution Timelines
Data indicates a clear link between COVID-19 infection and the onset of tinnitus, with studies reporting that between 4.5% and 27.9% of patients experience this symptom. This wide range reflects differences in study methodology and the patient population surveyed. For a substantial number of individuals, COVID-related tinnitus is temporary and resolves spontaneously over time.
Acute tinnitus associated with the initial infection frequently lasts for a few days or weeks, often subsiding as other viral symptoms clear. However, a significant group experiences persistent symptoms, categorized as long COVID when they continue for six months or longer. Prognosis for recovery is closely tied to initial severity. Those with milder cases are more likely to see a natural resolution without specific intervention. Conversely, individuals reporting more severe symptoms tend to have a poorer recovery outlook, suggesting the need for attentive management.
Proposed Biological Mechanisms
The precise ways SARS-CoV-2 triggers tinnitus are still under investigation, but current theories point toward several biological pathways. One leading explanation involves the body’s exaggerated inflammatory response, often referred to as a cytokine storm. These elevated inflammatory molecules can potentially impact the inner ear’s delicate structures, such as the cochlea or the auditory nerve, causing damage or dysfunction.
The virus may also exert a direct effect on the auditory system, as studies have shown SARS-CoV-2 can infect certain inner ear cells. This direct viral damage could disrupt the normal signaling processes required for hearing. Additionally, vascular changes related to the infection may play a role, particularly in long COVID cases. Abnormal blood clotting, including persistent microclots, can impair blood flow to the inner ear, which is highly sensitive to oxygen supply changes.
Another compounding factor relates to medications used during acute infection treatment. Certain drugs, such as some antibiotics or antimalarials administered early in the pandemic, are known to be ototoxic. Ototoxic drugs can cause temporary or permanent auditory damage, including tinnitus. It is also theorized that the intense stress, anxiety, and social isolation experienced during the pandemic may worsen or unmask pre-existing subclinical tinnitus.
Current Management Approaches
While waiting for potential spontaneous resolution, several non-clinical strategies can help patients manage the perception and distress caused by COVID-related tinnitus. Sound therapy, or masking, is a widely recommended approach involving introducing low-level background noise to reduce the contrast between silence and the internal ringing. This can be achieved using a fan, a dedicated sound machine, or apps that play nature sounds or white noise at a comfortable volume.
The long-term goal of management is often to achieve habituation, a process where the brain learns to filter out or ignore the tinnitus sound, making it less noticeable. Techniques derived from Tinnitus Retraining Therapy (TRT) and Cognitive Behavioral Therapy (CBT) focus on changing a person’s emotional reaction to the sound rather than trying to eliminate it. For individuals with measurable hearing loss, using hearing aids can help by amplifying external sounds, which naturally serves as a form of masking.
Lifestyle modifications are also important in reducing symptom intensity. Since stress and anxiety can exacerbate tinnitus, employing relaxation techniques and ensuring good sleep hygiene are beneficial practices. It is also helpful to identify and avoid common triggers like excessive caffeine intake, nicotine, or prolonged exposure to loud noise.
Signs Requiring Clinical Evaluation
While many cases of post-COVID tinnitus are not medically serious, certain accompanying symptoms warrant prompt consultation with a healthcare provider or an audiologist. Tinnitus that occurs only in one ear (unilateral tinnitus) should be evaluated to rule out specific underlying conditions. Similarly, the sudden or rapid onset of hearing loss alongside tinnitus requires urgent medical attention.
Pulsatile tinnitus, a rhythmical sound that beats in sync with the patient’s heart rate, should also be assessed by a clinician. This type of sound can signal a specific vascular issue needing diagnosis and targeted treatment. Other concerning signs include neurological symptoms, such as vertigo, dizziness, facial weakness, or difficulty swallowing, which indicate a need for further clinical investigation.