Hearing Loss From COVID: Causes, Symptoms, and What to Do

COVID-19 can damage hearing through several routes, including direct infection of inner-ear cells, widespread inflammation, disrupted blood flow to the cochlea, and immune-mediated injury. A large population-based study of young adults found the risk of hearing loss was roughly three-fold higher in people who had COVID-19 compared to those who did not, and sudden sensorineural hearing loss showed a similar increase.¹ That elevated risk, the variety of mechanisms involved, and the fact that hearing changes sometimes appear weeks after the initial infection make this a more complex story than a simple viral cold affecting the ear.

How the Virus Reaches the Inner Ear

Your inner ear is a tiny, fluid-filled structure buried deep in the skull, and for a long time researchers debated whether SARS-CoV-2 could actually get there. A study using human inner-ear tissue confirmed that cells in the cochlea carry the ACE2 receptor, along with two co-factors the virus needs to break in.² In other words, the virus has a molecular key that fits the lock on inner-ear cells. Once inside, it can damage the delicate hair cells that convert sound vibrations into nerve signals, or harm the blood vessels that supply them with oxygen.

Direct viral invasion is not the only pathway. The intense immune reaction COVID-19 triggers, sometimes called a cytokine storm, can cause collateral damage. Overactive immune cells in the brain and auditory nerve may inflame the tissue that carries sound signals, harming the auditory glial cells that support those nerve fibers.³ Blood-flow disturbances are another contributor; the cochlea depends on a single, tiny artery, and COVID-19’s tendency to cause clotting and vascular inflammation can choke off that supply. These mechanisms can act alone or in combination, which is partly why the severity and pattern of hearing loss varies so much from person to person.⁴

What the Hearing Loss Actually Sounds Like

The type of hearing loss most closely linked to COVID-19 is sensorineural, meaning the problem sits in the inner ear or auditory nerve rather than in the ear canal or eardrum. You might notice sounds seem muffled on one side, or speech becomes harder to follow in a noisy room. Some people wake up one morning with sudden, dramatic hearing loss in one ear, a condition called sudden sensorineural hearing loss (SSNHL). In a database study covering roughly a year of the pandemic, 234 people were newly diagnosed with sensorineural hearing loss within about a year of a confirmed COVID-19 infection.⁵

Most ear-related symptoms show up within the first month of COVID-19. A scoping review found that about two-thirds of patients who experienced hearing loss did so within that window, while tinnitus appeared that quickly in roughly nine out of ten affected patients.⁶ But hearing changes can also emerge later, as part of long COVID, sometimes in people whose original infection was mild.

Tinnitus and How It Connects

Tinnitus, the perception of ringing, buzzing, or hissing without any external sound, is one of the most commonly reported ear symptoms after COVID-19. In a survey of over 1,300 people who had been infected, roughly 28 percent developed tinnitus following their illness.⁷ Of those, about a third had severe tinnitus, and severity predicted worse treatment outcomes: people with the worst grades of tinnitus were far less likely to improve with standard management compared to those with mild ringing.

People who already had tinnitus before catching COVID were about twice as likely to experience it again afterward.⁷ An interesting wrinkle is that some patients develop severe tinnitus without any measurable hearing loss on standard tests, suggesting the virus can disrupt auditory processing at a level standard audiograms do not capture.⁸ For those people, the problem seems to sit deeper in the nervous system rather than in the hair cells of the cochlea.

Dizziness and Balance Problems

The inner ear does not just handle hearing; it also controls your sense of balance. COVID-19 can affect the vestibular portion of the inner ear, leading to dizziness or true spinning vertigo. Among 185 patients who recovered from COVID-19, about 18 percent reported balance problems afterward, mostly dizziness, with a small fraction experiencing acute vertigo attacks.⁹ Some of those patients also had tinnitus alongside the balance issues, consistent with the idea that the virus can hit multiple parts of the inner ear at once.

Balance symptoms tend to appear somewhat later than hearing loss or tinnitus. The scoping review mentioned earlier found that only about 30 percent of dizziness cases showed up within the first month, compared to the much higher early-onset rates for hearing changes and tinnitus.⁶ If you had COVID weeks or even a couple of months ago and have recently started feeling unsteady or experiencing brief spinning episodes, the infection is still a plausible culprit.

When Standard Hearing Tests Come Back Normal but You Still Cannot Hear Right

One of the more frustrating aspects of COVID-related hearing problems is that a standard hearing test, pure tone audiometry, sometimes misses what is going on. Several studies have found that patients report clear subjective hearing difficulties after COVID-19, yet their basic audiogram looks normal or unchanged from before their infection.¹⁰ The disconnect likely reflects damage to parts of the auditory system that standard tests are not designed to detect: the auditory nerve’s speed of transmission, the brain’s higher-order processing of sound, or the cochlea’s performance at extended high frequencies that conventional audiometry does not cover.

More advanced tests can pick up these hidden problems. Extended high-frequency audiometry has revealed elevated thresholds in long-COVID patients. Otoacoustic emissions testing, which measures sounds generated by healthy outer hair cells, has shown reduced output. Auditory brainstem response (ABR) testing has found increased latencies, meaning the nerve signals are traveling more slowly than normal. One study showed that people with long COVID had significantly greater delays in the wave V response of the ABR when faster click rates were used, and that delay correlated with self-reported cognitive fatigue.¹¹ Post-COVID adults have also shown signs of central auditory processing disorder, where the ear itself is fine but the brain struggles to interpret what it receives.¹²

If your hearing feels off after COVID but your audiogram is normal, it is worth asking about these more specialized tests. A normal basic audiogram does not necessarily mean your auditory system is functioning perfectly.

Will the Hearing Come Back?

This is the question most people want answered, and the honest answer is: usually, but not always. In one institutional study that followed 20 patients with post-COVID sensorineural hearing loss, 65 percent had recovered completely at one month. By three months that rose to 90 percent, and by six months only one patient, or 5 percent, was left with permanent hearing loss.¹³ Those numbers are encouraging, though this was a small study and the recoveries were likely helped by prompt treatment.

A systematic review of COVID-related sudden hearing loss cases painted a more mixed picture. Among 23 cases treated primarily with glucocorticoids, about 9 percent recovered completely, just over half improved partially, and about a quarter saw no improvement at all.¹⁴ The severity of the initial hearing loss, the timing of treatment, and whether the damage was to the hair cells versus the nerve all seem to affect outcomes. Hearing loss can also be the only lingering symptom of COVID or appear as a late complication of long COVID, sometimes showing up in people who seemed to have fully recovered from the acute illness.¹⁵

Treatment Options

Speed matters. Corticosteroids, given either by mouth or injected directly through the eardrum, are the standard first-line treatment for sudden sensorineural hearing loss, whether COVID-related or not. In one study of post-COVID patients treated with oral prednisolone, 65 percent showed complete recovery at one month, and the authors noted that starting treatment within the first two weeks was associated with better outcomes.¹⁶ Some treatment protocols add hyperbaric oxygen therapy, which aims to increase oxygen delivery to the damaged cochlea.¹⁷

For people whose hearing does not recover with acute treatment, hearing aids and cochlear implants are the standard long-term options.⁵ The key takeaway is not to wait. If you notice sudden hearing loss in one or both ears during or after a COVID infection, treat it as a medical urgency. Seeing an ear, nose, and throat specialist within days, not weeks, gives you the best shot at recovery.

Could the Medications Themselves Be to Blame?

Early in the pandemic, several drugs used to treat COVID-19 carried known risks of ototoxicity, meaning they could damage hearing on their own. Hydroxychloroquine, azithromycin, remdesivir, favipiravir, and lopinavir all have documented potential for ototoxic side effects.¹⁸ Most of these drugs have since fallen out of routine COVID treatment, but the concern remains relevant for anyone who received early-pandemic regimens, or for people taking combinations of medications where ototoxic effects might compound. If your hearing worsened during active COVID treatment, it is worth discussing whether the drugs themselves may have contributed.

People With Pre-Existing Hearing Loss

If you already had some degree of hearing loss before catching COVID-19, the infection may make it measurably worse. Data from patients who had audiometric records before and after infection showed that average hearing thresholds increased by about 7 decibels in both ears after COVID-19, a statistically significant worsening.¹⁹ Seven decibels does not sound like much on paper, but for someone already straining to hear, it can meaningfully change daily function and may require a hearing aid adjustment.

The Emotional and Quality-of-Life Toll

Hearing loss and tinnitus are not just ear problems; they reshape daily life. A study comparing tinnitus sufferers before and after COVID-19 infection found that loudness ratings, annoyance scores, and overall quality of life all worsened significantly after the illness. Physical function, social engagement, emotional well-being, and even pain ratings all took a hit.²⁰ The combination of newly impaired hearing, persistent ringing, and the general fatigue and cognitive fog of long COVID creates a compounding effect where each symptom makes the others harder to manage. People dealing with post-COVID hearing symptoms should know that asking for help with the psychological burden is as reasonable as seeking treatment for the ear itself.

Children and COVID-Related Hearing Loss

Most of the research focuses on adults, but children are not immune. Case reports have documented sudden sensorineural hearing loss in children following COVID-19 infection, with the affected children showing severe, unilateral loss across all frequencies on audiometry.²¹ Because children are less likely to report subtle hearing changes on their own, pediatricians have been urged to stay alert to ear and balance complaints in children who have recently had COVID-19.²² A young child who has started turning the television louder, frequently asking “what?” or seeming inattentive after a COVID infection deserves a hearing evaluation.

Infection Versus Vaccination

You may have heard concerns about hearing loss after COVID vaccination. A large retrospective study directly compared the two and found that COVID-19 infection carried higher odds of hearing loss than mRNA vaccination did, while mRNA vaccination was associated with somewhat higher odds of tinnitus compared to infection.²³ In practical terms, both the infection and the vaccine can affect the ear, but the infection appears to be the bigger threat to hearing itself. Reports of vaccine-related sudden hearing loss exist but are rarer and often resolve. This does not mean vaccine side effects should be dismissed, but it does put the risk in perspective for anyone weighing the two.

Autoimmune Mechanisms and Delayed Damage

One of the more unsettling possibilities is that the immune system, once activated by SARS-CoV-2, turns on the ear’s own tissue even after the virus is gone. This concept, known as molecular mimicry, occurs when antibodies developed to fight the virus happen to recognize proteins in the inner ear as well, attacking them as if they were foreign. The inner ear’s own immune system, centered in a structure called the endolymphatic sac, can sustain this misdirected response after the initial injury or inflammation has passed.²⁴ This may help explain why some people develop hearing changes weeks or months after an apparently mild infection: the virus itself may be long cleared, but the immune response it triggered keeps smoldering.

COVID-19 has also been linked to reactivation of dormant viruses like varicella-zoster, the virus behind chickenpox and shingles. When that reactivation involves the facial nerve near the ear, it can produce Ramsay Hunt syndrome, which often includes hearing loss, ear pain, tinnitus, and vertigo alongside facial paralysis.²⁵ Cases have been reported even in people whose COVID-19 infection was asymptomatic, suggesting that the immune disruption alone can be enough to awaken a latent virus.

What You Should Actually Do

If you notice any change in your hearing, new tinnitus, or unexplained dizziness during or after a COVID-19 infection, do not assume it will sort itself out. The evidence consistently points to better outcomes with early treatment, ideally within the first two weeks of symptom onset. Here is a practical sequence:

See a specialist fast: An ENT doctor or audiologist can run the tests needed to identify the type and degree of damage. Ask about extended high-frequency audiometry and otoacoustic emissions if your basic audiogram is normal but your hearing feels wrong.
Discuss steroids early: Systemic or intratympanic corticosteroids are the front-line treatment for sudden sensorineural hearing loss, and timing is critical.
Mention your COVID history: Hearing loss can be the only symptom of COVID-19 or the first sign of long COVID. Your clinician needs to know the timeline.
Get a baseline if you haven’t: For anyone with a history of COVID, having a documented audiometric baseline makes it far easier to detect future changes. Researchers have recommended that hearing diagnostics be performed routinely in patients after COVID-19.¹⁵
Watch children closely: Kids may not articulate hearing changes. Behavioral signs like inattention, louder media volume, or frequent requests to repeat are worth investigating with formal testing.

For persistent hearing loss that does not respond to medical treatment, modern hearing aids and cochlear implants are effective rehabilitation options. And for tinnitus specifically, cognitive behavioral therapy, sound therapy, and tinnitus retraining therapy have all shown benefit in managing the distress it causes, even when the ringing itself does not fully resolve.

1
The Lancet Regional Health. Association of COVID-19 with hearing loss and sudden sensorineural hearing loss in young adults: a nationwide population-based cohort study
2
PubMed Central. Direct SARS-CoV-2 infection of the human inner ear may underlie COVID-19-associated audiovestibular dysfunction
3
Canadian Journal of Neurological Sciences. Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis
4
PubMed Central. Sudden Hearing Loss Waves: The Effect of COVID-19 Infection and Vaccination on the Inner Ear
5
PubMed Central. Sensorineural Hearing Loss as a Complication of COVID-19 and the COVID-19 Vaccine
6
PubMed Central. Otologic and vestibular symptoms in COVID-19: A scoping review
7
PubMed Central. Prevalence and prognosis of tinnitus in post-COVID-19 patients: a cross-sectional survey
8
PubMed Central. New onset tinnitus in the absence of hearing changes following COVID-19 infection
9
PubMed Central. Long COVID, audiovestibular symptoms and persistent chemosensory dysfunction: a systematic review of the current evidence
10
PubMed Central. Audiovestibular Dysfunction Related to Long COVID-19 Syndrome: A Systematic Review of Characteristics, Pathophysiology, Diagnosis, and Management
11
Scientific Reports. Altered auditory brainstem responses are post-acute sequela of SARS-CoV-2 (PASC)
12
The Egyptian Journal of Otolaryngology. Central auditory functions in post-COVID-19 adults; a case control study
13
PubMed Central. Irreversible Sensorineural Hearing Loss in Post Covid-19 Patients-An Institutional Prospective Study
14
Frontiers in Neurology. COVID-19 and Sudden Sensorineural Hearing Loss: A Systematic Review
15
PubMed Central. Sensorineural Hearing Loss in Patients with Long-COVID-19: Objective and Behavioral Audiometric Findings
16
The Egyptian Journal of Otolaryngology. Effectiveness of oral corticosteroids (prednisolone) in sensorineural hearing loss post COVID-19
17
PubMed Central. Sudden Sensorineural Hearing Loss in Mild Covid-19: Case Series and Analysis of the Literature
18
PubMed Central. Don’t forget ototoxicity during the SARS-CoV-2 (Covid-19) pandemic!
19
Hearing Review. COVID-19’s Effect on Pre-existing Hearing Loss
20
PubMed Central. The Effects of COVID-19 on Tinnitus Severity and Quality of Life in Individuals With Subjective Tinnitus
21
PubMed Central. The First Cases of Sudden Sensorineural Hearing Loss Post Coronavirus Disease in Children
22
International Journal of Contemporary Pediatrics. Hearing loss, tinnitus and vertigo among pediatric patients with COVID-19 infections: a review
23
PubMed. Auditory complications of COVID-19 infection and vaccination: a TriNetX retrospective cohort study
24
International Journal of Medical Sciences. Investigating the Process of Autoimmune Inner Ear Disease: Unveiling the Intricacies of Pathogenesis and Therapeutic Strategies
25
PubMed Central. Ramsay Hunt Syndrome in Asymptomatic COVID-19 Infection: A Case Report and a Literature Review