COVID-19 infection can affect the auditory and vestibular systems, resulting in a range of ear-related issues often referred to as “COVID ear.” These symptoms can manifest during the acute illness or emerge weeks later. Understanding the typical timelines for these auditory and balance problems is important, as the persistence of these symptoms varies widely among individuals. While many ear symptoms resolve quickly, a subset of people experience problems that can linger for months, impacting their quality of life.
Defining COVID-Related Ear Symptoms
COVID-19 infection is associated with several specific auditory and balance complaints. Tinnitus, the perception of sound where none is present, is a frequent symptom, often described as ringing, buzzing, or hissing in the ears. This internal sound can be intermittent or continuous. Another common issue is aural fullness, a sensation of pressure, blockage, or “clogged ears,” typically linked to fluid build-up behind the eardrum. Some people experience otalgia, or ear pain, which is often a secondary effect of congestion and inflammation in the upper respiratory tract. Additionally, the virus can affect the vestibular system, leading to symptoms like vertigo or dizziness, which impair balance and coordination.
Typical Duration and Timelines
The duration of COVID-related ear symptoms falls into distinct time frames, depending on the underlying cause and the individual’s overall health. The majority of ear symptoms are acute, resolving within days or up to four weeks, often aligning with the duration of the initial respiratory illness. Symptoms like aural fullness and ear pain, frequently caused by sinus and Eustachian tube congestion, typically clear up as the upper respiratory inflammation subsides. Most patients who experienced ear pain saw complete resolution within two weeks.
A subacute phase covers symptoms that persist for four to twelve weeks following the initial infection. While many symptoms diminish during this period, a small percentage of individuals find their symptoms, particularly tinnitus and dizziness, continue. Current research suggests that between 4% and 15% of patients with COVID-19 report new-onset tinnitus, and a significant portion of these cases may last beyond the acute phase.
Symptoms lasting more than twelve weeks are categorized as persistent or chronic, often associated with post-COVID conditions, or “Long COVID.” Tinnitus and vertigo are the most frequently reported ear-related symptoms in this group. Studies of Long COVID patients, for example, have found that up to 30% report tinnitus and 60% report vertigo or dizziness, sometimes lasting many months.
Underlying Causes of Ear Dysfunction
The reasons behind COVID-19’s impact on the ear are complex, primarily involving three biological mechanisms.
Generalized Inflammation
A primary cause is generalized inflammation stemming from the body’s systemic response to the virus. This inflammatory process can lead to swelling and fluid buildup, particularly affecting the Eustachian tubes, which connect the middle ear to the back of the throat. Eustachian tube dysfunction creates pressure changes that result in aural fullness and temporary hearing changes.
Direct Viral Interaction
Another mechanism involves a direct viral interaction, where the SARS-CoV-2 virus may affect the delicate structures of the inner ear or the auditory nerve tissue. Evidence suggests the virus may infect inner ear cells, including the hair cells responsible for hearing. This neurotropic capability could explain the onset of severe symptoms like sudden sensorineural hearing loss or persistent tinnitus.
Vascular Issues
The third factor is vascular issues, where inflammation may impact blood flow to the inner ear. COVID-19 is known to cause a hypercoagulable state, meaning an increased tendency for blood clotting, which can obstruct the microvasculature supplying the cochlea and semicircular canals. This reduced blood supply can damage inner ear tissues, contributing to symptoms such as vertigo and hearing loss.
When to Seek Medical Attention and Management
Individuals should seek medical attention immediately if ear symptoms are severe or progress beyond the expected acute timeline. This includes sudden, severe hearing loss, intense vertigo that makes standing difficult, or symptoms that are rapidly worsening. A doctor’s visit is also warranted if ear pain or aural fullness persists beyond the subacute period of four to twelve weeks, suggesting a potential Long COVID symptom or a secondary issue.
Management strategies often focus on reducing inflammation and congestion, such as using over-the-counter decongestants to help clear the Eustachian tubes. For persistent symptoms, a healthcare provider may recommend a short course of oral steroids or, for sudden hearing loss, the administration of steroids directly to the eardrum. A referral to a specialist, such as an Otolaryngologist (ENT) or an audiologist, may be necessary for diagnostic testing and specialized interventions like sound therapies for chronic tinnitus.