Is Ringing in the Ears a Symptom of COVID?

Ringing in the ears, known as tinnitus, has been reported by a substantial number of people during and after COVID-19 infection. One cross-sectional survey of over 1,300 post-COVID patients found a tinnitus prevalence of about 28%, though estimates across studies range wildly depending on how and when the symptom was measured. The connection is real, but it turns out to be more tangled than a simple “the virus causes ringing.” Inner ear damage, brain inflammation, pandemic-era stress, and even the medications used to treat COVID all play a role, making it difficult to pin tinnitus on the virus alone.

How Common Is Tinnitus During and After COVID?

Estimates of COVID-related tinnitus vary enormously. A 2025 systematic review of 33 studies found that the prevalence of new tinnitus ranged from less than 1% to over 96%, a spread so wide it mostly reflects differences in study design, timing, and patient populations rather than a single reliable figure.¹ In a large post-COVID survey of 1,331 patients, about 28% developed tinnitus after their infection.² A study focused specifically on long COVID patients reported that 30% had tinnitus, with roughly one in five of those rating it severe.³

One pattern that stands out is a decline in post-COVID tinnitus over the course of the pandemic. A Brazilian study tracking cases through 2024 found the rate dropped from about 10% in 2020 to around 7% in 2021, 4% in 2022, and zero in 2023 and 2024.⁴ Whether that decline reflects changes in the virus itself, wider vaccination coverage, improved treatments, or some combination remains an open question.

How the Virus Could Directly Harm the Inner Ear

The inner ear is a delicate, heavily vascularized structure, and researchers have identified at least two plausible routes by which SARS-CoV-2 could damage it. The first is direct viral invasion. A study from MIT and Massachusetts Eye and Ear showed that human inner ear tissue carries the same cellular receptors the virus uses to enter the lungs and other organs. Specifically, hair cells and Schwann cells in the inner ear were found to express the necessary entry proteins, and in lab conditions the virus was able to infect those cell types.⁵ Hair cells are responsible for converting sound vibrations into nerve signals, so their infection or destruction could directly produce hearing problems and tinnitus.

The second route involves blood supply. The inner ear depends on tiny blood vessels that are vulnerable to the kind of inflammation and clotting abnormalities seen in COVID-19. When microcirculation to the cochlea is disrupted, the oxygen-hungry sensory cells can be damaged even without the virus physically reaching them.⁶ This vascular mechanism may explain why some patients develop sudden hearing loss alongside tinnitus, and why the damage sometimes appears weeks after the initial infection rather than right away.

Audiological testing has provided some objective evidence backing these mechanisms. One study examining COVID-19 patients found reduced function of the outer hair cells in the cochlea, even in patients who did not report major hearing symptoms.⁷ A separate study in Qatar showed that among COVID patients with tinnitus, nearly three-quarters had abnormal results on a test that measures outer hair cell function, and these abnormalities were far more common in patients with symptoms like fever and cough than in those who had asymptomatic infections.⁸ That finding suggests the severity of the overall infection matters: a worse systemic illness seems to correlate with greater cochlear impact.

The Brain’s Role in COVID-Related Ringing

Tinnitus is not always a problem that starts and ends in the ear. The brain’s auditory processing centers can generate the perception of sound even when no external stimulus exists, and SARS-CoV-2 appears capable of affecting those pathways too. One hypothesis draws on the virus’s known ability to invade the olfactory area of the brain. Because the olfactory and auditory regions are anatomically close, researchers have speculated that the same inflammatory process that steals people’s sense of smell could spill over into auditory circuits, producing transient hearing symptoms or tinnitus.⁹

Brain imaging and neural network analysis are starting to add weight to this idea. A pilot study using graph-based modeling found that patients who developed sudden hearing loss and tinnitus after COVID showed distinct patterns of neural rewiring compared to patients who developed the same symptoms without a COVID history. The COVID group showed reduced connectivity in brain networks involved in attention and self-awareness, and those changes correlated with tinnitus severity.¹⁰ The research is still early, but it points to COVID-related tinnitus as a phenomenon that can involve genuine central nervous system changes, not just ear damage.

When Tinnitus Lingers After Recovery

For some people the ringing stops as the infection clears. For others it persists well past what anyone would call the acute illness. In one cohort study, tinnitus tended to appear about a month after the onset of other COVID symptoms, suggesting it is often a delayed complication rather than an early one. When those patients were followed for an average of roughly 259 days, a third had fully recovered, another third saw some improvement, and the remaining third reported no change at all.¹¹

A systematic review of healed COVID patients found similar patterns. Among 21 patients with post-COVID tinnitus followed for months, 7 fully recovered, 7 improved partially, and 7 saw no improvement.¹² The picture that emerges is that COVID-related tinnitus does resolve for many people, but a meaningful fraction are left with a chronic symptom. By contrast, in the same review, patients with COVID-related hearing loss were less likely to recover fully, with only 2 of 17 reporting hearing that returned to normal.

Severity at onset appears to matter for the long-term outlook. In the large post-COVID survey mentioned earlier, patients whose tinnitus was rated severe were roughly seven times more likely to have a poor treatment outcome compared to those with only slight symptoms.² In practical terms, if the ringing is mild and quiet from the start, the odds of it fading over time are better.

Who Is More Vulnerable

People who already had tinnitus before catching COVID appear to be at higher risk of developing it again or having it worsen. In the survey of 1,331 post-COVID patients, those with a previous history of tinnitus were about twice as likely to experience it after their infection compared to those without that history.² The same systematic review that cataloged wide prevalence ranges also found that about 8% to 76% of tinnitus reports in COVID studies came from people with pre-existing symptoms, underscoring that the virus does not always create tinnitus from scratch, but frequently aggravates a pre-existing condition.¹

There are also factors that make it harder to separate the virus’s effects from everything else happening during a COVID infection. Emotional stress, anxiety, sleep deprivation, and social isolation, all common during both the acute illness and the broader pandemic, are well-established triggers for tinnitus on their own. The same systematic review concluded that a direct causal link between SARS-CoV-2 and tinnitus could not be definitively confirmed, partly because psychological burdens and ototoxic medications used during treatment are difficult to disentangle from the viral effect itself.¹ This does not mean the virus plays no role. It means the evidence points to a web of overlapping causes rather than one clean explanation.

When the Treatment Itself Causes Ringing

Early in the pandemic, several medications were thrown at COVID-19 before solid evidence supported their use. Some of those drugs are known to be ototoxic, meaning they can damage the ear. Hydroxychloroquine, chloroquine, azithromycin, lopinavir-ritonavir, interferon, ribavirin, and ivermectin were all identified in reviews as carrying potential ototoxic side effects.¹³ Another early-pandemic paper sounded a similar alarm about chloroquine, hydroxychloroquine, azithromycin, remdesivir, favipiravir, and lopinavir specifically.¹⁴

This creates a genuine diagnostic puzzle. If someone developed tinnitus during or just after COVID treatment, was it the virus, the drug, or both? In most clinical settings this question was never formally answered because audiological testing was not routinely performed before and after treatment. The practical takeaway is that people who received these medications, especially at higher doses or for longer courses, should mention that treatment history if they seek care for persistent tinnitus. Most of these drugs have fallen out of standard COVID treatment protocols, which may partially explain the declining rates of post-COVID tinnitus observed later in the pandemic.

Tinnitus and Other Ear Symptoms That Travel Together

Tinnitus after COVID rarely shows up in isolation. Vertigo and dizziness are the most common companions. A scoping review of otologic symptoms found 133 patients with vertigo or dizziness related to COVID, with about 35% reporting the symptom after the typical respiratory illness had already started.¹⁵ In the long COVID cohort, 60% of patients had vertigo or dizziness alongside the 30% reporting tinnitus.³ Ear fullness and ear pain also appear in the literature. One study of mild-to-moderate COVID cases found ear fullness in 20%, ear pain in 11%, and tinnitus in 10%, though none of those symptoms became permanent and formal audiological evaluation showed no lasting impairment in that particular group.¹²

The co-occurrence of tinnitus, dizziness, hearing loss, and ear fullness makes sense given the shared anatomy. The cochlea handles hearing while the vestibular organs handle balance, and both sit in the inner ear, sharing the same blood supply and fluid-filled chambers. An insult that damages one part of the inner ear frequently spills over into the other.

Tinnitus After COVID Vaccination

Reports of tinnitus after COVID vaccination have also surfaced, though the numbers are much smaller than with the infection itself. An analysis of the U.S. Vaccine Adverse Event Reporting System found that tinnitus was reported at rates of about 47 cases per million full vaccinations for the Pfizer vaccine, 51 per million for Moderna, and 70 per million for Janssen. Symptom onset was often rapid. For the two-dose vaccines, tinnitus reports were more common after the first dose than the second, but people who did develop tinnitus after the first dose had roughly a 50% chance of worsening symptoms after dose two. More women than men reported the symptom, and the sex difference widened with age. Pre-existing metabolic conditions such as diabetes and obesity were correlated with more severe reports.¹⁶

It is worth emphasizing that these are passively reported adverse events, not confirmed diagnoses from controlled studies, so the true rate of vaccine-caused tinnitus could be higher or lower than the raw VAERS numbers suggest. Researchers have hypothesized that rare cases of inner ear damage from the vaccine could result in sudden hearing loss, tinnitus, dizziness, or some combination.¹⁷ The mechanism is thought to involve an immune or inflammatory reaction rather than direct viral damage, since the vaccines do not contain live virus. Still, at rates measured in the tens per million, post-vaccination tinnitus remains far rarer than post-infection tinnitus.

What to Do If You Develop Ringing After COVID

If tinnitus appears during or after a COVID infection, the most useful first step is a hearing evaluation. Standard tests can check both conventional hearing thresholds and the function of the outer hair cells in the cochlea. The Qatar study described earlier found that nearly 40% of COVID patients had abnormal outer hair cell function on testing, including some who did not realize they had any hearing change.⁸ Catching subtle damage early may influence treatment decisions, particularly if sudden sensorineural hearing loss is involved, since that condition is sometimes treated with steroids and responds better when caught quickly.

There is no COVID-specific cure for tinnitus. Management follows the same principles used for tinnitus from any cause: sound therapy, cognitive behavioral therapy for the distress it creates, hearing aids if there is concurrent hearing loss, and attention to lifestyle factors like sleep and stress management. For many people the ringing does improve with time. But for the roughly one-third of patients in available studies who see no improvement over months, knowing that the symptom has been documented in post-COVID patients and taken seriously by the research community can itself be a small relief. Persistent tinnitus after an infection is not imagined, not trivial, and not something you should feel dismissed for reporting.