Tinnitus is the perception of sound, such as ringing, buzzing, or roaring, when no external sound is present. This auditory phenomenon can range from a minor annoyance to a condition that significantly interferes with daily life, affecting sleep and concentration. Since the emergence of the novel coronavirus, SARS-CoV-2, the wide array of reported symptoms has prompted questions about whether this infection can also trigger auditory issues. This article examines the scientific evidence connecting tinnitus to an infection with COVID-19.
Tinnitus as an Acute COVID-19 Manifestation
Tinnitus has been observed as a symptom that can occur during the active, acute phase of a COVID-19 infection. It is classified as a non-respiratory manifestation, distinct from common symptoms like cough, fever, or loss of taste and smell. This auditory disturbance is one of several otoneurological symptoms, including dizziness and hearing loss, that have been linked to the disease.
Data from various studies suggest that tinnitus occurs in a notable portion of patients during the initial illness. Systematic reviews indicate that the prevalence of new-onset tinnitus after infection ranges widely, with reports suggesting figures between 8% and 15% of infected individuals. Although the reported figures vary due to methodological differences, the clinical observation of acute tinnitus in COVID-19 patients is consistent.
For many who develop tinnitus during the acute illness, the symptom typically resolves as they recover from the viral infection. Its presence highlights the virus’s potential to affect systems beyond the respiratory tract, even though it is not a primary defining feature of the disease. The onset of tinnitus during this period suggests an immediate interaction between the infection and the auditory system.
Underlying Biological Causes of COVID-Related Tinnitus
The mechanisms by which SARS-CoV-2 may lead to tinnitus involve both direct viral effects and indirect systemic responses. A primary hypothesis centers on the body’s exaggerated immune response, often referred to as a cytokine storm. The systemic inflammation resulting from the massive release of pro-inflammatory molecules, such as interleukin-6, can damage sensitive tissues. This inflammatory damage may target the inner ear or the auditory nerve, disrupting the normal signal processing that leads to the perception of sound.
Another mechanism involves the potential for the virus to cause damage via the vascular system. SARS-CoV-2 is known to affect blood vessels and cause microvascular injury throughout the body, raising the possibility of ischemic processes. Reduced blood flow to the cochlea, the spiral organ responsible for hearing within the inner ear, can lead to auditory dysfunction and the onset of tinnitus.
Research has investigated the possibility of direct viral invasion into the inner ear structures. Studies show that human inner ear tissue, specifically the hair cells and Schwann cells, expresses the angiotensin-converting enzyme 2 (ACE2) receptor. ACE2 is the protein SARS-CoV-2 uses to gain entry into host cells. The co-expression of ACE2 alongside necessary viral cofactors suggests that the virus may be capable of directly infecting the inner ear.
Tinnitus in the Context of Long COVID
Auditory symptoms, including tinnitus, are recognized as sequelae that can persist beyond the initial recovery period. This long-term persistence or delayed onset of symptoms falls under the umbrella of post-COVID conditions, often called Long COVID. For some individuals, tinnitus can continue for weeks or months after the active infection has cleared, or it may first appear during the recovery phase.
Tinnitus is a frequent otoneurological complaint among individuals with Long COVID. Estimates of its prevalence within this group vary, with some studies suggesting that between 20% and 40% of Long COVID patients experience this symptom. The continued presence of tinnitus is often attributed to the ongoing effects of neuroinflammation or nerve damage initiated during the acute infection.
Tinnitus shares this characteristic of persistence with other neurological Long COVID symptoms, such as brain fog and chronic fatigue. The underlying pathophysiology in these prolonged cases involves a sustained disruption in the central nervous system, rather than just the initial viral presence. This highlights a distinction between temporary acute symptoms and long-term changes in the auditory pathway.
Steps for Managing Tinnitus and Medical Consultation
Individuals experiencing tinnitus should seek medical evaluation to determine the underlying cause and receive guidance. An examination by an otolaryngologist (an ear, nose, and throat specialist) is recommended to rule out other treatable, non-COVID-related causes, such as earwax blockage or medication side effects. A comprehensive audiological evaluation, or hearing test, is often the first step, particularly if the ringing is unilateral or accompanied by changes in hearing.
While there is currently no cure to eliminate the sound entirely, several effective strategies exist to manage the perception and impact of tinnitus. Self-management techniques often involve sound therapy, which aims to reduce the contrast between the internal sound and the environment. Using white noise machines, fans, or ambient soundscapes can help the brain habituate to the sound.
Professional management options include specialized counseling and behavioral therapies. Cognitive Behavioral Therapy (CBT) and Tinnitus Retraining Therapy (TRT) are non-pharmacological approaches that teach coping mechanisms to reduce the distress and anxiety associated with the sound. Stress reduction and maintaining good sleep hygiene are also important, as psychological factors can exacerbate the perception of tinnitus.