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Some people are reporting symptoms of tinnitus (ringing in the ears) after developing COVID-19. Gabriel Bucataru/Stocksy United
  • Tinnitus is the perception of sound when no actual external noise is present. It’s often explained as “ringing in the ears.”
  • During the pandemic, reports of tinnitus rose, especially in people with COVID-19, according to a study.
  • Experts explain how the connection between COVID-19 and tinnitus is biologically possible but needs more research.

As scientists learn more about the prolonged effects of COVID-19, tinnitus has made it on their list of conditions to research.

Often referred to as “ringing in the ears,” tinnitus is the perception of sound when no actual external noise is present.

Of the millions of people who live with tinnitus, many report hearing buzzing, hissing, whistling, swooshing, clicking, and in rare cases, music.

“Persistent and constant tinnitus can impact overall quality of life when it interferes with concentration, hearing, sleep, and a person’s mood. Patients with clinically significant tinnitus can become stuck in a vicious cycle where their sympathetic and parasympathetic nervous systems are out of balance, which may lead to anxiety, depression, and lack of sleep,” Julie Prutsman, audiologist, board member of the American Tinnitus Association (ATA), and founder of the Sound Relief Hearing Center, told Healthline.

The ATA states that tinnitus is a symptom of an underlying health condition. In most cases, tinnitus is caused by a “sensorineural reaction in the brain to damage in the ear and auditory system.”

According to a 2011–12 survey conducted by the Centers for Disease Control and Prevention (CDC), nearly 20 million people deal with burdensome tinnitus on a regular basis, and approximately 2 million people have severe, sometimes debilitating, tinnitus.

“Tinnitus is very common. The older you get, the more common it is. It can be very mild, intermittent, and severe and disabling, and change your whole quality of life. It has led to people being so afflicted that they take their own life,” Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville, told Healthline.

A 2021 study published in the International Journal of Audiology estimated that almost 15 percent of people with COVID-19 said they had tinnitus, often early in the course of their infection.

Audiologists like Prutsman have heard anecdotal accounts from patients who say they have experienced changes in hearing and tinnitus after having COVID-19.

Almost all viruses cause an inflammatory response to the host cells, which can cause damage to multiple systems in the body, said Prutsman.

“It is possible, although too early to understand fully, that COVID-19 is creating changes to the inner ear, auditory nerve, or auditory cortex in the brain that would be contributing to the tinnitus,” she said.

Examples of viruses that cause permanent hearing loss are cytomegalovirus and rubella. However, Prutsman said not all people who experience permanent hearing loss from a virus will experience tinnitus.

If the tinnitus is intermittent and does not persist, she said it is unlikely that COVID-19 is causing permanent damage to these structures.

“However, until more research can be done to better understand all of this, it is hard to know if there is a true connection between the two, and what might be causing it if there is a connection,” Prutsman added.

Schaffner said it’s worth researching because COVID-19 has the capacity to affect many organ systems, making it conceivable that it could cause tinnitus or worsen chronic tinnitus.

However, although it’s biologically possible, Schaffner said drawing conclusions like this without more evidence can be a logical trap because scientists cannot draw conclusions on the basis of an anecdote.

For example, he said while people know roosters crow before dawn, not many people believe that roosters make the sun rise.

“So, there are ways with elaborate epidemiology to determine whether tinnitus can indeed be caused by the previous COVID infection. It’s still an open question,” he said.

Other anecdotal accounts include people with chronic tinnitus reporting an increase in severity after receiving the COVID-19 vaccine.

In these cases, Prutsman said it is probably due to nerve inflammation, and it usually resolves within a couple of weeks.

However, Schaffner pointed out that you can’t measure tinnitus, which makes it difficult to objectively determine whether what a person is experiencing is coincidental or something that they have perceived, which may or may not be accurate.

“It’s like taste and smell — it’s just based on what patients tell you. We all know as humans that our perceptions, feelings, concepts, and circumstances in which we live influence our thinking and conclusions about stuff,” he said.

Prutsman agreed and noted possible explanations could be due to neuroinflammation induced by the vaccine, or due to an increased limbic system response caused by fear around getting COVID-19, the vaccine, or both.

“Stress, anxiety, and lack of sleep are three of the biggest triggers to louder tinnitus perception, and many patients would report that they experienced one of these after having the vaccine and/or even leading up to getting the vaccine,” she said.

Although there’s no current cure for tinnitus, Prutsman said there is effective treatment.

“Tinnitus is much like diabetes in that we can effectively manage it to a point where it is not a persistent, intrusive sound that creates insomnia or emotional distress for the person experiencing it,” she said.

Tinnitus treatment varies from person to person based on how bothersome it is and when it bothers the person.

For people only occasionally bothered by it, finding tools and strategies to distract their mind away from the tinnitus can help, such as focusing on a hobby or activity.

“For someone who is only bothered by it when going to sleep at night, using something as simple as a free app (i.e., Sleep Pillow) to listen to the sounds of rain or ocean waves through their cellphone or tablet can be helpful,” Prutsman said.

For people with persistent awareness of tinnitus, she said blocking their nervous system’s reaction to tinnitus, as well as teaching them how to block their perception of it so it does not intrude with normal daily activities, can be helpful.

Based on a person’s experience with tinnitus, an audiologist may recommend sound enrichment, relaxation exercises, prescriptive sound therapy, tinnitus retraining therapy, and tenets of cognitive behavioral therapy.

“The good news is that tinnitus is treatable, and patients do not have to just go home and live with it,” said Prutsman.