Can COVID-19 Cause Tinnitus? - Health Essentials from Cleveland Clinic

Imagine constantly hearing a ringing in one ear, both ears or even in your head. It might last for a few seconds or it might go on for minutes. You wish it would stop, but it won't. It's so maddening that it interferes with every aspect of your life. What was just described is called tinnitus and for more than 45 million Americans, it's a daily struggle to live with it.

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There have been numerous reports of hearing-related issues popping up as a result of COVID-19. Tinnitus was one of those conditions. But can we make the connection based on what we know so far? Sarah Sydlowski, AuD, PhD, MBA, helps us gain a better understanding of what tinnitus is and the available treatment options.

What is tinnitus?

"Tinnitus is most commonly a ringing in the ear, but it can be any kind of sound that you perceive when there isn't an actual sound being produced. Some people experience musical tinnitus — they'll hear a song over and over again. Others may hear ringing, roaring, buzzing or whooshing. What is being heard originates from somewhere else within your system," says Dr. Sydlowski.

While the scientific community still doesn't have a complete understanding of tinnitus, Dr. Sydlowski compares it to when someone loses a limb and experiences phantom pain in that area. The body is missing the input that it used to get from the lost part and is still expecting it.

"Commonly, tinnitus is the result of your inner ear (cochlea) being damaged in some way. When this happens, the cochlea doesn't stop working. It still tries to function so you're able to hear certain sounds. And when your inner ear isn't working correctly, it starts producing sounds to replace what you're supposed to hear naturally. It's a phantom sound."

How tinnitus can be a sign of hearing loss

Your cochlea is a series of tubes that are full of thousands and thousands of tiny, little sensory cells. These cells are like blades of grass that move hearing signals up to the brain. But when they're damaged, the sensory cells fail to move things along in the manner that they should. Your hearing can become quite poor once many of the cells have been damaged.

But tinnitus isn't always the final sign of hearing trouble. Dr. Sydlowski says that in some cases, it can precede hearing loss.

"Tinnitus can sometimes be a precursor even if you haven't noticed that your hearing has changed. It often occurs after being exposed to loud sounds. For instance, when you go to a concert and your ears are ringing after it's over. The ringing means the music or the environment was so loud, that it damaged sensory cells in the cochlea. But even though this ringing subsides, it can contribute to long-term damage. It may seem like your hearing is back to normal, but your sensory cells have already sustained damage that you'll never fully recover from. If you continue to expose yourself to loud music or sounds  without hearing protection, the damage just continues to get worse."

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How circulatory problems can cause tinnitus

The cochlea and its sensory cells require a very rich blood supply to function properly. And because this system is so delicate, it doesn't take much to damage it.

"A lot of very tiny arteries transport blood to the cochlea and the sensory cells. Sensory cells are tiny structures, and when I say tiny, I mean that about 18,000 can fit on the head of a pin. They're incredibly tiny, really delicate and they do require a rich blood supply. An interruption in that blood supply can result in damage to those structures and because they're so tiny and so delicate, it doesn't take much to have a really big impact. So, people who have heart disease or diabetes can also have hearing loss and tinnitus that is partly related to that circulatory influence."

Can Tinnitus be linked to COVID-19?

Reports of people experiencing tinnitus, vertigo and other hearing problems after having COVID-19 started emerging earlier in the pandemic. However, there wasn't enough research to determine if the virus was the cause of these conditions. But on April 29, the American Academy of Audiology, the American Speech-Language-Hearing Association and the Academy of Doctors of Audiology issued a statement regarding the matter.

The groups said that based on a recent study conducted by The University of Manchester and Manchester Biomedical Research Centre that was published in the International Journal of Audiology, scientists estimated that 7.6% of people infected with COVID-19 experienced hearing loss, 14.8% suffered from tinnitus and 7.2% reported vertigo. This study also conveyed that there is an urgent need for additional studies regarding the long-term effects of COVID-19 on the auditory system.

In addition to these findings, the British Tinnitus Association (BTA) reported a 256% rise in the number of webchats from May to December 2020 compared with the same period in 2019. And calls to its helpline increased by 16%.

The statement also spotlighted the importance of helping those who are socially isolated or experiencing COVID-19-related difficulties get the hearing care they need.

Treatment options for tinnitus

While tinnitus can cause depression or worse when left untreated, Dr. Sydlowski says there are ways to manage it. If you notice that you're having trouble with your hearing or balance, don't ignore what's going on. The sooner you reach out for help, the better. In fact, Dr. Sydlowski says sudden changes in your hearing should be considered a medical emergency and addressed immediately.

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"If you have a sudden change to your hearing loss, it's really important to have it assessed correctly —quickly — because there is a window to potentially improve it. Your audiologist can refer you to an ENT physician who may prescribe steroids, which are not always effective, but the sooner we can manage it, the better the chances that we might be able to restore that sudden change. Most of the time, an inner ear hearing loss that's caused by circulatory problems, noise, aging or certain medications is usually permanent. But there is a small sub-segment of cases where we might be able to improve it."

The main thing to keep in mind with tinnitus is that no matter how frustrating it can be, there is help.

"We can't make it go away, but we can provide good coping mechanisms. Some devices can help cover up the noise so you're not so bothered by it." She says when hearing loss is also involved, using appropriate hearing aids can help, or if the hearing loss is more severe, having a cochlear implant that directly stimulates the hearing nerve gives the ear something to listen to. "We've seen great outcomes in terms of reducing tinnitus without electrical stimulation."

Dr. Sydlowski adds that an interdisciplinary team of specialists will often work together to find comprehensive solutions for the management of tinnitus.

She says Cleveland Clinic's Tinnitus Management Clinic takes an interdisciplinary team approach to treat this condition. A treatment team will have an audiologist, a dentist, a neurologist and a psychologist. Why are all of these people involved? Since tinnitus can stem from TMJ problems or clenching your teeth a lot, a dentist can help treat those conditions. A neurologist will check for neck or cervical spine issues and a psychologist can provide cognitive behavioral therapy techniques to help manage tinnitus.

"Tinnitus is not something that you just have to live with. There's help and it's important to reach out for it to make sure that you've explored not only the potential cause so that it can be managed, but also find ways to manage tinnitus itself — and there are options to do that."