The Unexpected Link Between Tinnitus, COVID-19 & Vaccines

COVID-19 changed the world as we knew it. There is scarcely a part of our lives that hasn’t changed since December 2019, including our health. Because of this, the link between COVID and tinnitus has also been explored as reports of the two going hand-in-hand grow.

The Relationship Between COVID Infection And Tinnitus 

Coronaviruses are infectious respiratory diseases. COVID-19, commonly referred to simply as “COVID,” is the specific virus that has hit the world over the last several years. COVID primarily causes respiratory issues, such as cough, shortness of breath, sore throat, and taste or smell changes. However, it can also impact other areas of the body, as neurological symptoms, central and peripheral nervous system manifestations and skeletal muscle manifestations have all been reported.

Symptoms involving the auditory system such as hearing loss, tinnitus, dizziness, and ear pain have also been linked to COVID infection. It should be noted that these kinds of associated symptoms are not necessarily unique to COVID – as they may occur as sequelae to many different viral infections, of which COVID falls under the umbrella. What has demanded further investigation is whether there are any specific patterns of these symptoms, including tinnitus, that are unique or distinguishing to COVID. 

What Does The Research Say?

• A July 2022 study examined the relationship between occurrence of tinnitus with COVID. The authors found that tinnitus was not a symptom reported by the majority of individuals; however, a significant portion of the individuals (28%) did report this symptom either during or after COVID infection. Interestingly, a relationship was also reported between severity of COVID and tinnitus. 

• A 2021 systematic review of the literature examining the relationship between otologic symptoms and COVID confirms that a number of ear-related symptoms have been associated with COVID infection – including hearing loss, ear pain, discharge, tinnitus and vertigo (Ong & Cruz, 2021). The authors report that in cases where specific diagnoses were made regarding any of these symptoms (i.e. sudden hearing loss, vestibular labyrinthitis), they were treated the same way they would have been regardless of COVID status. Additionally, the authors conclude that the presentation of these symptoms in terms of onset, duration and course are “consistent with the natural history of a systemic viral infection.”

With regard to tinnitus, the authors report that most of the individuals who experienced tinnitus after having COVID, reported the symptom began within 1 month of testing positive. However, limited data was available to make conclusions about how the individuals with tinnitus following COVID recovered.

Changes In Pre-Existing Tinnitus After Covid

Another question that has come about is how COVID can impact individuals who already have tinnitus. Anecdotally, there have been reports of worsening tinnitus following infection in some cases. A study that examined the effects of the COVID on tinnitus from individuals across 48 countries reported that of those who had COVID, 40% had worsening tinnitus symptoms. 54% had no changes and 6% reported improved tinnitus (Beukes et al., 2020). Given that we know that COVID can impact the inner ear, it is not surprising that those who already experience tinnitus may notice a change following infection.

Other factors of the COVID pandemic were also discussed as possible reasons individuals may experience a change in their pre-existing tinnitus – not necessarily related directly to a COVID infection. The authors report tinnitus severity was significantly increased for those who had lifestyle and mental stresses during COVID. Risk factors were loneliness, poor sleep, reduced exercise levels, and self-isolation. 

COVID And The Impact On The Inner Ear

A study between MIT and Massachusetts Eye and Ear found that COVID can actually infect cells in the inner ear – specifically hair cells that are responsible for hearing and balance. The team had initially been working on how other viruses affected hearing altered their goal to better understand COVID early on in the pandemic. The authors discuss that while it is well known that viral infections can cause impact the middle ear and cause conductive hearing loss, results of the present study support the notion that COVID-19 can actually infect the inner ear – that can cause audiovestibular symptoms including sensorineural hearing loss and tinnitus.

Data is continuously emerging and the link between COVID and tinnitus will be better understood as our understanding of how COVID affects the body grows. A meta-analysis performed by Cambridge University examining audiovestibular symptoms in relation to COVID infection revealed a 4.5% occurrence rate. However, the authors note that the finding, “may result from the impact of SARS-CoV-2 on the auditory system and/or point to the mental or emotional burden of the pandemic.” Because tinnitus can be impacted by many different internal and external factors, it is challenging to pinpoint exactly what is the driving the mechanism causing the tinnitus.  Additionally, there is limited information regarding the sound of the tinnitus, the loudness, severity, duration, etc. which would be helpful in further understanding the COVID and tinnitus association. 

Tinnitus In Long Covid

Long Covid or Long Haul Covid is when some people have symptoms of Covid that last for months or even years after becoming infected. It’s unknown how long these symptoms may last, as our understanding of COVID is still developing. Tinnitus is emerging as a possible symptom of long COVID.

A 2021 study found that a large variety of symptoms impacting numerous organ systems can linger following COVID infection (Davis et al., 2021). The most frequent symptoms lasting past 6 months included fatigue, post exertional malaise and cognitive dysfunction. However, a number of other symptoms were also reported, including tinnitus. Interestingly, tinnitus and hearing loss are among the group of symptoms that actually increased slightly in later months. Tinnitus on average increased from 11.5% reporting in week one to 26.2% reporting in month seven. Most of the lasting symptoms overall were reported to be moderate in severity. 

COVID Vaccine And Tinnitus Link?

In order to prevent COVID, millions of people worldwide have gotten the COVID vaccine series and boosters. However, there have also been reported associations between the COVID vaccine and tinnitus. Anecdotally,  people have reported changes to their hearing and the development of tinnitus from the COVID vaccine. The Vaccine Adverse Event Reporting System, VAERS, is a system that monitors vaccine safety. VAERS has shown over 15,000 cases of tinnitus following someone getting a COVID vaccine. Now, people report any condition they get to VAERS after getting the vaccine, so it does not necessarily imply a causative relationship.

Billions of COVID vaccines have been given. Tinnitus has only been listed as a side effect for the J&J vaccine (not given often in the US); however, it has been reported after the Moderna and Pfizer vaccines. Let’s look at some evidence about the COVID vaccine and tinnitus.

This study investigated how many people got tinnitus after the COVID vaccine in comparison to other common vaccines. These three vaccines were the flu, polysaccharide pneumococcus (a pneumonia vaccine), and Tdap (tetanus, diphtheria, and pertussis) vaccines. It used data from over 2.5 million people who received their first dose of the mRNA COVID vaccine. These people did not have any prior tinnitus diagnosed. Results showed that 0.038% of them had reported tinnitus within 21 days following their COVID vaccine. Interestingly, also very small, but slightly higher rates of tinnitus were reported following flu (0.062%) and Tdap (0.0.69%) vaccines than COVID vaccines, accounting for differences in age, gender, race, and ethnicity to even things out and make sure the only difference truly measured was which vaccine each person received. The authors discuss this is as a point worth considering to help  reduce vaccine hesitancy, as the COVID vaccine didn’t have higher risk of tinnitus than other well established, efficacious vaccines. 

In summary, while COVID vaccination does show a low association with developing new tinnitus, other routine vaccinations have a higher association. There was also a slightly lower risk of suddenly developing tinnitus after the 2nd COVID dose (0.031%) than the first one (0.038%). You can still get tinnitus after either round of the vaccine. 

World Health Organization On Tinnitus After COVID Vaccine

The World Health Organization (WHO) believes there is a “possible link” between the COVID vaccine and getting tinnitus. Their first 2022 newsletter shared a report from the Uppsala Monitoring Centre, which is an independent center that studies drug safety and performs scientific research. A possible link between the vaccine and tinnitus is discussed, warranting further study. 

The authors discuss 164 case safety reports following vaccination of hearing loss and 367 for tinnitus. 56 had both tinnitus and hearing loss appear. Interestingly, 73% of these were in females and 25% in males, and in a portion of the data sex was not identified.. Reports came from different countries and results following Pfizer, Moderna, AstraZeneca and SinoVac vaccines. The authors report that a majority of the cases  (74%) were classified as “non-serious,” however a portion were regarded a “serious” (26%), indicating that either the symptom was debilitating, incapacitating, life-threatening or caused prolonged hospitalization. 

Comparing The COVID Vaccine And Getting COVID – Which Is Worse For Tinnitus? 

In general, the COVID vaccine has been determined to be beneficial, despite adverse reactions reported. Even though there is some associated risk of tinnitus following vaccination, the rate is extremely low – even when compared to other vaccines. Further, as has been shown there is a very real link between tinnitus and the COVID infection. Thus, the risk of getting tinnitus seems to be lower with the vaccine vs. contracting the virus.