Can COVID-19 Cause Hearing Loss and Tinnitus?

It’s been clear for several years that COVID-19 is not simply a respiratory condition. In addition to the lungs, the disease might affect the heart, brain, muscles, gastrointestinal tract, and other parts of the body. Now scientists are learning that COVID-19 can damage the nerves involved in hearing. In rare cases, people experience hearing loss as a COVID-19 symptom, while others develop hearing impairment months or years later as a long COVID symptom.

Issues range from hearing impairment to roaring or buzzing sounds in the ear due to tinnitus. Some studies have also linked tinnitus to the COVID-19 vaccine in a very small percentage of cases. “It’s been three years but we’re still learning about COVID’s effects on hearing,” says Douglas Hildrew, MD, an otologist (hearing doctor) at Yale Medicine in New Haven, Connecticut. Dr. Hildrew says he is seeing a substantial number of people whose hearing has been impacted by COVID-19.

Contracting any virus, including SARS-CoV-2, the virus that causes COVID-19, can increase your risk for hearing loss, Hildrew says. Once a virus enters the body, it starts replicating. It can do so inside of certain nerves, one of which is the cochlear nerve that runs from your brain stem to your inner ear.

Hildrew explains that inflammation from the virus can harm the nerve directly. Or, he continues, “swelling around the nerve can cause damage because the nerve rests inside a small, bony tunnel.”

• Mild hearing problems where soft sounds are hard to make out
• Moderate issues where normal speech volume is imperceptible
• Severe or profound hearing loss where people cannot hear speech and sounds

The good news is that virus-associated hearing loss during an initial bout of COVID-19 has a high rate of full recovery, Hildrew says. “If you find an ear, nose, and throat (ENT) doctor quickly — ideally within two days but definitely within a month — there’s more than a 60 percent chance that all or most of the hearing can come back,” he says.

Your doctor will likely perform an examination looking for possible explanations beyond the virus, including ear wax buildup, bacterial infections, or another medical condition. Your physician may also refer you to an audiologist who diagnoses hearing loss with hearing tests. These may include one where you hear sounds and words at various levels through earphones.

In many cases, COVID-19 likely speeds up the timetable for hearing problems a person was already developing, Hildrew says.

People may have had mild hearing issues they’d been trying to ignore but that became more obvious during the early phase of the pandemic — struggling to hear others talking through masks, for instance, made some individuals realize how much they’d come to rely on watching lips move, Hildew says. This may have pushed some people to complain of hearing loss and get testing and treatment when they might otherwise have delayed it.

Hearing loss that does not receive immediate steroid treatment or does not respond to this treatment is likely permanent, Hildrew says. In this case, doctors generally recommend a hearing aid if the loss is bothersome.

Hearing aids today are smaller and less visible than models were in the past and many have controls accessible through a smartphone to better reduce ambient sound, Hildrew notes.

Although the causes of tinnitus are unclear, Hildrew suggests that it may have links to hearing loss. “If we have hearing loss, the brain over activates the [nerve] pathway and creates the setup for this ringing by trying to help us hear better,” Hildrew says. Minor hearing loss from or in addition to COVID-19 causes the brain to ramp up this effort, he believes.

Those experiencing disruptive tinnitus symptoms during the day may benefit from a hearing aid. “With many brands, there’s a setting you can activate that plays modulating frequencies in the background” for distraction, Hildrew says.

Some people find cognitive behavioral therapy (CBT) helpful. It can’t make the sounds go away, but it can help you be a little less bothered by them, Hildrew says.

The CDC has not formally named tinnitus as a vaccine side effect.

Still, because so many people have received a COVID-19 vaccine, even a tiny percentage can translate into a lot of people.

In some cases, tinnitus that appears after COVID-19 vaccination gets better on its own, Hildrew says. He maintains that if it doesn’t, treatment is the same as for the illness brought on by the virus itself: distraction via external sounds or a hearing aid.

The most important thing if you suspect hearing issues related to COVID-19 or the vaccine is to contact your medical professional right away.

“Referral for otologic and audiologic services is necessary to determine the type and severity of the auditory disorder, which may help treat, mitigate, or cope with these ear-related issues,” Jafari says.

The Takeaway

• Hearing loss and tinnitus have emerged as uncommon but concerning effects of COVID-19, especially for those experiencing long COVID.
• Prompt steroid treatment can improve outcomes, particularly with virus-associated hearing loss, but tinnitus has no cure.
• If you're noticing any change in your hearing following COVID-19 infection or vaccination, visit a healthcare provider as soon as possible to determine the best course of action.