COVID-19, vaccinations, and tinnitus: What’s the connection?
A look at what the research shows about ringing in the ears after infection or vaccination
Late in October 2020, Paula Wheeler, who lives in central Kentucky, came down with COVID-19—a severe case that led to high fever, pneumonia, time in the hospital, and week after week of rolling symptoms. Five months after her initial diagnosis, Wheeler first noticed the tinnitus.
The ringing in her ears is a bit like the buzz of an old-time TV, Wheeler says. It’s unrelenting. “I've got that in my head in both ears all the time,” she says.
Wheeler isn’t alone in experiencing tinnitus after recovering from COVID-19.
In a 2021 systematic review of hearing-related symptoms post-coronavirus, nearly 15 percent of patients reported tinnitus. Although this figure may be an overestimate, per the study authors, it raises the question of whether COVID-19 might cause tinnitus.
Ringing in the ears has also been reported as a side effect of the coronavirus vaccination. As of April 2023, just over 16,000 cases of tinnitus following a COVID-19 vaccine were reported, according to data from the Vaccine Adverse Event Reporting System (VAERS). VAERS is run by the FDA and the CDC, and allows people in the U.S. to voluntarily self-report adverse effects of vaccines.
What is tinnitus, exactly?
Tinnitus is typically described as ringing in the ears, but as Wheeler notes, it can also present as buzzing or other sounds. This unpleasant sensation is common: About 10 percent of American adults are affected by tinnitus at some point in their life, per the American Tinnitus Association.
Many risk factors can lead to tinnitus, including:
There’s no cure for tinnitus, although treatments, which vary depending on the cause of the symptom, can help.
So, does COVID-19 cause tinnitus?
Here’s what we know: The novel coronavirus affects other organs and systems beyond the respiratory system, says Kevin Munro, Au.D., professor of audiology at the UK's Manchester Center for Audiology and Deafness. He was senior author of the 2021 systematic review on the evidence around COVID-19 and hearing symptoms.
That potentially includes the ears: Researchers discovered SARS-CoV-2 (the virus that causes COVID-19) infects cells in the inner ear, at least in lab studies using inner ear tissue from mice and humans. The results of this modeling were reported in October 2021 in the journal Communications Medicine. "Our findings suggest that inner ear infection may underlie COVID-19-associated problems with hearing and balance," they wrote.
So there’s a logic to a link between COVID-19 and tinnitus and other hearing issues. This isn't necessarily unusual—a number of other infections can cause hearing loss or tinnitus.
In December 2020, Munro examined the literature on COVID-19 and hearing. This led to a systematic review of 28 stuidies, which found an estimated:
These findings seem major, but Munro describes the evidence behind these percentages as “not great.”
The “confidence interval” for those estimates is high (meaning the true prevalence might be far higher or lower in reality). And, Munro notes, the quality level of the studies included in this systematic review is not high—well-designed studies have a control group, so they can compare two groups and determine if there’s any difference.
Further, data from the studies consisted of a combination of confirmed, probably, and suspected cases of COVID-19. So, it isn't known how many of the reports of tinnitus and other hearing issues occurred in people who were actually infected.
Another systematic review, this one published in July 2021, also looked at tinnitus and the pandemic. The review didn’t reveal any clear patterns when it came to a person’s risk of developing tinnitus after being sick with the coronavirus—there wasn’t anything consistent about people’s ages, gender, severity of the disease, or even the onset of the ringing in the ears. The authors concluded that it isn't known if tinnitus and hearing loss can be attributed to COVID-19 or if other factors are at play--such as people taking ototoxic medications. Examples: hydroxychloroquine and non-steroidal anti-inflammatory drugs (NSAIDs).
Bottom line: Because of the commonality of tinnitus, and the inherent challenges involved in this research, it’s difficult to know what—if any—connection there is between having COVID-19 and experiencing tinnitus.
Is there a link between vaccines and tinnitus?
As of May 2023, more than 13 billion doses of the COVID-19 vaccine have been administered worldwide. The US accounts for nearly 672 million of them.
Some people—albeit a tiny number in comparison to the total number vaccinated—experience tinnitus after getting vaccinated. As mentioned above, more than 16,000 people have filed reports of tinnitus after receiving a vaccine done, as of May 2023.
That includes Gregory Poland, MD, a vaccine expert, and the founder and director of the Mayo Clinic's Vaccine Research Group. Dr. Poland heard a loud noise in his ear after his second COVID-19 vaccine, and in the year since, has experienced tinnitus, according to reporting last year and this year from NBC News and other news organizations.
“The incidence of COVID-19 vaccine-associated tinnitus is rare,” per a March 2022 review in the Annals of Medicine and Surgery. But, the researchers point out, that doesn’t mean it’s not important to understand why this side effect occurs in some people—along with the best treatment options for vaccine-associated tinnitus.
Many things can cause tinnitus
Even if there is a connection between COVID-19 and tinnitus, that still doesn’t reveal the precise cause. Tinnitus could be an indirect consequence of the virus, Munro notes.
For example, treatment methods for the coronavirus, time spent in the hospital (which often leads to an array of symptoms, including brain fog), being on oxygen, and other factors might play a role, Munro says. And don’t discount stress: Lost loved ones, unemployment, financial difficulties, and strained circumstances transformed people’s lives during the pandemic.
“We're all a bit stressed and anxious and if you're not sleeping well people will often report tinnitus,” Munro says.
For people who already had tinnitus, getting COVID-19 might make the symptoms worse. A study published in Frontiers in Public Health surveyed more than 3,000 people with pre-existing tinnitus from 48 countries. “Having COVID-19 symptoms exacerbated tinnitus in 40% of respondents,” the study authors write. And for many respondents, pandemic-related issues—such as financial concerns, reduced activity, and poor sleep—worsened tinnitus symptoms.
What about hearing loss?
We've put together a separate report on COVID-19 and hearing loss. Research indicates that the virus is linked to hearing loss for some people, though it appears rare.
For instance, a 2022 investigation published in JAMA found a strong link between the Pfizer COVID-19 vaccine and sudden sensorineural hearing loss based on the number of observed cases compared to typical rates. However, the authors describe the risk as “relatively low.” They wrote “we firmly believe that the benefits of COVID-19 vaccinations far outweigh the potential association with sudden sensorineural hearing loss.”
'It's a lonely road'
As Munro notes, more studies, and well-designed ones, are needed to uncover a potential connection.
More insight might lead to evolving treatment tactics. And, if there is a connection, hearing-related services might see an uptick in patients, Munro notes.
Plus, with more studies, people will gain peace of mind, Wheeler says. Munro’s received about 200 emails since his systematic review went live, and many of them are from people with tinnitus. “They're relieved to hear that they're not the only ones,” Munro says.
“It's a lonely road that you walk,” Wheeler says. Connecting with other people experiencing tinnitus and other long-haul symptoms has reassured her the symptoms aren’t in her head, which can be a problem since doctors often dismiss tinnitus.
If you need help
If you have tinnitus or hearing loss, seeing your doctor or a hearing specialist for an evaluation is also a good idea. Find a tinnitus specialist near you by going to our directory of hearing care providers. Please note that not all hearing clinics treat tinnitus, so you may need to browse several clinic pages to find the right provider.
Before your first appointment, take note of your specific tinnitus symptoms, when they occur and what environments make them better or worse. For example, do you experience tinnitus spikes? This work ahead of time will prepare you for questions asked by the practitioner and ensure you get the most out of your evaluation.
More: Browse our full list of articles that discuss COVID-19, hearing loss and tinnitus.
Note: This piece originally published in June 2021. It was updated and medically reviewed in July 2023 by Dr. Patricia Weiser, a licensed pharmacist and medical writer. She obtained her Doctor of Pharmacy degree at the University of Pittsburgh.