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Doctors Still Aren't Sure Why COVID-19 Is Causing Hearing Loss

hearing problems and COVID-19

 Lara Antal / Verywell

Key Takeaways

  • Many COVID-19 patients report hearing loss and tinnitus as a late-onset symptom.
  • Hearing issues may be caused by COVID-19 itself, the medications used to treat it, or the stress surrounding the illness.

She describes it as a siren—sudden and sharp, with no stutters or pauses as it sears through her eardrums. The sound erupts intermittently throughout the day, without a distinct source triggering its arrival. Linda Gaviria, a 35-year-old pediatric ICU nurse in Miami, Florida, is experiencing what is medically known as tinnitus. But Gaviria recognizes it as one of the many new symptoms she's endured since contracting SARS-CoV-2, the virus that causes COVID-19, in June. 

Gaviria is not alone. Case studies show one in 10 COVID-19 patients report experiencing some form of hearing loss or tinnitus. Cases of COVID-induced hearing loss have been documented globally, everywhere from Iran and Egypt to Thailand and Turkey. Now, doctors and researchers are taking a closer look. 

Hearing Symptoms Vary In COVID-19 Patients

Kevin Munro, PhD, a professor of audiology at the University of Manchester in the U.K., tells Verywell that hearing loss and/or tinnitus tend to appear later in the course of a COVID-19 infection, or even after recovery. These symptoms can manifest in multiple variations and volumes, and more research needs to be done to pinpoint their exact prognosis. 

Munro, who also serves as the director of the Manchester Centre for Audiology and Deafness, is examining the link between COVID-19 and hearing loss in his own research.

“What surprises me the most is the number of people who are reporting problems with their hearing—I’ve been getting hundreds of emails from people telling me they’re experiencing hearing loss or tinnitus,” Munro says. “Still, I think we have to be careful and not say that COVID-19 is causing everyone to be deaf. We can say that more than one in 10 people are reporting that something has changed with their hearing, but we still don't know everything about it."

In his first study on the topic, Munro reviewed seven research projects studying hearing loss in COVID-19 patients. The patients all exhibited some form of hearing impairment: one patient had severe hearing loss in both ears, another mild hearing loss in one ear, and others experienced tinnitus that fluctuated between both ears. But there was no unifying root between them.

His second study examined 121 adult patients and found that 13% self-reported hearing deterioration or the development of tinnitus eight weeks after discharge.  

Munro says it’s too early to tell the extent of the damage COVID-19 will cause on the ears. Some of the patients contacting him have reported an increase in their symptoms, while others have noted improvement over time. 

What This Means For You

If COVID-19 has affected your hearing or triggered tinnitus, you’re not alone. Researchers don’t yet know if this condition is temporary or permanent, but they advise you to seek guidance from a medical professional as soon as possible. If the hearing loss is sudden, steroids may help reverse it in the first 24 hours.

SARS-CoV-2 Isn’t the First Virus to Cause Hearing Loss  

It isn’t rare for a virus to affect the auditory system. Even though MERS and SARS—two other coronaviruses from the same family as SARS-CoV-2—weren’t known to trigger hearing loss, other viruses can. 

Examples of these include:

  • Measles: Can cause an ear infection that leads to permanent hearing damage
  • Mumps: Triggers severe swelling on one side of the face and usually inflicts hearing damage on the affected side
  • Human immunodeficiency virus: Causes the body to attack its cells, sometimes leaving patients with hearing loss and tinnitus as a result 
  • Congenital cytomegalovirus infection: Can induce hearing loss in children

“We know that viruses can damage our hearing through different mechanisms that can cause permanent damage,” Munro says. “None of the other coronaviruses caused hearing problems, but none of the other coronaviruses cause the long-term health problems that we are now fighting with this particular one. That's why people have been surprised when these young, healthy people who may have had mild symptoms are now reporting a hearing deterioration.”

How COVID-19 Could Affect the Ears

For Gaviria, her tinnitus most likely has a neurological root, as most of her post-COVID-19 symptoms—vertigo, concentration difficulties, and chronic brain fog—have neurological underpinnings. 

But scientists don't yet know if these symptoms are purely neurological in origin or if they can also affect the auditory system in other ways.

Direct Auditory System Damage

Researchers at John Hopkins Hospital reviewed the autopsies of three patients who died of COVID-19 and found genetic traces of SARS-CoV-2 in the ears of two of them—showing that the virus can physically infiltrate the ears. 

However, according to Caitlin Barr, PhD, an audiologist and CEO of Soundfair Australia, it’s unlikely that the SARS-CoV-2 virus will enter your ear canal the way it would enter your mouth and nose.

“The organ of the ear that is responsible for taking in sounds is called the cochlea, and it’s made up of tiny auditory hair cells that can easily be damaged,” she tells Verywell. “The blood supply going to it is very small, so it’s very easy for a virus that's in your bloodstream to go into your cochlea. Just a small amount can have a really big impact, and this is most commonly what causes the damage.” 

Nasal Inhalation

According to Munro, inhaling SARS-CoV-2 could trigger ear infection-like mechanisms that cause blockage in the ear.

Nerve Damage

Recent findings show that COVID-19 is sometimes associated with the development of Guillain–Barré Syndrome (GBS)—a rare condition that can lead to paralysis. Munro says that in this case, ears aren’t directly damaged, but the nerves that transmit sounds are. This type of damage is called peripheral neuropathy.

Cytokine Storm

Barr says that cytokine storm, a severe immune reaction released by the SARS-CoV-2 virus, can trigger inflammation throughout multiple organs in the body. If this inflammation occurs in any of the structures next to the ears, it could trigger a ringing sound. 

“The fact that these hearing symptoms have a later onset means it may take some time for the damage to build-up and be noticeable, and this could be because of a slow progression of inflammation to the brain, joints, or facial nerves,” Barr says. 

Medication May Contribute to Hearing Loss

According to Munro, COVID-19 is probably not the sole source of ear-related symptoms. Medications prescribed for the disease, like remdesivir, hydroxychloroquine, lopinavir, and ritonavir, are all ototoxic medications that cause damage to the cochlea.

“It’s possible that some of these patients were given high doses of drugs to help them with a life-threatening condition, and that it’s the drugs themselves that directly caused a hearing problem or tinnitus,” Munro says.

Munro is currently raising funds for a research study that looks at the longer-term impact of COVID-19 on adult hearing.

How to Cope With COVID-Induced Hearing loss and Tinnitus

Barr says she's been inundated with calls since the start of the pandemic. She advises patients experiencing any form of hearing loss or tinnitus to initially consult with an audiologist for an evaluation. From there, the audiologist can perform a hearing test that measures ability to discern different pitches and frequencies. 

If the hearing loss is sudden, Barr says to seek medical attention immediately.

“[Steroids are] one of the medical interventions that could potentially reverse hearing damage," she says. "But if it turns out to be permanent, there are therapeutic options available, such as hearing aids and cochlear implants."

Tinnitus is more complicated. If it accompanies hearing loss, then treating the hearing loss will most likely treat the tinnitus, Barr says. However, if tinnitus happens on its own, then there is currently no medical remedy for it.

According to Barr, tinnitus can be triggered and aggravated by any form of stress. To combat mental stress, she recommends Cognitive Behavioral Therapy (CBT), which can reprogram the mind’s negative perception of the auditory symptoms and help people cope.

You can try CBT through apps such as Relax. This app also includes different sounds to buffer the tinnitus.

“All of these treatments have varying levels of success and depend on the willingness of the patient to go through with the course of treatment,” Barr says. “Ultimately, seeing a professional is key, and as we learn more about this phenomenon, we will be better equipped to help.” 

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