Tinnitus after being diagnosed with COVID-19?! What are the causes? How can it be improved?

COVID-19 and its later Omicron variants are widely known to cause symptoms such as cough, muscle aches, fever, diarrhea, and even loss of smell and taste. These respiratory symptoms are generally well understood by the public. However, why do some people develop tinnitus after being diagnosed with COVID-19? Below, tinnitus specialists Dr. Chien-Chih Chen, a dual specialist in Otolaryngology and Neurology, and psychiatrist Dr. Bing-Tao Tseng explain this phenomenon.
 

Can COVID-19 Affect Your Ears? Three Major Reasons Why Tinnitus May Occur

In addition to the typical symptoms of COVID-19, many patients have reported experiencing ear fullness or a persistent "buzzing" sound after infection. These patients often say, "I've never had this before," yet they developed tinnitus after contracting COVID-19. Others who already had tinnitus before infection noticed that it became more severe or occurred more frequently after they were infected.

▲Some patients experience tinnitus in addition to common COVID-19 symptoms such as coughing and fever.
 
Dr. Chien-Chih Chen explains that the body does not produce sounds without a reason. The appearance of tinnitus during a COVID-19 infection is not merely a coincidence. To better understand why this happens, it is important to first understand the three primary causes of tinnitus:

1. Compensatory Tinnitus

Also known as hearing-loss-related tinnitus, this type results from impaired auditory function, such as ear canal blockage, fluid accumulation in the middle ear, or damage to the cochlea or auditory nerve. When the brain receives less auditory input than expected, the brainstem activates a compensatory mechanism by reducing inhibitory signals. As a result, the cochlear hair cells vibrate more intensely, auditory neurons increase signal transmission, and the cochlear nucleus increases neural firing—all in an effort to amplify weakened auditory information.

2. Inflammatory Tinnitus

Another common type is inflammatory tinnitus, which is primarily caused by viral or fungal infections. This is the type most commonly associated with COVID-19. Because the cochlea and auditory nerve lack pain receptors, inflammatory substances cannot trigger pain signals. Instead, they generate warning signals that are perceived as sound, ultimately producing tinnitus.

3. Conversion Tinnitus

The third type is conversion tinnitus, which is related to psychological factors. Stress, frustration, loneliness, and feelings of helplessness can trigger physiological changes that form persistent neural circuits within the hippocampus. These circuits may overwhelm the brain's regulatory mechanisms involving the nucleus accumbens, causing widespread activation of the cerebral cortex. As a result, auditory sensations become amplified into what is often referred to as "brain tinnitus," producing symptoms similar to the sound of a large truck constantly driving inside the head. This condition is frequently accompanied by anxiety, panic attacks, insomnia, and autonomic nervous system dysfunction.
 

What Should You Do If COVID-19 Causes Tinnitus? Yuanjing Specialists Explain How Early Treatment May Help

At first glance, tinnitus associated with COVID-19 appears to be most closely related to inflammatory tinnitus. However, Dr. Bing-Tao Tseng points out that COVID-related tinnitus does not always arise from the same mechanism. Even the same virus may trigger different physiological responses in different individuals. This explains why some people who never experienced tinnitus before develop it after infection, while others with pre-existing tinnitus notice significant worsening that may persist for several months after recovery. The following examples illustrate two possible mechanisms:

1. The Virus Can Travel Through the Eustachian Tube, Causing Conductive Hearing Loss

Although all three major causes of tinnitus may contribute to COVID-related tinnitus, it is helpful to first understand how respiratory viruses reach the ear. Under normal conditions, the middle ear is connected to the nasopharynx through the Eustachian tube, which serves as a pathway through which viruses can travel from the upper respiratory tract into the ear. Once the virus enters the middle ear, it may cause infection, resulting in swelling of the mucosal lining and blockage of the Eustachian tube. This traps pressure within the middle ear, leading to conductive hearing loss, ear fullness, and ultimately compensatory tinnitus. Therefore, COVID-related tinnitus is not always caused solely by inflammation.

2. Friendly Fire: When the Immune Response Causes Tinnitus

Another possible mechanism resembles the tinnitus occasionally reported after COVID-19 vaccination—namely, an excessive immune response. Many people assume that tinnitus develops simply because viral infection causes middle ear inflammation. While this may play a role, Dr. Chen explains that the process is often more complex. During viral infection, the immune system produces large numbers of macrophages, white blood cells, and antibodies to eliminate the virus. However, this immune response may inadvertently damage the tiny arteries supplying the cochlea, causing inflammation and swelling of the arterial lining. Reduced blood flow leads to cochlear swelling, which further compresses these small arteries and worsens ischemia, creating a vicious cycle. This may result in low-frequency hearing loss together with compensatory tinnitus.
 
In clinical practice, physicians may prescribe oral or injectable medications such as antibiotics (when bacterial co-infection is suspected), antihistamines, and anti-inflammatory therapies to control inflammation and prevent further infection. If necessary, corticosteroids may also be administered to reduce tissue swelling, relieve arterial compression, and suppress excessive immune responses. In addition, excessive anxiety about the illness itself, together with the psychological stress of recovery and daily emotional burdens, may further affect brain function and contribute to the development of brain tinnitus. Therefore, psychological support and appropriate mental health treatment may also form part of a comprehensive treatment plan.
 

Additional Advice: Avoid Using Cotton Swabs to Relieve COVID-Related Tinnitus

Some patients experiencing ear fullness and tinnitus during COVID-19 attempt to relieve discomfort by cleaning their ears with cotton swabs. Dr. Chen cautions that using round-tipped cotton swabs often pushes earwax deeper into the ear canal rather than removing it. This may compact the earwax and interfere with its natural outward migration, making spontaneous removal even more difficult.


▲Many people instinctively use cotton swabs when their ears feel blocked, but doing so may actually worsen the problem.
 
Eventually, impacted earwax may block the external ear canal, interfering with normal sound transmission and hearing. It can also stimulate Arnold's nerve, sending sensory signals to the brainstem. The brain may mistakenly interpret these signals as irritation involving the throat, trachea, or lungs—areas supplied by the vagus nerve—triggering a protective cough reflex in an attempt to clear a nonexistent irritant. As a result, this may even worsen coughing symptoms during COVID-19.
 

Identifying the Correct Cause Is the First Step Toward Effective Treatment

As discussed above, tinnitus has many possible causes and may present in different ways. However, with a comprehensive evaluation performed by experienced specialists, the underlying causes can often be identified and treated individually, allowing patients to regain their quality of life. Dr. Chien-Chih Chen and Dr. Bing-Tao Tseng encourage patients not to panic if tinnitus develops after COVID-19 infection. Instead, they recommend seeking medical evaluation as soon as possible. Based on their clinical experience, patients who follow medical advice carefully and complete the prescribed course of treatment have a good chance of recovering from tinnitus.