One of the most common questions we’ve been asked recently is whether there is a link between covid and tinnitus. The answer is that there are a number of links, though the exact relationships are not yet completely understood.
A Difficult Year
The last year has been a difficult time for many of us, even more so for people whose tinnitus may have been worse than normal and driving them crazy.
The uncertain times created by the COVID-19 pandemic have left people both with and without underlying health conditions struggling more than usual.
Feeling Isolated
This is especially true for people with tinnitus.
Lockdowns and social distancing only serve to worsen the feeling of isolation experienced by many with tinnitus and hearing loss. If that is you, you are not alone. Check out this article on how to manage your tinnitus.
Covid Linked to Tinnitus
Early on in the pandemic the main concerns were understandably of life and death, rather than quality of life.
More recently, however, a number of reports have been published in the scientific literature highlighting the potential association of COVID-19 and injury to hearing health, including causing or worsening tinnitus, as highlighted by the group from Manchester.
More Research Reports
The same group recently revisited the same topic and found more than 50 scientific reports linking tinnitus and Covid.
These were mostly what researchers call case reports, case series and observational studies, which are not usually considered to be the most conclusive evidence.
Hearing Loss as a Result of Covid
However, they do show that this is a common complaint and suggest that around 7.6%, or around 1 in 13 people, report hearing loss as a consequence of having Covid-19.
The relatively good news is that for most people these effects seem to be transitory, with no significant persisting problems.
Can COVID Make Tinnitus Worse?
Yes. For many people this has been the case.
A large study of more than 3,000 people, mostly in North America and Europe, showed that 40% of people reported worsening of their tinnitus, compared to 54% with no change and 6% that reported improvement.
Social and Emotional Consequences
A large amount of this was driven by the social and emotional consequences of the pandemic, such as social isolation, and this was particularly so for females and younger people with tinnitus.
Stress Has Worsened Tinnitus
As with pre-pandemic times people reported that increased depression, anxiety, irritability and financial worries were all associated with reports of worsening tinnitus.
A complex relationship between mental health and tinnitus
There is a complex relationship between mental health and tinnitus: tinnitus can worsen mental health, whilst those with poor mental health are more likely to develop tinnitus and find the effects more troubling.
This vicious cycle is something that many people with tinnitus will recognise.
The research
Face Masks and Tinnitus
No evidence for masks worsening tinnitus
Whilst there is no evidence that the wearing of masks causes or worsens tinnitus there are some challenges associated with their use.
Can't use facial clues
Around 80% of people with tinnitus have hearing loss.
Whether they are aware of it or not, people with hearing loss often come to rely, at least to some extent, on lip reading and other facial clues to follow speech.
This is much more difficult if the person you are trying to speak to is wearing a mask, potentially altering the sound of their voice as well as hiding their lips.
Tinnitus and Medication
There are a number of medications that are known to cause tinnitus, particularly when taken in high doses or as an overdose.
The best known of these is Aspirin, though you can find a long list compiled by the American Tinnitus Association.
Covid Drugs and Tinnitus
Early on in the pandemic there was significant interest in Chloroquine and Hydroxychloroquine, two drugs usually used to treat Malaria, as potential treatments for COVID-19.
Both of these medicines are no longer recommended as they are not effective for treatment of prophylaxis.
Ototoxicity
However, they have also been shown to cause ototoxicity, a term used to describe worsening hearing or tinnitus as a result of taking a medication, with mixed results as to whether or not these effects are reversible.
Interestingly, in addition to Chloroquine and Hydroxychloroquine several other treatments for COVID-19 have been shown to have ototoxic properties, including
- Azithromycin
- Lopinavir-Ritonavir
- Interferon
- Ribavirin
- Ivermectin.
Extra caution should be used in particularly vulnerable groups, such as older people or those who already have hearing loss.
Health Services Negatively Affected
Reprioritisation
Reprioritisation of healthcare resources, including redeployment of staff to emergency work and cancellation of face to face appointments has had a significant impact on the delivery of hearing healthcare.
Telehealth
Whilst some studies have shown that telehealth approaches to tinnitus therapy, usually via telephone, are an option for many people, they were not acceptable to 20%, often those with worse hearing and more bothersome tinnitus.
Change in practice
COVID-19 appears to have caused a real change in practice.
30% of audiologists used telehealth approaches prior to the pandemic, but now 98% report having done so and 86% saying that they would be likely to continue to use this approach, at least some of the time after the pandemic.
The Way Forward
As with so much else relating to Covid, we don’t yet understand the full implications for hearing, tinnitus and balance.
A New Study
To better understand this, a new study being run by Professor David Baguley, one of the UK’s leading tinnitus experts, is about to launch and hopes to systematically assess the short and long term implications on hearing health following recovery from COVID-19.
Audiometry
The CHEAR (Covid and HEARing) study plans to make use of extended high frequency audiometry, whether hearing is tested above the range of frequencies normally used for hearing tests, which may show earlier signs of hearing damage.
Are you particularly struggling with tinnitus at the moment?
Online Support Groups
The British Tinnitus Associations has created online support groups to connect different people living with tinnitus across the UK.
There are multiple BTA online groups at varying times during the week to offer you a variety of options to suit your schedule.
Engaging with other people in the same situation and learning about different coping mechanisms can provide you with the support you need to get through this time.
Changes to services
The British Association of Audiology in partnership with the BTA has written more detailed information about the changes to tinnitus services during this COVID-19 pandemic.
Download Oto if you're feeling lonely or isolated and in need of help and you can also seek professional help for tinnitus as needed.
Join Oto
The Oto app offers techniques to reduce tinnitus intrusion including:
- CBT techniques
- Sound enrichment and audio landscapes
- Mindfulness activities
- Exercises to promote relaxation and physical wellbeing
- Sleep support
Check out Oto's Tinnitus Support Group, a supportive community for individuals with tinnitus or related conditions to receive regular tips and tricks from the expert team at Oto!
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