Tinnitus and COVID-19: effect of infection, vaccination, and the pandemic

Introduction: The COVID-19 pandemic, which began worldwide around March 2020, has had an impact on hearing health, specifically tinnitus and hearing loss. Physiologically, COVID-19 infection, or medication used to treat the infection, has been reported to be a potential risk factor for tinnitus onset. In addition, tinnitus was reported to be a long COVID symptom or to occur after a COVID-19 vaccination in some cases. With most reports focused on the clinical population, this study aimed to investigate how the onset of tinnitus is associated with COVID-19 infection, long COVID, and COVID-19 vaccination in the general population based on self-report, while accounting for otologic and psychological symptoms. Methods: In this study, a cross-sectional online survey that included general demographic questions, questions about tinnitus, hearing loss, hyperacusis, emotional status, and the Tinnitus Functional Index (TFI) was conducted. Results: Completed survey data of 1,511 respondents who reported having tinnitus or believed to have COVID-associated tinnitus were included in the analysis. Participants were categorized into four groups based on their judgment regarding the etiology of their tinnitus: (1) COVID infection group, (2) long COVID group, (3) COVID vaccination group, and (4) pre-existing tinnitus group. The results suggest that tinnitus severity (estimated using TFI scores) was significantly lower in the pre-existing tinnitus group than in any of the COVID-associated tinnitus groups. While varying factors were found to contribute to tinnitus severity among the COVID-associated groups, overall, depression and/or anxiety accounted for the most variance in predicting tinnitus severity. Discussion: The findings highlight the need to evaluate the impact of varying otologic and psychological symptoms in individuals with COVID-associated tinnitus for better patient-centered care.