A Report on Emerging Evidence and Implications of COVID-19 Related Tinnitus: Preliminary Survey Results

Survey Study

A survey study assessed the prevalence and impact of COVID-19 and vaccines on tinnitus. The survey was designed to address (i) if the COVID-19 virus had any impact on preexisting tinnitus, (ii) if the COVID-19 vaccination had any impact on preexisting or lead to the on-set of tinnitus, and (iii) whether the pandemic-induced circumstances affect existing tinnitus or hyperacusis. The questionnaire was designed to capture demographics, occurrence, characteristics, and the change of tinnitus before and after COVID-19 vaccination.

The study encompassed 421 participants with an average age of 55.6 years (14.2 SD). The majority of respondents identified as European American/White. Regarding gender distribution, 51.4% were female, 47.8% were male, 0.3% identified as other, and 0.5% did not disclose their gender. Notably, individuals aged 40 years and above displayed a higher degree of impact, particularly within the age bracket of 46 to 70 years, who exhibited a more pronounced occurrence and alteration in tinnitus perception.

Covid-19 Infection/Vaccination and Tinnitus

In the early stages of the pandemic, tinnitus emerged as one of the initial indicators of COVID-19 [1].

Subsequent case reports [2, 3, 4] and comprehensive studies further indicated its frequent occurrence among affected patients [5, 6]. Studies like Erinc, et al. [7] reported the relationship between tinnitus and hyperacusis in patients affected by COVID-19 infection. The authors reported a notable increase in tinnitus reporting in individuals affected by COVID-19 and hyperacusis has worsened in individuals who did not get in contact with COVID vaccine.

In the current study, 86.7% of the participants had not Contacted COVID-19 prior to receiving any dosage, and 87% remained uninfected throughout the intervals between doses refer to Figure 1. Among this group, 5% of those infected required hospitalization. Analysis of responses indicated that 53.5% received a total of two doses along with a booster, with Pfizer-BioNTech being the primary initial vaccine chosen by 54% of individuals, followed by Moderna refer to Table 1.

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Before COVID-19 vaccination (BCV), 45.8% of respondents did not experience tinnitus symptoms, while 54% had preexisting tinnitus. The described tinnitus manifestations included roaring, ringing, hissing, buzzing, and sounds resembling crickets. Among these, 64.1% of individuals reported ringing as the most common symptom. Regarding ear distribution, 13.8% experienced tinnitus in the right ear, 14.2% in the left ear, 61.5% in both ears, 6.4% at the center of the head, and 4.1% described the location as other.

Following COVID-19 Vaccination (ACV), tinnitus was reported by 91.8% of participants, while 8.2% indicated the absence of tinnitus. Changes in tinnitus, marked by adverse symptoms, were more prevalent after the first dose (35.6%) and second dose (37.3%) refer to (Table 2). Among the 346 individuals who experienced altered tinnitus or new instances of tinnitus post-ACV, the reported symptoms included ringing, roaring, high-pitched electric whirling, hissing, buzzing, sensation of air in the ears, and whistling, occurring in both ears. Predominantly, this tinnitus was described as high-pitched in nature (30.27%), with 278 cases (80.35%) describing it as continuous and 37 cases (10.69%) as intermittent or fluctuating.

Participants reported that their tinnitus symptoms worsened within a few days after vaccination, with the duration of exacerbation varying from a few hours to a few months. Out of the total responded count (269), 70 (26 %) individuals reported to have noticed the change after a few days. Detailed data shown in (Table 3).

In individuals with preexisting tinnitus (108), the changes in tinnitus perception were reported a few days post-vaccination by 25.6% of respondents. For individuals with a new onset of tinnitus, 161 respondents experienced symptoms post vaccination, with 40.2% reporting onset following the second dose. The onset of tinnitus symptoms varied among respondents, but a majority reported onset occurring after a few days following vaccination.

When comparing tinnitus occurrence frequency for BCV and ACV “Have you had noise (such as ringing or buzzing) in your head or in one or both ears that lasts for more than five minutes?” the total counted responses were greater for ACV (74.8 %) for Yes, most or all of the time (90%- 100%) compared to BCV (32.6%). For ACV, only 34 (8.3%) out of 408 responded individuals reported no, never compared to BCV (45.9%) Refer to Table 4.

Psychological Well-Being During Pandemic and Tinnitus

Stress and anxiety during the pandemic have been linked to some individuals’ tinnitus development [8, 9].

Several studies have reported a rise in anxiety, depression, and other psychopathologies during the COVID-19 pandemic [10, 11, 12, 13]. Individuals who experience tinnitus have a devastating impact on their lives. The majority of the participants in the survey reported to have adverse effects on the quality of life due to the sudden onset of tinnitus post vaccination. These effects descriptions ranged from mild to severe anxiety, sleeplessness or difficulty sleeping, difficulty focusing on work, fear of tinnitus getting worse, and suicidal thoughts.

One of the participants described their condition as follows: After receiving the three booster shots from Pfizer in October 2022, I developed tinnitus after 20 days. To date, I have received a total of five shots. Seeking relief, I consulted with two ENT doctors, both of whom provided the same diagnosis - that there is currently no known cure for tinnitus, and they couldn’t offer any specific treatment. Their advice was to learn to cope with the condition. Regrettably, following this counsel from the specialists, I struggled with insomnia and anxiety attacks for about two and a half weeks, pushing me to the brink of desperation. The severity of the situation led me to seek a semester of medical leave from the university where I work, hoping to find assistance in my home country.

Such experiences emphasize the importance of timely intervention and support for tinnitus patients.

Based on the self-reported results from this survey study future research might need to focus on questions related to tinnitus reported by 91.8% of participants after COVID-19 vaccination such as, how does this prevalence compare to the rates observed in other m-RNA vaccinations? What could be potential mechanisms linking the COVID-19 vaccination to changes in tinnitus, and how might these findings contribute to our understanding of the vaccine’s effects and physiological manifestations? In light of the findings, what considerations should be considered when assessing and addressing tinnitus-related concerns in individuals receiving COVID-19 vaccinations?