The Washington PostDemocracy Dies in Darkness

Can covid make your ears ring? What we know about its possible connection to tinnitus.

(iStock/Tinnitus, or the perception of a sound that isn’t there, is not curable, but it can be treated, experts say.)
Placeholder while article actions load

The recent death of Texas Roadhouse CEO Kent Taylor is bringing more attention to what experts say is another troublesome physical ailment that may be associated with the coronavirus pandemic: tinnitus, or the perception of a loud ringing or buzzing sound in the ears.

Taylor, 65, died by suicide last week, and his family told news outlets, including The Washington Post, that he had been battling “post-Covid related symptoms, including severe tinnitus” at the time of his death.

Texas Roadhouse CEO dies by suicide while battling ‘unbearable’ post-covid-19 symptoms, family says

Though early research and anecdotal reports have documented tinnitus and sudden hearing loss in some covid-19 patients, audiologists emphasized that there is no conclusive evidence connecting the virus to the onset or worsening of tinnitus.

The condition is “one of those things that is just so variable in every single person,” said Eldré Beukes, an audiologist and research fellow at Anglia Ruskin University in the United Kingdom, who has published research on how individuals with tinnitus have been affected by the pandemic. In the United States, more than 50 million people experience some form of tinnitus, which is often linked to hearing loss. About 20 million struggle with a chronic condition, while 2 million have extreme and debilitating cases, according to the American Tinnitus Association.

“There are at least 200 reasons” why people may develop tinnitus or feel like their existing condition is worsening, Beukes said, including factors related to hearing damage as well as stress and mental health conditions. “Some people do just get tinnitus that’s seemingly out of the blue.”

Beukes and other experts say it’s critical for people with tinnitus to understand the condition and be aware that there are a variety of evidence-based treatments that can provide relief. People should “not accept that their quality of life has to go down because they have tinnitus,” Beukes said. “There is hope and there are things that they can do to live the life they want to live.”

Here’s what audiologists say you need to know about tinnitus, its possible association to covid-19 and recommended treatments.

National Suicide Prevention Lifeline is 800-273-TALK (8255)

What is tinnitus?

Tinnitus is the perception of a sound that isn’t being generated by an external source, said Catherine Fabian, an audiologist and faculty member at Northwestern University. “It’s really quite varied in terms of how people hear it and how people describe it.”

The condition can be temporary or chronic, according to the American Tinnitus Association. People most commonly report a ringing in one or both ears, but the noise can also sound like buzzing, hissing, whistling, swooshing or clicking.

Tinnitus often is the result of damage in the inner ear, said Jason Leyendecker, an audiologist and secretary of the Academy of Doctors of Audiology.

“We all have thousands of little hairs in the inner ear and if they are damaged, they are no longer sending the signal to the brain accurately,” Leyendecker said. “So your brain picks up that there is missing information and tries to re-create it,” which causes you to perceive sounds that aren’t there.

In other cases, tinnitus can be triggered by exposure to medications or chemicals that are potentially toxic to the ear or, as with hearing loss, the condition could be genetic, Leyendecker said.

Fabian noted that stress, anxiety and fatigue can exacerbate tinnitus, making your brain pay more attention to the sound, which then causes the noise to be more pronounced and distracting.

It’s not uncommon for people who are affected by tinnitus to enter a “vicious cycle,” largely driven by stress, said Holly Lovering, an audiologist with the George Washington Medical Faculty Associates. “We’re stressed because we have tinnitus, and then it gets louder because we’re stressed.”

What do we know about tinnitus and covid?

A handful of published studies and individual case reports have suggested that hearing loss and tinnitus may be a rare or potentially less frequently documented “long-haul” symptom of covid-19.

A case study published in the BMJ in October described a 45-year-old covid patient who, after being severely ill and hospitalized, noticed tinnitus and sudden hearing loss. The patient did not have a history of hearing problems, according to the report. A month later, an international survey-based study examining the changes in tinnitus sufferers’ experiences during the pandemic was published in the peer-reviewed journal Frontiers in Public Health. Of the more than 3,100 people surveyed, 237 respondents reported that they had suffered coronavirus symptoms. Among that smaller group, about 40 percent said their symptoms worsened their tinnitus.

Still, the existing research does not provide “conclusive links,” said Beukes, who was the lead author of the survey-based study.

“There is research being done that’s more robust now,” she said. “They’re doing research to look into the mechanisms of this.”

Experts do have some theories.

Certain types of viral inflammation can affect the inner ear and cause a tinnitus response, Fabian said, noting that she has seen two or three patients who recovered from covid-19 and are reporting new auditory problems including tinnitus. Another possibility, she said, is that upper respiratory infections, such as a cold, may cause infections in the middle ear.

Such infections can lead to a build up of fluid and debris behind the eardrum. This can “trap and block sound and make your ability to hear your tinnitus or start perceiving your tinnitus really, really easy,” Fabian said. This hearing loss is usually temporary, she added, but once a person starts hearing their tinnitus, it may be difficult to stop noticing it.

Tinnitus may also be the result of the stress of having covid or just living life during the pandemic, Lovering said.

“We’ve had people with normal hearing come in because they have tinnitus and we’ve counseled them that we are living in very stressful times,” she said.

A third of Americans now show signs of clinical anxiety or depression, Census Bureau finds amid coronavirus pandemic

How does tinnitus affect people?

Beyond increasing the risk of anxiety, depression and insomnia, untreated tinnitus that is bothersome “can affect almost all aspects of life,” Beukes said. People, for instance, tend to avoid activities that they think might make their tinnitus worse, such as going out to a noisy restaurant or attending a party.

“People that enjoyed reading can’t read because they can’t concentrate anymore because of the sounds,” she said. “Having a normal conversation is hard because they can’t focus on the other person because … the sound in their heads is louder and overpowering. It can get people really, really down.”

While there have been reports of people with tinnitus dying by suicide, Lovering said such incidents are “very rare.” There are often other factors at play in those situations, Leyendecker added.

“This is one of those things that is tough to manage for some,” he said. But, “if they have hope, if they have understanding of where it’s coming from and why it bothers them, it can drastically reduce their reaction to it and make it more manageable.”

How to talk to loved ones when you’re worried about their mental health

How is tinnitus treated?

There isn’t a cure, but experts say there are many treatment options available for people suffering from tinnitus and resources can be found on the American Tinnitus Association’s website.

First, Leyendecker recommends seeing a primary care physician or an ear, nose and throat specialist to determine whether your tinnitus has a treatable medical cause, such as an ear infection or impacted ear wax. Then, it’s important to visit an audiologist, who can test your hearing and help create an appropriate treatment plan. If you have hearing loss-related tinnitus, hearing aids can be an effective treatment, Leyendecker said.

One of the most common methods of relieving tinnitus is sound enrichment or sound therapy, Fabian said. “What we want to do is give the brain a lot of stimulation and enrichment, so it has a lot of other types of sounds to listen to and to process and it’s not just processing the tinnitus signal itself,” she said.

This can be as simple as using a white noise machine, listening to music or podcasts, or leaving the television on, Fabian said. Lovering recommended apps created by hearing aid companies, such as ReSound Relief or Relax by Starkey, which allow users to customize sounds. Cognitive behavioral therapy and psychological counseling can also be helpful, experts said.

You like to drift off to podcasts. Your partner prefers silence. Headphones offer a compromise.

Some audiologists such as Leyendecker specialize in tinnitus retraining therapy, which involves counseling and the use of sounds to habituate people to their tinnitus. “Over time, we’re able to change the reaction to the tinnitus,” Leyendecker said. “If you don’t care about it, you won’t listen to it.”

Additionally, people with tinnitus are encouraged to practice mindfulness and other stress-reduction strategies, including meditation, deep breathing and exercising.

“With tinnitus, often there isn’t one tool or one magic bullet,” Beukes said. “You need a toolbox of different things and different strategies might work in different situations.”

Got a question about the coronavirus and vaccine rollout? Ask The Post.