Hearing problems and COVID-19: tinnitus explained

Hearing problems and COVID-19: tinnitus explained

Among people suffering from what is called 'long-COVID' a new ailment sprang up, tinnitus. Not one that is commonly reported, but it came to the headlines recently when a the founder of a restaurant chain committed suicide after suffering from severe tinnitus as a result of COVID-infection.
While tinnitus is not a symptom you'd expect from a virus, tinnitus is much more common than you'd expect as you rarely hear people complain about it. 
Turns out, there's not much known about tinnitus. You'd expect it is the same as for hearing loss after exposure to excessive noise from work, hobby or a singular event like a very loud concert, fireworks or explosions. While true, that's not the only reason why people contract tinnitus. 
Let's start with the relation between tinnitus and the virus. 

Hearing problems and COVID-19

Cases of COVID-induced hearing loss have been documented world-wide. From case studies it appears one in ten COVID-19 patients report experiencing some form of hearing loss or tinnitus.
Of those patients experiencing hearing problems, symptoms vary between severe hearing loss in both ears, mild hearing loss in just one ear, and others experiencing tinnitus fluctuating between both ears. 
It's too early to tell the extent of the damage COVID-19 will cause on the ears. Some of the patients have seen an increase in their symptoms, while others have noted improvement over time. 
Researchers don’t yet know if this condition is temporary or permanent, but they advise you to seek guidance from a medical professional as soon as possible. If the hearing loss is sudden, steroids may help reverse it in the first 24 hours.

Hearing loss after viral infection is not all that uncommon

It is known that viruses such as measles, mumps, meningitis and HIV can cause hearing loss. This doesn't just hold true for viruses, but has also been widely reported about bacterial infections such as Lyme disease. 
Coronaviruses can damage the nerves that carry information to and from the brain. 
Past reports show that viruses like the coronavirus can cause a condition called auditory neuropathy. This condition affects the auditory nerve, which sends information from the inner ear to the brain. As a result, a patient can experience hearing changes such as tinnitus. Other symptoms that were reported are hearing loss, and vertigo. These unpleasant effects are usually associated with the inner ear.

How COVID-19 may affect the ears

For some people who experience tinnitus after a COVID-19 infection, tinnitus most likely has a neurological cause, just like how vertigo, concentration difficulties, and chronic brain fog are probably caused by neurological problems. 
But scientists don't yet know if these symptoms are purely neurological in origin or if they can also affect hearing in other ways.

Direct damage to the ears

After autopsies done on a few patients, who died of COVID-19, the virus was detected inside the ears, showing that the virus can physically infiltrate the ears. However, it’s unlikely that the SARS-CoV-2 virus will enter your ear canal the way it would enter your mouth and nose.
The organ of the ear that is responsible for taking in sounds is called the cochlea, and it’s made up of tiny auditory hair cells that can easily be damaged. The blood supply going to the cochlea is very small, so it’s very easy for a virus that's in your bloodstream to go into your cochlea. Just a small amount can have a really big impact, and this is most commonly what causes the damage.

Nasal inhalation

Inhaling SARS-CoV-2 could trigger ear infection-like mechanisms that cause blockage in the ear.

Nerve damage

Recent findings show that COVID-19 is sometimes associated with the development of a rare condition (Guillain–Barré Syndrome) that can lead to paralysis. In this case, ears aren’t directly damaged, but the nerves that transmit sounds are. This type of damage is called peripheral neuropathy.

Cytokine storm

Cytokine storm, a severe immune reaction released by the SARS-CoV-2 virus, can trigger inflammation throughout multiple organs in the body. If this inflammation occurs in any of the structures next to the ears, it could trigger a ringing sound. 
The fact that these hearing symptoms have a later onset means it may take some time for the damage to build-up and be noticeable, and this could be because of a slow progression of inflammation to the brain, joints, or facial nerves. 

Medication may contribute to hearing loss

COVID-19 is probably not the sole source of hearing problems. Medications prescribed for the disease, like remdesivir, hydroxychloroquine, lopinavir, and ritonavir, are all medications that may cause damage to the cochlea in high doses.
Even the vaccines administered (Moderna, Pfizer, J&J and AstraZeneca) to prevent COVID have been reported to cause tinnitus among a minority of people that were vaccinated. 

What is tinnitus?

About 30% of people will experience tinnitus at some point in their lives, and the number of people who live with persistent tinnitus is around one in eight people (~13%). 
Tinnitus is the perception of a sound that isn’t being generated by an external source. It’s really quite varied in terms of how people hear it and how people describe it. 
Tinnitus can be temporary or chronic. People most commonly report a ringing in one or both ears, but the noise can also sound like buzzing, hissing, whistling, swooshing or clicking.
Common causes of tinnitus include:
- earwax blocking the ear canal
- sudden or long-term exposure to loud noises
- medicins that damage the ear
- head trauma such as a concussion or a fracture
- temporomandibular joint disorder (TMJ)
- stress and anxiety
Tinnitus often is the result of damage in the inner ear. 
There are thousands of little hairs in the inner ear and if they are damaged, they are no longer sending the signal to the brain accurately. Your brain will notice 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. 
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. They are stressed because of tinnitus, and then it gets louder because of stress. 

How is tinnitus treated?

There isn’t a permanent cure, but experts say there are many treatment options available for people suffering from tinnitus. 
It is recommended to see 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. 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. 
One of the most common methods of relieving tinnitus is sound therapy. The brain is given a lot of stimulation, 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. 
This can be as simple as using a white noise machine, listening to music or podcasts, or leaving the television on. 
Some hearing aids have special apps which allow users to customize sounds. Cognitive behavioral therapy and psychological counseling can also be helpful. 
Sounds can be used to habituate people to their tinnitus. Over time, the reaction to the tinnitus can change. Once 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 specific solution. You need several different different strategies in different situations.

Can supplements help?

There is little attention nor research done on whether supplements may help with tinnitus.
While there's no real cure for tinnitus, some supplements might be able to help address the worst symptoms of the conditions. 
Some information suggests that the following supplements may help to reduce tinnitus symptoms. 
* antioxidants such as vitamin C, olive extract, and green tea are said to reduce symptoms
* B-vitamins, B1 (thiamin), B3 (niacin) and B12 (cobalamin) are all popualar s they improve blood circulaton and stabilize nervous system. Vitamin B12 deficiency itself may lead to tinnitus.
* ginkgo biloba improves blood flow
* magnesium supplementation has been shown to stop tinnitus
* melatonin seems to exert positive effects on blood vessels and nerves
* zinc deficiency is very common among people suffering from tinnitus
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