The COVID-19 pandemic has disrupted nearly every dimension of life. To reduce virus transmission, restrictive measures were enforced that changed the way we socialize, interact, and access medical care. Although such measures reduced the spread of the virus and saved lives, accumulating evidence indicates the negative impact they have on well-being.1 As tinnitus has been known to be initiated or exacerbated during stressful periods,2 concerns were raised about the impact of the pandemic on people with tinnitus. As several viruses are known to affect the auditory system, questions regarding the impact of COVID-19 on auditory-related symptoms were also raised. To learn more about the pandemic-related experiences and challenges of tinnitus patients and their implications on hearing care, we explore recent reports and surveys.
CAN COVID-19 CAUSE TINNITUS?
Recent reports note long-term effects of COVID-19, including hearing-related symptoms. An increasing number of studies have reported tinnitus initiation after contracting COVID-19 in individuals who had no prior tinnitus.3 Although prevalence rates are still not clear (ranging from 0.4-23%), these exploratory studies have provided a foundation on which further robust research can be designed to learn more about the incidence of tinnitus post-COVID-19. As the mechanisms of tinnitus initiation post-COVID-19 are not known, further research should be done to determine if it can be directly attributed to the virus or to other factors such as the impact of receiving critical care, ototoxic medications, and/ or the stress of being hospitalized.
CAN CONTRACTING COVID-19 CHANGE TINNITUS?
As numerous case studies also highlighted tinnitus worsening post-COVID-19, a larger study was initiated by Beukes and collegues4 investigating the impact of COVID-19 on people with pre-existing tinnitus. Of the 237 participants who reported experiencing COVID-19 symptoms, 54 percent said their tinnitus remained stable, 40 percent reported that their tinnitus symptoms were significantly exacerbated, while six percent had experienced improvements in their tinnitus. Further longitudinal research is required to understanding the mechanisms behind these heterogeneous effects.
DOES THE PANDEMIC IMPACT PRE-EXISTING TINNITUS?
Beukes and colleagues4 asked 3,103 individuals about the effect of the pandemic on their tinnitus. At the time of the study (May-June 2020), a majority (67%) of the respondents reported that the pandemic had not altered their tinnitus, 31 percent reported exacerbated tinnitus, and two percent reported that their tinnitus was better. Females and younger adults were more likely to report bothersome tinnitus, and it is suspected this may be due to the pandemic having a greater impact on the work and lifestyle changes of these populations.
Mediating factors that significantly exacerbated tinnitus included loneliness, self-isolation, poor sleep, and reduced levels of exercise, as well as increased levels of depression, anxiety, irritability, and financial worries.
WHAT KEPT TINNITUS STABLE AMID THE PANDEMIC?
Since many individuals with pre-existing tinnitus reported having unchanged or even improved tinnitus during the pandemic, Beukes and colleagues5 explored what factors may have contributed to this. When comparing the coping strategies used by individuals with different levels of tinnitus severity as measured on the Tinnitus Handicap Inventory Screening version (THI-S), it was found that tinnitus distress was less for individuals who received support from family and friends, spent time outdoors or in nature, and those doing active relaxation. Other activities that helped coping included arts and crafts, woodworking, cooking, reading, music, gardening, house/yard maintenance, and doing other projects. Some respondents reported that having a calm lifestyle, getting more sleep, eating healthy meals, meditating, and doing yoga during the pandemic helped keep their tinnitus stable amid the pandemic. These findings illustrate the importance of social contact, relaxation, and enjoyable activities in helping patients cope with tinnitus. Joining support networks such as tinnitus support groups as well as being involved in activities that aid relaxation and exercise should be promoted.
WHAT CAN HEARING CARE PROFESSIONALS DO?
Health care professionals should be aware of the effects of COVID-19 and the pandemic on tinnitus. As tinnitus has worsened for some during the pandemic, health care centers reported an influx of tinnitus patients reporting more bothersome tinnitus on reopening after the first wave.6 Such an influx may also be expected as many healthcare services, including audiological services were severely limited during the first wave of the pandemic. Beukes and collegues5 compared help-seeking for tinnitus before and during the pandemic in North America for 1,522 individuals. The findings revealed that significantly less support was sought during the pandemic compared with before the pandemic. Of those who sought help, eight percent sought help from hearing care professionals, seven percent from self-help resources, three percent from tinnitus patient associations, and two percent from online interventions. Tinnitus distress was found to be significantly less among those who sought help via their usual clinics, and had ongoing or remote support. This indicates the importance of accessible support for those with tinnitus distress despite the restrictions imposed by the pandemic.
To identify the kind of support that would be helpful, Beukes and collegues6 asked people with tinnitus what specific tinnitus support would be helpful. Respondents articulated a desire to be able to consult with caring, understanding, multidisciplinary tinnitus experts. They also expressed a need for more patient-centered, evidence-based therapies and greater intervention options. They wanted reliable online information provided by experts. They also stressed the need for tinnitus to receive greater research support and finding a cure was required. Many participants who had hearing difficulties also expressed the need for more affordable hearing aids and hearing protection, as well as more social and peer support and better public awareness of tinnitus. Lastly, additional support during the pandemic to help cope and deal with resulting insomnia, loneliness, and anxiety was requested. These requests, summarized in Figure 1, can be used by hearing care professionals in shaping patient-centric tinnitus care.
The need for accessible evidence-based tinnitus interventions especially using remote care models to ensure that service delivery is not affected due to external factors such as the pandemic was highlighted. One example is online cognitive behavioral therapy (www.tacklingtinnitus.org) specifically developed for tinnitus.7,8 Moreover, these findings indicate a clear and immediate need to provide adequate social support through online tinnitus support groups, for example.
Various COVID-19 related studies have provided many insights into how people with tinnitus are affected by outside influences and the need for accessible meaningful interventions. Patient organizations and professionals should be encouraged to work together to provide improved outlets for tinnitus care. The need for greater awareness of the toll of tinnitus should be advocated. Health professionals who may be involved with COVID-19 patients should be mindful that contacting COVID-19 may lead to tinnitus and hearing loss, and other audiovestibular difficulties and such individuals should be directed to appropriate care. Additional support should be offered where tinnitus severity has increased due to the health, social, and/or emotional effects of the COVID-19 pandemic. This may include those experiencing loneliness, having fewer social interactions, and those who are more anxious or worried. Further studies are required to collate ongoing implications of COVID-19 on tinnitus so that service provision can be structured accordingly.
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2. Mazurek, B., Boecking, B., & Brueggemann, P. (2019). Association between stress and tinnitus—new aspects. Otology & Neurotology
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3. Micarelli, A., Granito, I., Carlino, P., Micarelli, B., & Alessandrini, M. (2020). Self-perceived general and ear-nose-throat symptoms related to the COVID-19 outbreak: a survey study during quarantine in Italy. Journal of International Medical Research
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4. Beukes, E.W., Baguley, D.M., Jacquemin, L., Lourenco, M.P.C.G., Allen, P.M., Onozuka, J., Stockdale, D., Kaldo, V., Andersson, G., & Manchaiah, V. (2020b). Changes in tinnitus experiences during the COVID-19 pandemic. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.592878
5. Beukes, E.W., Onozuka, J, Brazell, T, & Manchaiah, V. (2021) Coping with tinnitus during the COVID-19 pandemic. American Journal of Audiology
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6. Anzivino, R., Sciancalepore, P. I., Petrone, P., D'Elia, A., Petrone, D., & Quaranta, N. (2020). Tinnitus revival during COVID-19 lockdown: how to deal with it?. European Archives of Oto-Rhino-Laryngology
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7. Beukes, E. W., Baguley, D. M., Allen, P. M., Manchaiah, V., & Andersson, G. (2018). Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Adults With Tinnitus in the United Kingdom: A Randomized Controlled Trial. Ear and hearing
, 39(3), 423–433. https://doi.org/10.1097/AUD.0000000000000505
8. Beukes, E. W., Andersson, G., Allen, P. M., Manchaiah, V., & Baguley, D. M. (2018). Effectiveness of Guided Internet-Based Cognitive Behavioral Therapy vs Face-to-Face Clinical Care for Treatment of Tinnitus: A Randomized Clinical Trial. JAMA otolaryngology-head & neck surgery
, 144(12), 1126–1133. https://doi.org/10.1001/jamaoto.2018.2238