Do you ever hear what sounds like ringing, humming or noise in your ears or head? If so, you may be experiencing tinnitus. At times, everyone hears tinnitus noise but may not pay much attention to it until it's brought into focus. There is always internal information coming into our brain, but the noise may not be at the forefront until we're conscious of it. Thankfully, tinnitus is a symptom, not a disease, and it's very common.

What does tinnitus feel like?

Tinnitus is more than just ear ringing. It may be in one ear, both ears or alternating from side to side. The noise you hear may come in different forms, including ringing, scratching, pulsating, hearing your heartbeat, chimes, crickets, clicking, static, humming or whooshing. 

What causes tinnitus? 

Anything that causes hearing loss can cause tinnitus," says Geoffrey Casazza, MD, Nebraska Medicine otolaryngologist and head and neck surgeon. "Many patients think it will lead to deafness, which is extremely unlikely. They may worry it could be due to a tumor, which is possible but also unlikely. They may wonder it is due to an inner ear infection, which is possible, but not likely without other additional symptoms." 

While we're not certain what is going on physically to cause tinnitus, much of the time (about 99%), certain types of stress are at play. 

Five types of stress can have a significant impact, including: 

1. Chemical Stress: Excess coffee, nicotine, alcohol, high doses of over-the-counter (OTC) pain medication or a side effect of certain prescription medications.
2. Acoustic Stress: Noise input or exposure. Very loud or prolonged noise, such as high volume concerts, firearms or noisy work environments like factory work.
3. Pathologic Stress: Hearing loss, ear infection, wax impaction or other diseases of the ear.
4. Physical Stress: Your heart pumps 60 to 100 times per minute for your entire life. You may hear this when you are exercising, performing a strenuous activity or when you lie down – especially if you have an illness or fever.
5. Emotional Stress: Anxiety or depression are common reasons tinnitus may become noticeable or seem worse.

Can COVID-19 cause tinnitus?

The relationship between COVID-19 and tinnitus is unclear

"Since tinnitus is so common, the answer is a challenging one," says Dr. Casazza. "While there have been reports of sudden hearing loss, tinnitus is so common it's difficult to see if there's a relationship between the two. It is not always clear if studies report an actual change, development of a new symptom or simply more awareness of an already existing issue."

Social consequences of COVID-19 may be a factor

The pandemic's increased stress and anxiety, social isolation and restrictions may also exacerbate a person's already existing tinnitus and bring it to the foreground.

Certain proposed treatments for COVID-19 may contribute

"Chloroquine and hydroxychloroquine, azithromycin, interferon and ivermectin, are known to be ototoxic and could cause someone to develop hearing loss, which may lead to tinnitus," adds Dr. Casazza. "Available evidence suggests that the ototoxic effects may be improved or mitigated by stopping the offending agents. Therefore, recognizing hearing loss, tinnitus or vertigo is crucial to facilitate early intervention and prevent long-term damage."

COVID-19 vaccines or post-COVID-19 syndrome 

There is no definite correlation between COVID-19 vaccination and new or worsened otologic symptoms. Further studies are needed. "While there may be some evidence that those who have persistent COVID symptoms, such as loss of taste or smell, fatigue and the like may also develop tinnitus," says Dr. Casazza. "But if this is a true development of the tinnitus or an exacerbation of a prior symptom is unclear." 

What can I do to manage tinnitus symptoms? Does it go away on its own?

The brain prefers to listen to external noise, so use this to your advantage. Having some baseline noise level, even low enough to be subconscious can be helpful to mask tinnitus. Over time, most will see improvement. 

Management tips:

• Turn on a fan, open a window, turn the TV on low or use a sound machine
• If you have associated hearing loss, hearing aids or amplifiers may help 
• Tinnitus retraining therapy or cognitive behavioral therapy has been shown to be effective 
• OTC treatments or vitamin supplements are not recommended 

Can seeing a doctor help?

If the tinnitus is only on one side, if you're hearing your heartbeat while at rest, if you're distressed or not sleeping, it's a good idea to see a doctor. Also, make an appointment if there are other neurological symptoms like numbness, facial weakness, trouble swallowing or hearing loss. A doctor can help rule out potential physical causes of tinnitus and if needed, perform hearing tests, order imaging tests, initiate treatment or give therapy referrals. 

"Most patients who struggle with tinnitus don't realize that there is help to manage it," says Dr. Casazza. "Don't be afraid to reach out to your doctor and have a discussion about it."