Among many other clinical symptoms of COVID-19, tinnitus has been observed as a major subject due to an increase in complaints by coronavirus patients. The condition had caused a major impact on the quality of life of these patients, affecting their emotional, concentration and sleep quality. 
In this article, we will discuss an association of COVID-19 with tinnitus and sensorineural hearing loss. Take a look.
COVID-19 And Tinnitus
Tinnitus is characterised by ringing or buzzing noise in one or both the ears, constantly or at regular intervals, which may progress to hearing loss. As per a report mentioned in a study, neurological involvements of coronavirus was found in around 30 per cent of positive COVID-19 patients, especially with otoneurological symptoms (relating to the ears). 
The study was questionnaire-based and results were evaluated based on the response from patients diagnosed with COVID-19. Around 43 patients (28 males and 15 females) out of 185 positive cases reported tinnitus which is characterised as follows:
- 17 out of 43 reported recurrent tinnitus
- 10 out of 43 reported episodic or occasional tinnitus
- 7 out of 43 reported continuous tinnitus with intensity changes throughout the day
- 4 out of 43 reported persistent tinnitus always present, day and night
- 3 out of 43 reported pulsatile tinnitus, means synchronous with the heartbeat
- 2 out of 43 reported continuous tinnitus with the same intensity, causing a disturbance during sleep time.
The aforementioned data suggest COVID-19 viral infections tend to damage inner ear cells which may cause hearing alterations and lead to hearing loss.
Controversy On Sensorineural Hearing Loss And COVID-19 Connection
Several reports based on positive COVID-19 patients show that sudden sensorineural hearing loss could be a possible non-specific symptom of coronavirus. However, the reports are controversial and need further evaluation.
Why they could be connected?
A report brings out a point that due to disruptions in regular ENT services during the pandemic, many cases of sensorineural hearing loss due to COVID-19 might be missed or remained undiagnosed. 
COVID-19 is linked to many peripheral neuropathies. This shows that the possibility of impairment of the auditory pathway is high due to the infection, which may get complex and lead to permanent hearing loss in some groups of people.
This can be due to infection of the nasopharynx. Fluid buildup in the nasal cavity can spread to the middle ear leading to middle ear infections. This can cause hearing problems such as tinnitus, sensorineural hearing loss, conductive hearing loss and other auditory problems. 
Why they couldn’t be connected?
A study says that though viral infections are among the most common causes of the condition, there are other factors which are also considered for increasing incidences of tinnitus or hearing loss such as autoimmune diseases or heart-related conditions. 
Also, other antiviral antibodies serum such as those of herpes and influenza B were isolated from the patients with sensorineural hearing, who were also COVID positive.
Therefore, due to the lack of larger case series and the presence of other viral serum, it was reported that hearing loss and COVID-19 could just be coincidental.
A study has shown the administration of steroids for the successful treatment of hearing ailments due to COVID-19. The course of oral steroid (60 mg) was for seven days. This has resulted in partial improvement in hearing functions. 
Auditory complications due to COVID-19 infection is an ongoing research topic. Due to the lack of discussion and ignorance of the symptom, a large number of people are facing total hearing loss. Early detection of the symptom during the time of COVID-19 diagnosis may prevent the condition.
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