Sensorineural Hearing Loss After COVID-19: Understanding the Risks

Many people in the United States have reported changes in their hearing after a COVID-19 infection. Some notice muffled hearing, ringing in the ears, or balance problems. Others are told they have sensorineural hearing loss after COVID-19, a type of inner-ear or nerve-related hearing damage. While research is still developing, it is important to understand what is known so far—and what you should do if you notice new hearing symptoms.

What Is Sensorineural Hearing Loss?

Sensorineural hearing loss (SNHL) happens when there is damage to the inner ear (cochlea) or the auditory nerve that carries sound to the brain. It is the most common type of permanent hearing loss.

SNHL can be caused by many factors, including aging, noise exposure, certain medications, infections, and genetic conditions. In some cases, it may appear suddenly and require urgent treatment.

Common Symptoms of Sensorineural Hearing Loss

• Difficulty understanding speech, especially in noisy places
• Sounds seeming muffled or less clear
• Ringing, buzzing, or hissing in the ears (tinnitus)
• Needing to turn up the TV or ask others to repeat themselves
• Feeling that one ear hears worse than the other

How COVID-19 May Affect Hearing

COVID-19 can affect many systems in the body, including the respiratory, cardiovascular, and nervous systems. As research has continued, some people have reported hearing loss after COVID infection, along with symptoms such as tinnitus and dizziness.

Possible Mechanisms (What Doctors Are Studying)

Experts are still working to understand the exact relationship between COVID-19 and hearing problems. Proposed explanations include:

• Inflammation that affects blood flow to the inner ear
• Immune system reactions that may damage inner-ear structures
• Nerve involvement affecting the auditory or balance pathways
• Side effects of certain medications used during severe COVID-19 illness

Current evidence is mixed, and not everyone with COVID-19 will develop ear or hearing issues. However, because hearing and balance structures are delicate, any new symptoms should be taken seriously.

Post-COVID Sensorineural Hearing Loss and Long-Term Symptoms

Some people experience ongoing issues, sometimes referred to as post-COVID sensorineural hearing loss or part of “long COVID” symptoms.

Long COVID Hearing Problems

Long COVID hearing problems may include:

• Persistent or fluctuating hearing loss
• Ongoing tinnitus (ringing, buzzing, or roaring in the ears)
• Sensitivity to sound
• Problems understanding speech, even if sounds are loud enough

These symptoms can occur even after a mild COVID-19 illness and may appear days to weeks after the initial infection.

COVID-Related Tinnitus

COVID-related tinnitus has been reported by some patients during or after infection. Tinnitus may:

• Occur in one or both ears
• Be constant or come and go
• Vary in loudness from day to day

While tinnitus can be related to hearing loss, it can also occur even when a hearing test appears mostly normal. Because tinnitus can be distressing, evaluation by a hearing care professional is recommended.

Sudden Hearing Loss After COVID: A Medical Urgency

Sudden hearing loss after COVID should be treated as an emergency, just as it would be in any other situation. Sudden sensorineural hearing loss (SSNHL) usually develops over a period of 72 hours or less and typically affects one ear.

Warning Signs of Sudden Sensorineural Hearing Loss

• Waking up with significantly worse hearing in one ear
• A “pop” in the ear followed by sudden muffling
• Feeling of fullness or pressure in one ear that does not clear
• Sudden onset of loud tinnitus in one ear
• Noticeable difference in hearing between the two ears

If you notice any of these symptoms, seek medical care right away, even if you recently had COVID-19 or are still recovering.

Steroid Treatment for Hearing Loss

In many cases of sudden sensorineural hearing loss, doctors may consider steroid treatment for hearing loss. Steroids are commonly used to reduce inflammation and may help improve the chances of recovery when started promptly.

Steroids may be given:

• Orally (by mouth)
• By injection through the eardrum into the middle ear (intratympanic)

The decision to use steroids, and the type and dose, depends on your overall health, medical history, and the findings of a hearing and ear exam. Only a qualified healthcare professional can determine if this treatment is appropriate for you.

Vertigo and Balance Problems After COVID-19

Some people experience vertigo after COVID-19—a spinning sensation or feeling that the room is moving—along with nausea or unsteadiness.

Common Balance-Related Symptoms

• Spinning sensation or feeling off-balance
• Dizziness when changing positions
• Nausea or motion sensitivity
• Difficulty walking in the dark or on uneven surfaces

These symptoms can result from inner-ear (vestibular) involvement, but they can also come from other neurological, cardiovascular, or metabolic causes. Because the causes can be complex, thorough evaluation is important.

When to See a Doctor or Hearing Specialist

After a COVID-19 infection, contact a healthcare provider promptly if you notice:

• Sudden or rapidly worsening hearing in one or both ears
• New or significantly louder tinnitus
• Persistent feelings of fullness or pressure in the ears
• Ongoing vertigo or severe dizziness
• Difficulty understanding speech that is new for you

Who May Be Involved in Your Care

• Primary care provider – First point of contact to assess overall health and refer as needed
• Audiologist – Performs hearing and balance tests and helps with hearing aids or other devices
• Ear, nose, and throat (ENT) specialist / Otolaryngologist – Evaluates ear structures, orders imaging if needed, and manages medical or surgical treatment
• Neurologist – May be involved if there are broader nervous system concerns

What to Expect During an Evaluation

An evaluation for possible COVID-related ear or hearing issues may include:

• Detailed medical history, including timing of COVID-19 infection and symptoms
• Ear exam to check the ear canal and eardrum
• Hearing tests (audiogram) to measure the type and degree of hearing loss
• Balance testing if you have vertigo or unsteadiness
• Blood tests or imaging (such as MRI) in selected cases

These tests help determine whether the hearing loss is conductive (outer or middle ear), sensorineural (inner ear or nerve), or mixed, and guide treatment recommendations.

Living With Hearing Changes After COVID

Even when hearing loss is permanent, there are effective ways to manage symptoms and improve communication.

Hearing and Communication Strategies

• Use hearing aids or other amplification devices if recommended
• Ask family and friends to face you and speak clearly, not from another room
• Reduce background noise (TV, music, fans) during conversations
• Use captioning on TV, video calls, and streaming services
• Consider assistive listening devices in group or public settings

Managing Tinnitus and Dizziness

• Sound therapy or background noise (fans, soft music, sound apps) to reduce focus on tinnitus
• Relaxation techniques, such as deep breathing and mindfulness, to manage stress that can worsen symptoms
• Vestibular rehabilitation therapy if recommended for balance issues
• Regular follow-up with your hearing specialist to adjust your care plan as needed

Protecting Your Hearing Going Forward

Whether or not you have experienced sensorineural hearing loss after COVID-19, protecting your hearing is important for your long-term health and quality of life.

• Avoid loud noise when possible; use hearing protection at concerts, while using power tools, or in noisy workplaces
• Follow your healthcare provider’s guidance on medications, especially if they could affect hearing
• Stay up to date with recommended vaccinations and regular health checkups
• Seek prompt care for new ear pain, drainage, sudden hearing changes, or severe dizziness

If you notice any new hearing or balance changes after a COVID-19 infection, do not ignore them. Early evaluation and, when appropriate, timely treatment can make a meaningful difference in your outcome and daily comfort.