(PP1406) A Systematic Review on the Impact of COVID-19 and the Pandemic on Tinnitus

Abstract: This study systematically reviewed 33 publications regarding tinnitus experiences during the COVID-19 pandemic. Findings from 28 studies found that the estimated prevalence of tinnitus after contracting COVID-19 was 8% (CI: 5 to 13%). Results from a further 5 studies indicated that exposure to the COVID-19 pandemic could worsen pre-existing tinnitus. Increased stress and anxiety during the pandemic contributed to tinnitus worsening. The importance of these findings for clinical practice and patient management will be outlined during this presentation. Recommendations for research investigations regarding the impact of COVID-19 on audio-vestibular conditions were made for uniform reporting.

Summary: In March 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak a global pandemic. Due to the rapid spread through human-to-human transmission of COVID-19, many countries implemented social distancing and regional lockdowns to reduce social interactions, which have negatively impacted the wellbeing of individuals and increased mental health difficulties in the general population. The contraction of COVID-19 has been associated with a wide range of symptoms, including auditory vestibular conditions, such as dizziness, tinnitus, and otalgia. Previous systematic reviews identified estimates of tinnitus and other audio-vestibular dysfunctions. However, there is little known about the presentations of tinnitus and the effects of the pandemic of tinnitus. The specific aims of this review were to (i) investigate the effect of contracting COVID-19, (ii) determine the impact of the pandemic on tinnitus experiences, (iii) identify the progression and characteristics of tinnitus, and (iv) comprehensively evaluate factors to understand the association between COVID-19 and tinnitus.

Method: The keywords ‘tinnitus’ AND ‘COVID-19′ OR ‘coronavirus’ were used for searching databases: PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and EBSCOhost including Web of Science. The primary outcome was tinnitus associated with the COVID-19 virus and pandemic. Therefore, populations describing audiological symptoms without tinnitus were excluded. All studies irrespective of study design were included but systematic reviews were excluded. Quality assessment for the included studies was assessed using the National Institute of Health Quality Assessment Tools. Additionally, meta-analysis was conducted to pool the prevalence of tinnitus from the cross-sectional studies.

Results: Of the 181 records identified, 33 met the inclusion criteria, which generally had a fair risk of overall bias. 28 studies focused on the impact of the COVID-19 virus on tinnitus including 17 cross-sectional studies (n = 8913) and 11 case series or case report studies (n = 35).
5 studies focused on the impact of the pandemic on tinnitus including 2 cross-sectional studies (n = 3232) and 3 pre-post-test design studies (n = 326). No consistent patterns were found regarding the presentation of the tinnitus or additional factors that could have tinnitus developing in the disease impact studies. For the pandemic impact studies, the associated stress and anxiety of the pandemic were consistently suggested to contribute to tinnitus experiences. The pooled estimated prevalence of tinnitus post-COVID-19 was 8% (CI: 5 to 13%).

Conclusion: Preliminary results are identified by this study providing an early understanding of the link between COVID-19 and tinnitus. Medical professionals should be aware that tinnitus might be more problematic following the pandemic or contraction of COVID-19. These findings have important implications for clinical services such as a need for understanding professional support and access to multidisciplinary experts, access to more information about tinnitus, prioritizing tinnitus research, and more support for hearing protection and hearing loss prevention. Additionally, this review identified a need for consistency in reporting and gathering data to be able to synthesize information. Lastly, further research is required to investigate the long-term effects and effects of COVID-19 vaccinations.