As COVID-19 continues to spread, scientists are discovering that it can cause a slew of symptoms, some rarer than others. When the coronavirus pandemic first hit the U.S., public health officials only listed three signs of illness to look out for: fever, cough, and shortness of breath.

That list, of course, has grown exponentially and now includes other signs associated with respiratory diseases, like overwhelming fatigue, headaches, and a sore throat. The virus is also causing lasting health issues in certain people dubbed as “COVID-19 long haulers,” who report experiencing side effects like hair loss, memory problems, and heart palpitations for months after initially becoming sick.

Now, another symptom seems to be getting buzz: earaches, which can cause pain, a sensation of blockage, and even muffled hearing. “There have been reports of people with COVID-19 having earaches, and there is biological plausibility with it,” says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York.

Tinnitus, a condition that causes a ringing, roaring, clicking, or buzzing sound in the ears, has also been linked to COVID-19, sometimes with devastating consequences. Kent Taylor, the CEO of Texas Roadhouse, died by suicide after experiencing “severe tinnitus” and other “post COVID-related symptoms,” according to a joint statement released by Taylor’s family and Texas Roadhouse shared with Prevention. He was 65.

“Kent battled and fought hard like the former track champion that he was, but the suffering that greatly intensified in recent days became unbearable,” the statement reads, noting that Taylor recently committed to fund a clinical study to help members of the military who also suffer with tinnitus.

This raises a lot of questions, but should you automatically assume you have COVID-19 if you have ear-related symptoms? Here’s what doctors have to say.

First, what are the official symptoms of COVID-19?

According to the Centers for Disease Control and Prevention (CDC), the most common signs of the novel coronavirus include:

However, the agency does note that this list doesn’t cover all possible symptoms. For instance, skin rashes and pink eye have also been linked to COVID-19, but more research is needed to understand how these side effects are linked to the virus.

Is an earache a symptom of COVID-19?

The World Health Organization (WHO) doesn’t list earaches as a symptom of COVID-19 and ear symptoms are not routinely asked about as part of COVID-19 screening questions in the U.S. Like the CDC, the WHO simply confirms that you may experience “aches” from the coronavirus.

But doctors agree that it’s possible to experience an earache from COVID-19, even though it doesn’t seem to be a common symptom like a fever or dry cough. “It’s on the spectrum of symptoms you would expect,” says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security.

“I have not seen this with any of my patients,” adds Richard Watkins, M.D., an infectious disease physician and professor of medicine at the Northeast Ohio Medical University. Dr. Adalja confirms he hasn’t either.

Of course, it could just be a rare manifestation of the virus—and scientists are digging into the connection. “This is an active area of research,” says Elliott D. Kozin, M.D., an otolaryngologist at Massachusetts Eye and Ear. “It is generally not known to what degree ear symptoms may be indicative of COVID-19.”

How could COVID-19 cause an earache?

“To date, there are published reports that have identified SARS-CoV-2 (the novel coronavirus) in the middle ear,” Dr. Kozin explains. “However, we do not know to what degree the presence of the virus may result in any hearing symptoms. In other words, SARS-CoV-2 may be present, but not result in any noticeable symptoms.”

There are some theories. “For the vast majority of patients, given available data, hearing symptoms are most likely due to a secondary inflammation of the upper airway,” which includes your nose, nasal cavity, mouth, throat, and voice box, Dr. Kozin says. “That said, our understanding of the virus and its impact on the body is changing on a daily basis.”

COVID-19 can also cause inflammation in the sinuses, back of your throat, and eustachian tubes (which run from the middle ear to the upper throat and back of the nasal cavity). “That can cause discomfort in your ear,” Dr. Adalja says.

Can tinnitus also be a symptom of COVID-19?

Tinnitus can be soft, loud, and high or low pitched, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). The sounds signal that something is wrong in the auditory system, and can be caused by a range of things. Those include:

Tinnitus may be an infrequent symptom of COVID-19. That means it doesn’t happen a lot, but it can happen. A recent study published in the International Journal of Audiology analyzed 28 case reports and 28 cross-sectional studies, revealing that between 7% to 15% of adults who are diagnosed with COVID-19 have some kind of hearing issue. The most common symptom, per the findings, is tinnitus, followed by hearing difficulties and vertigo. The researchers do note, however, that this could be an over-estimate given that the data doesn’t always clearly state if people struggled with hearing issues before their diagnosis.

Regardless of how common tinnitus is from COVID-19, experts say there does seem to be a link. “We do know that the new coronavirus doesn’t just affect the lungs—it can affect the central nervous system, brain, and other organs,” Dr. Russo says. In terms of ear symptoms, COVID-19 could potentially affect nerves in the vestibular system, which includes the inner ear and brain.

“It may be a similar mechanism to what causes loss of taste and smell—inflammation or damage to the blood vessels supplying the anatomical structures involved,” Dr. Adalja says. Still, the reason why COVID-19 may cause tinnitus isn’t entirely clear.

Bottom line: If you have an earache or tinnitus, it doesn’t necessarily mean you have COVID-19.

“COVID-19 may cause a constellation of symptoms,” Dr. Kozin says. However, there are many causes of ear-related issues, including infections, earwax buildup, or even a change in ear pressure. If you’re experiencing an earache or tinnitus without other common signs of the coronavirus, you probably don’t have much to worry about in terms of COVID-19.

Of course, if you happen to develop an earache and you do show other signs of illness, Dr. Russo recommends calling your doctor to discuss your symptoms. “When in doubt, it’s always safer to get tested than not,” he says.

If the ear pain persists for longer than a few days or gets worse over time, call your doctor. They can help identify the issue and recommend treatment if needed.

If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.

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