Long COVID and Tinnitus

Did you know that up to 73% of people with Long COVID experience tinnitus? Learn about this and more with Dr. Hamid Djalilian, world-renowned tinnitus specialist and Chief Medical Advisor for NeuroMed. 

We hope you enjoyed this podcast! You can find us at www.neuromedcare.com or call us at 1-888-226-6330. 

Transcript

We're going to talk about long COVID and tinnitus While a lot of studies have shown that between 20 to 40 percent of patients with long COVID have tinnitus, there was a recent study about 900 patients that showed 73 percent of patients with long COVID have tinnitus. So there appears to be a significant relationship between these two conditions.

Long COVID has been thought to be due to brain inflammation or the aftereffects of brain inflammation.

When acute COVID is present, that can create a pretty stressed state for the brain, and that stressed state can trigger this process related to migraine. And that the migraine process is what can make tinnitus become very loud and prominent in patients with long COVID. We also see the same thing with dizziness, and mental fogginess in patients with long COVID.

So what is long COVID? Long COVID is the persistence of symptoms beyond the initial infection from COVID. Forty three percent of patients actually have symptoms from long COVID meaning they have symptoms that continue from COVID that cannot be explained by another condition.

Now the question is, how often is this occurring? Is it related to how severe the COVID is? And the answer is yes.

The more severe the COVID is, the more likely patients are to develop long COVID. A study of over 10,000 patients. They found that patients who had severe COVID had about a 64% chance of developing long COVID symptoms, whereas patients who had asymptomatic COVID had a substantially lower chance of developing this.

Now what are the symptoms of long COVID?

These symptoms could be general, like fatigue and malaise, and joint pains. It could be cardiovascular with palpitations, chest pain. It could be respiratory due to the injury to the lungs, shortness of breath, or it could be a memory loss. And dizziness and tinnitus are pretty significant in this population. We have seen in some patients incidents of sudden hearing loss on rare occasions. And finally, psychiatric symptoms like anxiety and depression and post traumatic stress disorder.

What we have seen is that there are a lot of symptoms in long COVID that are in common with other conditions, like migraine and fibromyalgia and chronic pain.

These people tend to have a lot of sensitivities and have significant changes to their symptoms on a sort of fluctuating basis. And that's something that's very commonly seen in atypical migraine. It's become increasingly clear that long COVID is a form of what we call central sensitization, meaning that the brain has become overly sensitive. And so when they're stimulated by certain things that could be things like diets, sleep, stress, light sound, motion, etcetera.

Then there's an exaggerated reaction by the brain. That's the same phenomenon we see in a typical migraine. Atypical migraine is also a sensitivity of the brain. It's a central sensitivity.

People are sensitive to sound, motion, light, foods, and dietary items, dehydration, hunger, sleep, stress, etcetera; this is what causes elongation symptoms in not only atypical migraine, but also in long COVID. So there is definitely a link between long COVID and atypical migraine.

And what we have found in our practice is correcting that atypical migraine process can actually correct a lot of the symptoms of long COVID Just because someone is suffering from long COVID doesn't mean that we can't fix it.

Now are all the symptoms fixable? Not necessarily. We can't reverse the lung injury that occurs. But we can reverse a lot of the changes that occur on the brain as a result of the sensitization.

Are tinnitus and long COVID related? There appears that there is a significant relationship in that about 30 to 73 percent of patients with long COVID have tinnitus.

This doesn't take into account the fact that tinnitus can actually get worse with long COVID. In another study where they looked at people who had tinnitus before they got COVID, 40 percent of them said their tinnitus got worse and louder after they had COVID.

Now the question is, how do these things link to each other? How is tinnitus related to long COVID? It appears that central sensitization is probably the underlying process that makes tinnitus worse and also can cause a lot of the symptoms of long COVID.

Now the initial process is caused by an attack of the COVID virus. But then the maintenance of the symptoms are oftentimes due to things like stress, sleep, diet, over stimulation, hormonal changes, things like that. And a lot of those factors are correctable, meaning that a lot of long COVID symptoms like tinnitus, dizziness, headaches, mental fogginess, or brain fog are all treatable when you control that underlying atypical migraine process; a lot of the symptoms of long COVID got better.

In addition, COVID virus may directly involve the inner ear because the receptor for the COVID virus has been found on the inner ear cells. It's unclear whether that actually happens because we would expect to see a lot more hearing loss from it, but we don't.

I, myself, I'm not sure if that actually is occurring, but we certainly know that at the brain level, there is increase in sensitivity as a result of the significant inflammation that occurs in the body, and that process of sensitivity in the brain is fixable.

Does COVID vaccine cause tinnitus? Any vaccine causes a significant inflammatory process in the body. That's what it's meant to do. Now, when the brain sees this inflammation in the body, the brain has a reaction to it. It creates that stress, which then can trigger this atypical migraine process.

Do we see tinnitus at occurring after vaccination? Yes. Do we see it after every vaccination? Yes. Actually, that is true. Now it has been thought that it occurs more frequently after the COVID vaccine because the COVID vaccine is a new type of vaccine that creates more inflammation in the body. But does that mean you shouldn't get the vaccine? No. That does not mean that. But on the day of vaccination, you wanna reduce any other factors that can induce this atypical migraine.

Can COVID cause hearing loss? In a large study of a couple thousand patients, they found that between 5 to 6 percent of patients indicated that they noted some hearing loss after three months post infection. There is a link between sudden hearing loss and COVID potentially. This may be due to an activation of this migraine process in the brain. That migraine process in turn causes some change in the blood flow to the inner ear and that causes a sudden loss of hearing.

Now in long COVID, we see a lot of patients having difficulty with word understanding or speech discrimination. This may be due to the changes in long COVID, and specifically the atypical migraine, create where it affects the part of the brain that keeps us alert and awake. So that's what causes the symptoms of brain fog. In addition, you can have what's called auditory processing disorder, which is a reversible phenomenon that occurs as a result of this atypical migraine process, where people say that they can hear, but they don't understand because they can't concentrate. As I mentioned, the atypical migraines affecting parts of the brain where it's just not functioning as crisply as it should.

Can long COVID cause vertigo? Yes, certainly; we have seen that very commonly in our practice. And in a study of over 3,000 patients, they found that between 27 to 42 percent of patients have symptoms of dizziness or vertigo.

And when they looked at the combination of vertigo and tinnitus together, that was actually a pretty substantial percentage as well. Another study of about a thousand patients found that sixty percent of patients had experienced dizziness or vertigo as a result of their long COVID symptoms. The reason we see the combination of long COVID and vertigo is due to this condition called vestibular migraine. So, some patients have migraine, but they don't get headaches instead they can get vertigo.

And as I mentioned before, a lot of the long COVID symptoms, the brain symptoms of long COVID, are due to an activation of this atypical migraine process. So atypical migraine becomes active after COVID, and it can stay active as a result of things like stress, poor sleep, diet, overstimulation, etcetera.

And that overactivity of this migraine process can lead to symptoms of long COVID and can separately lead to symptoms of vertigo. So, vertigo is one form of migraine, and a lot of the symptoms of long COVID are another form of atypical migraine.

How can you treat long COVID related tinnitus? The surprising thing is that long COVID symptoms are treatable. The brain symptoms, the tinnitus, dizziness, mental fogginess, headaches, or all treatable controlling the atypical migraine that controls the long term COVID symptoms.

The approach we use to treat this is called the Biopsychosocial Approach. As part of a comprehensive approach, we treat all three of those things by taking into account the biology (the problem which we have a much better understanding than we used to), and the other aspects of it that are necessary to treat patients with this long term COVID-related tinnitus.

Part of the treatment strategy includes using nutraceuticals that have been found to be low in people with chronic atypical migraines. We use medications to balance out the neurotransmitters get the brain in a more healthy environment. We use dietary changes because there are certain molecules in foods that can trigger and continue this process in the brain, so that needs to be controlled. As well as also addressing other factors such as hunger, dehydration, stress, sleep, over-stimulation. All of these things need to be approached and treated separately as part of a comprehensive program because if we just look at this as a singular problem, "We're just gonna give you a pill"... That's not going to work. We have to do this as part of the whole package.

I tell patients that it's a prefixed menu. "You're getting this the menu, these are the items that the chef's going to give you". Meaning that you have to do the diet. You have to do the stress control. You have to do the sleep, you've got to do the supplements, and you have to do the medication. It's not like "I get to choose this one. I want to just do this and I want to do this. I don't want to do the rest of it".

Unfortunately, that just doesn't work. I wish it did. It would be a lot easier for me and you if we could just do it that way, but it just doesn't work. So you have to do the whole package deal.

In addition, we need to do Cognitive Behavioral Therapy because a lot of stress is how we react to environmental conditions. We have developed an online protocol that you can use that teaches you a lot of this stuff without the need for visits to a psychologist.

In addition, we have our nurse practitioner who can help you to make sure that you are staying on track to getting better. The good news is long COVID-related tinnitus is treatable. A lot of doctors out there will tell you, "There's nothing that could be done. We don't understand why". We do understand why long-term COVID-related tinnitus happens, and that's because of a phenomenon related to atypical migraine. Correcting that atypical migraine process which may be giving you the tinnitus, may give you neck stiffness, headaches, dizziness, mental fogginess, this brain fog; that is all is related to the same process and fixing that will fix the rest of the problems. Our approach in NeuroMed is really dealing with the brain and all the brain related changes that cause tinnitus and dizziness; especially, long COVID, being a very common cause nowadays.

If you want to learn more, please schedule a pre-visit consultation with one of our intake specialists. You can see whether this program fits for you.

Best of luck in your journey towards relief from tinnitus.

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