Imagine having the sound, “eeeeeeeeeeeeeee”constantly ringing in your ear or ears. That’s what tinnitus can be like. And with a Facebook group called “Tinnitus and Hearing Loss/Impairment after COVID vaccination,” having over 3.9K members, one question that’s gotten the ears of people over the past couple years is whether tinnitus can be a side effect of Covid-19 vaccines.

Tinnitus is the sensation of ringing or other noises in either or both of your ears, assuming that you don’t have more than two ears. Tinnitus is specifically when there’s no such external sound that others can hear. So standing next to an answering machine that keeps repeating, “leave a message after the beeeeeeeeep” or a person who’s constantly yelling, “eeeeeeeeeeeeeeeeee,” wouldn’t count as tinnitus. Tinnitus is not an uncommon problem, in general, affecting an estimated 15 to 20 percent of people, according to the Mayo Clinic.

Searching PubMed for “tinnitus” and “Covid-19 vaccine” does yield a handful of case reports, studies, and reviews of the literature such as one published in the Annals of Medicine and Surgery in March 2022 and another published in the European Review Medical and Pharmacological Sciences in June 2022. One of the studies was a review of medical charts at a otology and otolaryngology practice at the University of North Carolina at Chapel Hill conducted by Doris Lin, MD, and Anne Morgan Selleck, MD, both of whom are Assistant Professors of Otolaryngology there. They published this study in the American Journal of Otolaryngology, which is a respectable peer-reviewed journal focusing on, you guessed, is otolaryngology, which is the medical specialty covering the ears, nose, and throat. This chart review found that out of 1254 patients, 16 patients suffering tinnitus after the Pfizer-BioNTech Covid-19 mRNA vaccine, seven after receiving the Moderna Covid-19 mRNA vaccine, and four patients after receiving the Janssen vaccine. These aren’t huge numbers and the publication did say that “A correlation cannot be proven with this retrospective study with such few cases.” So, essentially you can say, “Few” about the findings of this study.

There was a another similar study conducted at an otolaryngology clinic at New York-Presbyterian/Columbia University Irving Medical Center by Stephen Leong, Bing M. Teh, MBBS, and Ana H. Kim, MD, the last of whom is an Associate Professor at Columbia University. This study was also published in the American Journal of Otolaryngology. The research team found that of 500 patients screened, 61 patients (14.5 %) reported one or more ear or hearing-related symptoms within four weeks of vaccination, including 21 (5.0 %) with hearing loss, 26 (6.2 %) with tinnitus, 33 (7.9 %) with dizziness, and 19 (4.5 %) with vertigo. Now the frequency of patients reporting hearing loss was comparable to that of the general population so it is not completely clear how many of those cases may have been due specifically to vaccination against Covid-19. If you said, “Few,” to the 1254-patient study, the same would apply to this 500-patient study.

That’s why it’s not super surprising that the CDC has indicated that there is no evidence detailing a link between Covid-19 vaccines and tinnitus as NBC News’s Erika Edwards reported here:

But, and that’s a big but one cannot lie, just because studies so far have not shown a clear correlation between Covid-19 vaccination and getting tinnitus doesn’t necessarily mean that a link doesn’t exist. The studies to date have been limited. The experiences in single or a few clinics are not enough to rule out a possible correlation. That could be like going out to your backyard, noticing no rhinoceroses and then concluding that rhinoceroses don’t exist. Instead, firmer conclusions can be drawn only after something has been studied across a broader swathe of the population. Plus, you can’t simply discount the experiences of people who are insisting that they developed tinnitus after Covid-19 vaccination as, “Oh, you’re just hearing things.”

It is certainly not beyond the realm of possibility that Covid-19 vaccination could lead to tinnitus. As you’ve probably heard by now, the Pfizer-BioNTech, Moderna, and Janssen vaccines are designed to get your cells to produce the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins. These spike proteins are then supposed to get your immune systems to effectively say, “What is that, that doesn’t smell like teen spirit,” and to generate an immune response to the spike protein. That immune response may vary among different people. For some, it could potentially cause inflammation in different parts of the body, including various nerves and blood vessels. Such inflammation if around hearing-related parts of the body could possibly result in hearing issues. Whether this is a possible ear-y effect remains to be seen.

Another possibility is what’s called “molecular mimicry,” which may sound like a party game that Jimmy Fallon would play on The Tonight Show. Instead, it’s more like when you are in a dark dance club, briefly see someone you like, notice that the person is wearing a red outfit, spend the entire night chasing after someone with a red outfit, and then realizing in the end that its not the person whom you first saw. “Molecular mimicry” is when a normal part of your body is similar enough to the spike protein that your immune system mistakes that body part for something to react against. There haven’t been enough studies to rule in or out this possibility for Covid-19 vaccination.

A third possibility is whether something in the vaccine itself is directly reacting with cells in or leading to and from the ear. The vaccines actually have fewer ingredients than a lot of things that people put in their mouths every day like Cheez Whiz, many breakfast bars, and many types of frozen waffles. So it would be helpful to see if any of the ingredients in the vaccine can react with ear and other hearing-related cells.

Then there’s the fact that your ears are connected to the rest of your head, at least they should be. There can be a close interplay between what you are thinking and feeling and tinnitus. The authors of the Columbia University study did point out that the incidence of tinnitus may have increased in general since the start of the Covid-19 pandemic. That could be because of Covid-19 itself, which can play havoc with your senses such as taste and smell. That may also be because tinnitus can be associated with stress, depression, and stress-induced problems like teeth-grinding and TMJ (temporomandibular joint) syndrome. And, news flash for many folks, the past few years have been kind of stressful. There certainly have been concerns about Covid-19. But also, many politicians have continued to raise a fuss about random issues like what Big Bird is saying, sort of like a bunch of cats stuck in Spanx.

A number of other conditions unrelated to Covid-19 vaccines can cause tinnitus. These include age-related hearing loss (presbycusis), exposure to loud noises, other medications such as erythromycin, Ménière’s disease, TMJ, foreign objects lodged in your ear, excessive earwax (cerumen), allergies, an acoustic neuroma, other growths, anemia, atherosclerosis, and high blood pressure. So if you do develop tinnitus, don’t automatically assume that it’s caused by the Covid-19 vaccine. For example, you may want to first check if a hot dog happens to be lodged in your ear. Of course, timing is everything in life. While developing tinnitus could always be a coincidence, if the symptoms emerged shortly after getting vaccinated, it does raise the question of whether vaccination was indeed the culprit.

It’s not yet clear how many of these tinnitus cases may have occurred after Covid-19 vaccination. It’s also difficult to tell how long such symptoms have tended to persist. Covid-19 vaccination has only been around since 2020, which may be a lot of Scaramuccis but not necessarily long enough to study how long tinnitus may last—again that’s assuming that there may be a link to Covid-19 vaccines.

Searching the Vaccine Adverse Event Reporting System (VAERS), which is co-sponsored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) did yield 18,709 reports of people suffering tinnitus after getting the Covid-19 vaccines as of April 14. The problem, though, is that anyone can submit a claimed adverse event to VAERS without providing any real supporting evidence or verification. And there’s is evidence that anti-vaxxers have been treating VAERS like the insides of a bathroom stall, writing all kinds of random stuff on it. So you’ve got to take anything on VAERS with a fanny pack full of salt.

There also isn’t clear consensus on how to manage such cases. Doctors have tried corticosteroids, which can suppress the immune reaction. But will that, in turn, reduce the protective effect that the Covid-19 vaccine is supposed to bring?

There are other possible approaches raised by the Annals of Medicine and Surgery review article such as counseling, tinnitus retraining therapy, sound therapy, auditory perceptual training, sodium channel blockers, anti-depressants, anti-convulsant, benzodiazepines, and other medications. But more research is needed to determine what approach may be most effective, again assuming that there is a link between Covid-19 vaccination and tinnitus.

What you are hearing is common refrain, there needs to be more and more in-depth studies looking at the possible link between Covid-19 vaccines and tinnitus. Further studies need to be broader, use a wider variety of different methodologies that cover larger swathes of the population. And the studies can’t be simply conducted by manufacturers like Pfizer and Moderna. That would be like asking Elon Musk whether Twitter is being operated well or Jared Leto whether you should watch the movie Morbius versus bury your head in a vat of popcorn. Vaccine manufacturers kind of have a vested interest in their products looking good.

At the same time, vaccine manufacturers should release all of their clinical trial data to the scientific community. That’s ALL of the data in ALL CAPS. These manufacturers did receive considerable funding and support from the federal government, which ultimately is supported by taxpayer money. So, it shouldn’t be too much of an ask for independent scientists to be able to review all of the data.

One of the challenges throughout this pandemic has been separating the noise from anti-vaxxers from real questions about the Covid-19 vaccines. There’s been an earful of unfounded conspiracy theories such as the vaccines are being used to depopulate the world, control people, or turn people into 5G receivers, Magnetos, or refrigerator doors. At the same time, the Covid-19 vaccines have not been perfect. The efficacies of the Covid-19 vaccines have not been as high as initially reported. They do bring some risk of side effects, ranging from feeling kind of poopy after vaccination to different possible allergic or autoimmune reactions to inflammation of the heart. Fortunately, the more severe side effects to date have appeared to be rather rare. By contrast, study after study has shown that getting Covid-19 can bring a host of problems ranging from long Covid to that little thing called death. Thus, so far, the risks of getting Covid-19 seem to far outweigh the risks of getting vaccinated.

This doesn’t mean that there shouldn’t be more independent research into possible Covid-19 vaccine side effects. There have been enough credible reports of tinnitus after Covid-19 vaccination to merit further ongoing investigation. It’s unlikely that people who clearly state that they are pro-vaccine will claim just for the heck of it that they’ve been hearing something like a dog whistle after getting vaccinated. That would be quite a dog whistle claim that just wouldn’t ring right. So this tinnitus issue should be taken seriously. The question is how many people are hearing what those suffering hearing issues have to say.

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