Kris Bordessa, a writer in Hawaii, developed tinnitus shortly after contracting a presumed case of COVID-19 in December 2021. It has not cleared up. “I’ve had occasional ringing in the ears before, but not this ongoing screaming tinnitus,” Bordessa said. Her doctor is quite sure that the tinnitus—and the occasional “full body buzzing” Bordessa experiences—is a result of COVID-19 infection, but has no solutions to offer.
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May 2023
Because supplements and smell retraining are relatively benign and fairly inexpensive with minimal to no side effects, I recommend the combination to a lot of my patients —Alfred Marc Iloreta Jr., MD
To date, no medical treatments have been found to be particularly efficacious in treating otologic symptoms of long COVID. A case study reported in the American Journal of Otolaryngology noted improved tinnitus after gabapentin treatment. The 49-year-old male patient developed new onset severe tinnitus and mild hearing loss after COVID-19 infection. Conservative treatment, including white noise masking, did not offer relief. The patient’s physician started him on gabapentin 300 mg daily; after two weeks, the dosage was increased to 300 mg twice per day. The patient’s tinnitus symptoms “significantly improved within two weeks” and continued to be tolerable at a onemonth follow-up (Am J Otolaryngol. 2022;43:103208). (Gabapentin has also been suggested as a treatment for persistent COVID-19-related olfactory dysfunction, and a randomized, double- blinded, placebo-controlled trial to assess the efficacy of oral gabapentin for post-COVID-19 olfactory dysfunction is currently enrolling patients (ClinicalTrials.gov Identifier: NCT05184192).)
Laryngologic Manifestations
Initially, the medical community assumed that COVID-19 patients who were intubated during their infection would be most likely to experience persistent laryngeal symptoms after recovery. But while it’s true that many individuals who were intubated or underwent a tracheotomy continue to have airway issues, vocal changes, or dysphagia, some patients with laryngeal symptoms—like Cynthia
Adinig—had only mild cases of COVID-19. Adinig wasn’t even hospitalized during the acute phase of her infection. Yet she still experiences throat tightness, difficulty swallowing, and vocal hoarseness. Other patients with long COVID report globus, a persistent or intermittent sensation of “something” stuck in the throat.
“What we think may be going on is laryngeal hypersensitivity,” Dr. Kirke said. Pre-COVID, she used larynx rehabilitative techniques to treat patients with laryngeal hypersensitivity, so she’s using the same techniques to treat long COVID patients with laryngeal symptoms. “Largely, it seems to be working,” she said.
Dr. Kirke is also conducting a histopathological study on autopsy specimens to better understand laryngeal sequelae of COVID-19. “We haven’t examined a lot of tracheas yet, but in the pilot study we’ve done, we’ve noted significant amounts of inflammation and loss of cilia in the airways,” she said. “COVID-19 tracheas also demonstrated increased intensity of ACE2 and TMPRSS2,” the receptors commonly upregulated in COVID-19. Dr. Kirke has already compared COVID-affected tracheas to non-COVID-affected tracheas, and eventually plans to compare the tracheas of intubated patients who had COVID-19 to the tracheas of intubated patients who did not have COVID-19. If significant differences are noted, they may suggest a novel pathology for COVID-19-related laryngeal symptoms.