Ear infections and COVID: The link, symptoms, and treatments - Medical News Today

In some cases, COVID-19 can lead to ear infections. People may get ear infections following infection or as a complication of SARS-CoV-2, the virus that causes COVID-19.

Middle ear infections are common in children, but adults can also get them. They often follow another infection, such as an upper respiratory infection, and occur when fluid builds up behind the middle ear, causing pain and inflammation.

While it can cause symptoms in the middle ear, COVID-19 may also affect the inner ear. The inner ear affects balance, so people with this symptom may experience dizziness, a feeling of being off-balance, or ringing in the ears.

Despite the data linking ear infections and COVID-19, some research suggests that the overall rate of ear infections may have declined during the height of the pandemic, especially in children. This is because isolation and social distancing meant less exposure to pathogens that might cause ear infections. However, this data does not mean that SARS-CoV-2 causes fewer ear infections — it is merely an incidental finding.

Read more about how COVID-19 has links to ear infections, their symptoms, how to manage them, and more.

Both viral and bacterial infections can cause ear infections. SARS-CoV-2 is an example of a virus that may lead to an ear infection.

Middle ear infections occur when bacteria or viruses cause infection in the middle ear, leading to swelling, inflammation, and pain. The middle ear is a small space, and inflammation from other infections — such as SARS-CoV-2 — can place pressure on it, leading to fluid buildup and possible infections. When swelling in the ear traps fluid, it can be uncomfortable and cause muffled hearing. In some cases, it can lead to an infection.

A small 2021 study found that SARS-CoV-2 may directly cause infection to the inner ear, the part of the ear that plays an important role in balance. Additionally, a 2021 meta-analysis supports the idea that ear symptoms are fairly common among people with COVID-19.

The analysis, which looked at 12 studies of individuals with the virus, found that 3.1% reported hearing loss, 4.5% had ringing in the ears, and 12.2% experienced dizziness.

Several studies documented a decrease in ear infections among children during the COVID-19 pandemic. According to a 2021 study, this is likely because staying home and wearing masks decreased exposure to the infections that could cause ear infections.

However, as this article previously notes, the data do not say anything about SARS-CoV-2's ability to cause ear infections. People still can and do get ear infections, both from SARS-CoV-2 and other infections.

All currently identified strains of SARS-CoV-2 could potentially cause ear infections.

A 2022 study that included 63,002 people who tested positive for COVID-19 in 2021 and 2022 suggests that some ear symptoms might be slightly more common with the Delta variant than the Omicron variant. Drawing on data that study participants submitted to an app, researchers found higher rates of ear ringing and dizziness with Delta. In contrast, a sore throat and hoarse voice were more common among people with Omicron.

However, these may be skewed figures because these individuals underwent testing. Those with mild or asymptomatic infections may not have taken a test and did not have significant symptoms.

It is not possible to diagnose the SARS-CoV-2 variant a person has according to only their symptoms, and determining the variant does not determine treatment. Additionally, in both variants, an ear infection may develop later in the course of the disease because of inflammation in the middle ear.

Despite this, some symptoms are slightly more common with each variant. We outline common symptoms of the Delta and Omicron variants below.

Delta variant

Some symptoms a person may experience with Delta include:

• fever
• breathing difficulties
• exhaustion
• muscle aches
• headache
• nausea, vomiting, or diarrhea

Omicron variant

Some symptoms someone might notice with Omicron include:

• sore throat
• hoarse voice
• stuffy nose
• congestion
• fatigue
• headache

Ear infections are very common in children. Around 80–90% of children will have at least one ear infection before starting elementary school.

Children with ear infections and COVID-19 will likely have ear pain, but very young children may not be able to verbally express this pain. Signs of an ear infection to look for include:

• difficulty sleeping
• difficulty nursing or taking a bottle
• changes in eating habits
• frequent crying
• increased behavior problems
• pulling at the ear
• hitting or banging the side of the head near the ear
• being clingier than usual
• running a fever

Learn more about the signs and symptoms of ear infections.

Treatment for ear infections in a person with COVID-19 depends on how severe the symptoms are and how long they have had them. If someone has a bacterial ear infection, an antibiotic can kill the bacteria and relieve pain. To avoid the overuse of antibiotics, they can wait a few days to see if symptoms resolve on their own.

Pain medication may help with the pain of both an ear infection and COVID-19. Do not use cough or cold medication in children younger than 4 years old unless a doctor recommends this.

The following are answers to frequently asked questions about COVID-19 and ear infections.

Can I get an ear infection after contracting SARS-CoV-2?

An ear infection can follow any other infection. SARS-CoV-2 may directly cause infection in the ears, but it can also indirectly cause an infection by causing inflammation in the space around the ears. This can trap fluid, allowing bacteria to grow in the ears.

Is it an ear infection or COVID-19?

It is not possible to tell whether a person has an ear infection or COVID-19 according to their symptoms alone. An individual may also develop ear pain as their only COVID-19 symptom. Their ear pain also may linger after recovering from the disease. To know whether a person has an ear infection, COVID-19, or both, they should take a COVID-19 test.

How long do ear infections last with COVID-19?

Many ear infections improve on their own in 2–3 days. If the symptoms do not improve, a person likely needs antibiotics. It is important to take the full course of antibiotics, even if symptoms resolve. In most cases, an individual will need antibiotics for 10 days.

Will COVID-19 damage hearing?

A small portion of people with COVID-19 report trouble hearing. According to the above 2021 systematic review, 3.1% of individuals who tested positive for COVID-19 during the study period reported hearing loss. However, this hearing loss is generally temporary and will resolve once a person recovers from the disease.

COVID-19 can affect the body in unpredictable ways. According to current research, SARS-CoV-2, the virus that causes the disease, may cause infections in the inner and middle ears in some people, leading to painful ear infections.

While ear infections sometimes get better on their own, they can also be serious if they spread and a person does not treat them. People with a fever, severe ear pain, or hearing loss should contact a doctor if symptoms do not improve in 1–2 days.

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