Ear Pain With COVID: What To Know

COVID-19 is a viral infection that typically causes symptoms like fever, chills, cough, and loss of smell or taste. Less commonly, COVID can also affect the middle and inner ears, causing dizziness and balance problems (vertigo), hearing loss, tinnitus (ringing in the ears), and pain.

You may have a higher risk of developing ear pain if you’re between one and three years old, have had a previous respiratory (lung and airway) infection, or smoke. You may also experience ear symptoms with long COVID, and symptoms may return after having the initial infection.

Ear pain (otalgia) is a common, temporary symptom of respiratory infections, which is when viruses or bacteria infect the lungs, throat, sinuses, or airways. It develops due to inflammation (swelling) and fluid buildup in the eustachian tubes, the narrow bone and cartilage tubes connecting the middle ear to the back of the throat.

Common earache causes other than COVID include common cold or influenza viruses and Streptococcus (strep) bacteria.

COVID causes a range of ear-related symptoms, including:

• Dizziness/vertigo: The most common ear-related symptom, vertigo causes dizziness, loss of balance, and a sensation of spinning or turning.
• Tinnitus: You hear a ringing, buzzing, or hissing in the ear without any outside noises causing it.
• Ear fullness: A feeling of fullness or blockage in one or both ears is a common symptom of respiratory infections.
• Hearing loss: This symptom may be acute (short-term) or chronic (long-term) for people and can affect one or both ears.

Risk Factors

Anyone can develop ear pain, but some factors increase your risk. For example:

• Younger age: Earaches or ear infections are especially common in babies, with about 80% experiencing either before the age of three. Babies have smaller eustachian tubes and weaker immune systems, making them more prone to infection.
• Smoking: Smoking or second-hand smoke exposure raises your risk of developing ear infection and pain.
• Respiratory infections: Having a recent respiratory infection, like a cold, the flu, or COVID, significantly raises your earache risk.
• Allergies: Seasonal allergies, also known as hay fever or allergic rhinitis, can cause inflammation in the nasal passages and eustachian tubes, resulting in ear pain.
• Sex: People born male might be at an increased risk of primary ear infection (direct infection of the middle ear). People born female are more likely to develop secondary cases due to other conditions, such as dental and oral (mouth) conditions, upper respiratory infections, or joint conditions.

Ear Infections and COVID

With COVID, these ear and balance symptoms may occur as the virus spreads to the middle and inner ear, as well as the surrounding nerves. This causes inflammation and fluid buildup, leading to possible bacterial infection and more persistent symptoms. COVID also weakens the immune system, making the eustachian tubes more prone to infections.

Ear pain or infection can often resolve on its own without the need for prescription treatment. Over-the-counter (OTC) anti-inflammatory medications, decongestants, and hot or cold compresses can relieve symptoms. Your healthcare provider may prescribe antibiotics, antivirals, or corticosteroids to clear the infection and manage symptoms.  

Long COVID occurs when symptoms last longer than four weeks after infection or go away and come back. It affects 4% of children and 10-26% of adults who have COVID. Symptoms can vary greatly and range in severity, which can make long COVID hard to diagnose and treat.

Common long COVID symptoms include:

• Chronic fatigue that interferes with daily life
• Worsening symptoms with physical or mental effort
• Fever
• Difficulty breathing, such as shortness of breath
• Cough
• Chest pains
• Brain fog, or difficulty concentrating or remembering things
• Headache
• Dizziness or light-headedness
• Changes in smell or taste
• Depression or anxiety

Long COVID may cause ear-related symptoms like tinnitus, vertigo, or hearing loss (rarely). You may experience these symptoms because COVID damages tissues and tiny veins in the ear. More research is necessary to fully understand the connections.

Treatment for ear pain depends on how severe it is and the underlying cause. OTC medications can often manage symptoms. If it’s severe, you may need prescription medications or additional care to treat the underlying causes of the symptoms.

OTC Medications

You can take certain OTC medications to help relieve earache symptoms, such as:

• Pain relievers: These include Motrin (ibuprofen) and Tylenol (acetaminophen).
• Decongestants: These include Sudafed (pseudoephedrine) and Afrin (oxymetazoline), which can help with nasal congestion and swelling.
• Antihistamines and allergy medications: These include Benadryl (diphenhydramine) and Zyrtec (cetirizine).

Medications and Treatments

If resting and home management treatments don’t help, your primary care provider or an ear, nose, and throat (ENT) specialist may consider prescribing you certain medications or treatments. These options may include:

• Antibiotics: Your healthcare provider may prescribe antibiotic ear drops, tablets, or pills if a bacterial infection is causing your symptoms.
• Corticosteroids: These medications ease the inflammation that can cause ear pain. They can be taken by mouth or applied as drops.
• Antivirals: Ear pain related to viruses may require antiviral medications. For COVID, options include Paxlovid (nirmatrelvir) and Veklury (remdesivir). 

Ear pain from COVID typically resolves with the other symptoms once the infection clears. Seek medical care if you experience:

• Ear pain, tinnitus, or other ear symptoms that persist after other COVID symptoms resolve
• Repeated ear infections
• Fluid in the ear that won’t drain
• Symptoms that worsen

COVID can become serious for some people, so it’s important to know when your symptoms are severe. Seek emergency care if you experience:

• Difficulties with breathing or catching your breath
• Pain or pressure in the chest
• Confusion, extreme fatigue, or changes in consciousness
• Blue lips or face, which is a sign of a lack of oxygen
• Any other severe COVID symptoms

COVID can sometimes cause ear pain and related symptoms like dizziness, vertigo, and tinnitus. Some people may experience ear-related symptoms with long COVID.

OTC medications can help with ear pain caused by COVID. However, if your symptoms do not improve or worsen, consider consulting a healthcare provider. They may prescribe medications or recommend additional treatments to relieve your symptoms, such as antivirals, antibiotics, or corticosteroids.