Pandemic Stress Worsens Tinnitus and Depression

During the strictest phase of the COVID-19 pandemic, people with chronic, bothersome tinnitus were significantly more likely to report high stress and symptoms of depression than those with milder tinnitus or no tinnitus at all. This is the core finding from a study by Sang-Yoon Han and Young Ho Kim, published in the *European Archives of Otorhinolaryngology*, which analyzed national survey data from South Korea. The research provides a stark look at how pandemic-related isolation and stress can uniquely impact individuals already coping with a challenging auditory condition.

### Study Design: Comparing Two Phases of the Pandemic

The researchers used data from a large, nationally representative survey in South Korea: the Korea National Health and Nutrition Examination Survey (KNHANES). They compared responses from the 8th survey in 2020, a period of significant COVID-19 restrictions and lockdowns, with those from the 9th survey in 2022, a “living-with-COVID” phase with fewer restrictions.

From this data, they classified 5,965 adult participants into three groups:
* **Bothersome tinnitus:** Individuals with chronic tinnitus who rated its severity above 4 on a 10-point visual analogue scale (VAS).
* **Non-bothersome tinnitus:** Individuals with chronic tinnitus who rated its severity at 4 or below on the VAS.
* **Non-tinnitus:** Individuals who reported no tinnitus.

Psychological health was measured using the standardized Patient Health Questionnaire-9 (PHQ-9) to screen for depressive symptoms, and a single-item question to assess perceived stress levels. The team then performed complex statistical analyses to compare these outcomes across the groups and the two different time periods.

### Bothersome Tinnitus Linked to Worse Mental Health in Lockdown

The results revealed a clear pattern tied directly to the timing of the pandemic. In 2020, the group with bothersome tinnitus stood out. They had significantly higher PHQ-9 scores and a greater prevalence of both depressive symptoms and high stress than both the non-tinnitus group and the non-bothersome tinnitus group.

By 2022, however, this pattern had changed. During the “living-with-COVID” period, there were no significant differences in depressive symptoms or stress levels among the three groups. The psychological burden had notably eased for those with the most severe tinnitus.

Most tellingly, when the researchers compared the bothersome tinnitus group across the two years, they found significant declines. Scores for depression, the prevalence of depressive symptoms, and reports of high stress were all lower in 2022 than they had been in 2020. This indicates that the psychological state of this group improved as pandemic restrictions lifted, pointing to the environment of lockdowns as a major aggravating factor. Our article, “Tinnitus Distress Increased in Pandemic“, explores similar findings on how global stress events exacerbate auditory conditions.

### Why Isolation Hit Tinnitus Patients Harder

The study authors explain that the pandemic’s unique stressors created a “perfect storm” for individuals with bothersome tinnitus. Lockdowns and social isolation likely led to increased attention on internal bodily sensations, including the persistent perception of tinnitus. With fewer external sounds and distractions in quiet home environments, the tinnitus signal can become more prominent and harder to ignore.

Furthermore, the widespread anxiety about health, financial uncertainty, and disruption of normal support networks during 2020 added a heavy layer of general stress. For someone with bothersome tinnitus, this general stress can directly amplify the perceived loudness and distress of the condition, creating a vicious cycle where tinnitus increases anxiety, and anxiety worsens tinnitus. This interplay between stress and auditory perception is also a key focus in understanding conditions like hyperacusis, where sound sensitivity is a primary symptom.

### Practical Implications for Treatment and Management

This research moves beyond simply identifying a problem and offers clear directions for clinical practice and patient support.

First, it underscores that **tinnitus severity matters**. Clinicians should actively assess how bothersome a patient’s tinnitus is, as this is a strong indicator of psychological vulnerability, especially during times of societal crisis. A simple VAS rating can be a powerful tool for identifying who needs more comprehensive support.

Second, the findings make a strong case for **integrated care models**. Managing chronic tinnitus effectively, particularly during periods of restricted movement, requires combining audiological management with psychological support. Cognitive Behavioral Therapy (CBT) for tinnitus, which helps patients change their emotional response to the sound, is one evidence-based approach that should be more widely accessible.

Finally, the study explicitly calls for the development and implementation of **non-face-to-face management approaches**. The improvement seen in 2022 suggests that restoring access to care and social connection is vital. Telehealth consultations, structured online therapy programs, and digital sound therapy platforms can provide continuous support when in-person visits are not possible. This aligns with broader mental health strategies, such as those discussed in the cross-site article, “CBT-I Outcomes: Baseline Depression Predicts Long-Term Results,” which highlights the importance of accessible therapeutic interventions.

For patients, this study validates that if their tinnitus felt overwhelming during the pandemic, it was a real and measurable phenomenon. It also emphasizes the importance of maintaining mental health routines and seeking professional help that addresses both the auditory and emotional components of the condition. Building resilience through good sleep practices, as outlined in resources like the “Evidence-Based Sleep Hygiene Guide,” can be a foundational part of this management, given the known bidirectional link between tinnitus and sleep disturbance.

The study by Han and Kim, available via PMID: 42684457, provides concrete evidence that public health crises can disproportionately affect those with sensory health conditions. It reinforces the need for healthcare systems to be prepared with flexible, integrated, and remote care options to support this vulnerable population in future times of crisis.