Pandemic Stress Worsens Tinnitus and Depression

During the peak of COVID-19 restrictions, people with bothersome chronic tinnitus faced significantly more depression and stress than those without tinnitus or with milder symptoms. This is the core finding of a new study by Sang-Yoon Han and Young Ho Kim, published in the *European Archives of Oto-Rhino-Laryngology*.

How the Study Measured Tinnitus and Mental Health

Han and Kim analyzed data from the large, nationally representative Korea National Health and Nutrition Examination Survey (KNHANES). They compared two distinct time periods: the height of pandemic restrictions in 2020 and the “living-with-COVID” phase in 2022. The study included 5,965 participants who were divided into three groups based on their reported tinnitus experience.

Tinnitus severity was measured using a simple visual analogue scale (VAS), where a score above 4 indicated “bothersome tinnitus.” The researchers then assessed mental health using the standardized Patient Health Questionnaire-9 (PHQ-9) to screen for depressive symptoms, with a score of 5 or more suggesting clinical relevance. They also evaluated participants’ self-reported stress levels. This method allowed them to directly compare the psychological burden carried by different groups during two very different societal contexts.

Bothersome Tinnitus Linked to Worse Mental Health During Lockdowns

The results revealed a clear and troubling pattern specific to 2020. During the restriction period, the group with bothersome tinnitus had significantly higher PHQ-9 scores than both the non-tinnitus group and the group with mild, non-bothersome tinnitus. The prevalence of depressive symptoms and high stress followed the same trend.

For example, the psychological distress in the bothersome tinnitus group was measurably worse than in the other groups. By 2022, however, this clear distinction had faded. During the “living-with-COVID” period, there were no significant differences in depression or stress scores among the three groups. The analysis confirmed that the psychological state of people with bothersome tinnitus improved from 2020 to 2022, while the other groups remained relatively stable.

This pattern reinforces the idea that external stressors and isolation can interact powerfully with pre-existing conditions like chronic tinnitus. The findings align with other reports, such as our article on how the COVID-19 pandemic worsened tinnitus and depression, highlighting a widespread phenomenon.

Why Tinnitus Severity Matters for Psychological Risk

A critical insight from this research is that not all tinnitus is equal in terms of psychological impact. The study found no significant mental health differences between people with mild, non-bothersome tinnitus and those with no tinnitus at all during either time period. The major psychological vulnerability was concentrated entirely in the subgroup whose tinnitus was severe enough to be bothersome.

This suggests that clinical assessments must go beyond simply asking if a patient has tinnitus. Measuring its perceived severity and impact on daily life is essential for identifying who is most at risk for co-occurring conditions like depression and anxiety. This focus on individual impact is similar to the personalized approach needed for conditions like hyperacusis, where sensitivity levels vary greatly.

The Stress-Sound Cycle and Access to Care

The researchers propose that a vicious cycle likely explains their findings. Pandemic-related stress, isolation, and anxiety are known to exacerbate the perception and distress of tinnitus. In turn, worsened tinnitus can increase stress and depressive symptoms, creating a feedback loop that is difficult to break. Furthermore, public health restrictions during 2020 likely disrupted access to routine healthcare and in-person audiological or psychological support, leaving individuals without their usual coping mechanisms.

This disruption underscores a major practical implication of the study: the need for adaptable, accessible treatment formats. The authors explicitly recommend developing and implementing integrated management plans that address both the auditory and psychological components of tinnitus. They note that non-face-to-face approaches, such as telehealth and digitally delivered cognitive behavioral therapy, become vital when traditional access is limited.

Practical Implications for Patients and Clinicians

For individuals living with bothersome tinnitus, this study validates a difficult experience and offers direction. First, it confirms that feeling more distressed during periods of high general stress is a recognized response, not a personal failure. Second, it emphasizes the importance of proactively managing both mental health and tinnitus symptoms as interconnected issues.

Seeking help for stress or low mood is a direct form of tinnitus management. The connection between mental health and sensory disorders is a growing area of focus, as seen in research on the link between childhood trauma, emotion regulation, and misophonia.

For clinicians, the findings argue for routine mental health screening in patients presenting with bothersome tinnitus. It also supports the development of hybrid care models that combine in-person visits with remote support, ensuring continuity of care during future public health challenges or for patients in remote areas. Effective stress management is a cornerstone of well-being, and resources like an evidence-based sleep hygiene guide can be a useful component of a broader management plan, given the known bidirectional link between tinnitus and sleep disturbance.

A Call for Integrated and Accessible Management

The work by Han and Kim, available with full details via PMID 42684457 or DOI 10.1007/s00405-026-10553-w, provides strong evidence that bothersome tinnitus is a marker for psychological vulnerability during times of widespread societal stress. The severity of tinnitus is the key differentiator.

Moving forward, the goal should be to normalize integrated care pathways that address the sound and the emotional distress it causes simultaneously. Building healthcare systems that are resilient enough to deliver this support, whether in person or remotely, is a necessary step to protect the mental well-being of this vulnerable population during future crises.