Tinnitus Distress Increased in Pandemic

Patients with chronic, bothersome tinnitus experienced significantly more depressive symptoms and higher stress during the peak COVID-19 restriction period compared to quieter times. A new study from South Korea, analyzing national health survey data, found that the psychological burden associated with severe tinnitus was uniquely amplified by the social isolation and anxiety of lockdowns.

Measuring Tinnitus and Mood Across a Pandemic

Researchers Sang‐Yoon Han and Young Ho Kim from Hanyang University and Seoul National University used data from the large-scale Korea National Health and Nutrition Examination Survey (KNHANES). They compared two distinct time points: the height of pandemic restrictions in 2020 and the more open “living-with-COVID-19” phase in 2022.

The study included 5,965 participants who were sorted into three groups based on their self-reported tinnitus. The “bothersome tinnitus” group rated their tinnitus severity above 4 on a 10-point visual analogue scale (VAS). The “non-bothersome” group had a VAS score of 4 or less, and the final group reported no tinnitus.

Psychological health was measured using the Patient Health Questionnaire-9 (PHQ-9), a standard tool for screening depression, and a simple question about perceived stress levels. The team used complex statistical methods to account for the survey’s design, ensuring the results were representative of the national population.

Psychological Distress Spiked with Bothersome Tinnitus During Lockdowns

The findings revealed a clear pattern tied directly to the pandemic’s social context. In 2020, the group with bothersome tinnitus stood out. They had significantly higher PHQ-9 scores and greater prevalence of both depressive symptoms and high stress compared to both the non-tinnitus group and the group with mild, non-bothersome tinnitus.

“During the COVID-19 restriction period, the bothersome tinnitus group demonstrated significantly higher PHQ-9 scores and greater prevalence of depressive symptoms and high stress than the non-tinnitus group and the non-bothersome tinnitus group,” the authors report. All these comparisons were statistically strong.

By 2022, however, this pattern had changed. The significant psychological differences between those with bothersome tinnitus and the other groups were no longer present. When the researchers looked within the bothersome tinnitus group across the two time periods, they confirmed the change: scores for depression and high stress were significantly lower in 2022 than in 2020.

Tinnitus Severity, Not Just Presence, Predicts Vulnerability

The core finding is that the severity of tinnitus mattered most. Simply having tinnitus was not the primary risk factor. Instead, having tinnitus that was perceived as bothersome was the marker for increased psychological vulnerability during a period of widespread external stress.

This makes clinical sense. Tinnitus often exists on a spectrum from barely noticeable to severely intrusive. The lockdowns of 2020 created a perfect storm for those with severe symptoms. Increased quiet environments could have made the tinnitus more noticeable, while social isolation, anxiety about health, and reduced access to normal coping strategies and distractions likely compounded the distress. This created a cycle where stress worsened the perception of tinnitus, and the tinnitus, in turn, increased stress, similar to the vicious cycle seen with tinnitus and sleep disturbance.

The study’s design also rules out the possibility that people with bothersome tinnitus are always more depressed. The fact that the psychological gap closed in 2022 suggests their distress was situationally exacerbated by the unique pressures of the lockdown period.

Implications for Integrated and Accessible Care

Han and Kim state their conclusions plainly: “These findings highlight the importance of tinnitus severity assessment for identifying psychological vulnerability.” For clinicians, this means that during times of broad societal stress—like a pandemic or other crises—patients reporting bothersome tinnitus should be proactively screened for depression and anxiety.

The research also points to a pressing need for care models that integrate tinnitus management with psychological support. The authors specifically mention the value of “non-face-to-face approaches” for times when in-person access is restricted. This could include structured telehealth programs combining sound therapy principles with elements of cognitive behavioral therapy (CBT) delivered remotely. The effectiveness of remote psychological interventions is supported by related research, such as a study on CBT-I outcomes where baseline depression predicts long-term results, demonstrating the potential of structured digital programs.

Furthermore, helping patients manage overall stress and improve sleep hygiene—a known factor in tinnitus perception—could be a practical first step. Resources like an evidence-based sleep hygiene guide can be useful adjuncts to formal treatment.

The study, published in the European Archives of Otorhinolaryngology, provides concrete evidence that our auditory and emotional health are deeply intertwined, especially during challenging times. It reinforces that treatment must address the whole person, not just the perceived sound.

Source: Han SY, Kim YH. Increased prevalence of depressive symptoms and stress in patients with chronic bothersome tinnitus during the COVID-19 pandemic. Eur Arch Otorhinolaryngol. 2026. doi:10.1007/s00405-026-10553-w. PMID: 42684457.