Symptoms like ringing in the ear and dizziness, which occur with ear infection, may occur in people with COVID-19 too. A small number of people with COVID-19 (about 3%) also experience hearing loss, another shared symptom, according to a 2021 research review.
Additionally, there is some research indicating that COVID-19 may not only mimic an ear infection but cause one, though this connection is far from firm at the time. A 2021 study found a link between the two in only a small number of patients and research is ongoing.
Read on to learn more about how symptoms of COVID-19 and an ear infection overlap and differ, and what's known so far about how COVID-19 can affect the ears.
Both COVID-19 and an ear infection can cause fever and headaches.
Ear infections can result in fevers of 100 to 104 degrees F. It’s reported that about 50% of children who get ear infections will have a fever.4 Headaches are most regularly found in people with middle ear infections.
While some people diagnosed with COVID-19 can be asymptomatic, many develop symptoms like fever and headache in addition to respiratory symptoms like a cough.
When to See a Doctor
Given how variable both COVID-19 and ear infections can be, you shouldn’t try to self-diagnose. To ensure you don’t spread COVID-19 to others, you should reach out to a healthcare provider or seek local resources in your area to find a place to get tested. The same goes for an ear infection. You should seek medical attention if you are unsure what is causing your symptoms. If your headaches or fever become increasingly severe, seek out medical attention right away.
Symptoms Unique to COVID-19
Common symptoms specific to COVID-19 can include:
- Bluish lips and face
- Cough, dry without mucus
- Chest pain
- Chills and body aches
- Conjunctivitis, or pink eye
- Digestive problems, including diarrhea
- Loss of smell, taste
- Nasal congestion
- Shortness of breath
- Sore throat
- Tiredness or fatigue
Some COVID-19 symptoms are more serious than others, and there are also some that are less likely to present themselves in some cases. If you begin to experience any of the following, contact your healthcare provider right away:
- COVID toes: This refers to purplish or red discoloration of your toes. Your toes may feel painful and itchy.
- Delirium: Confusion and disorientation can be caused by COVID-19 affecting the body’s central nervous system. This can be very serious, so seek immediate medical attention if you experience delirium.
- Deep vein thrombosis: Some people with COVID-19 may be at higher risk of developing this blood clotting in the lower leg or thigh. This can be serious since it can lead to a pulmonary embolism, where the blood clot travels up to the blood vessels of the lungs. If you notice your legs showing signs of this condition, like swelling, cramping, discoloration, and itching, consult your healthcare provider right away.
- Stroke: Blood clots can lead to a stroke, but this is particularly rare. It’s been found that people with underlying cardiovascular issues are at higher risk of stroke if they have COVID-19. Make sure you see your healthcare provider right away if you start seeing any signs of a stroke, including slurred speech, confusion, and blurred vision.
Symptoms Unique to Ear Infections
Some common symptoms specific to ear infections include:
- Ear pain
- Fullness in the ear
- Fluid drainage from the ear
- Loss of appetite
- Sleep disruption
Other symptoms of an ear infection include:
- Otitis media with effusion: This is also known as secretory otitis media, which refers to fluid buildup in the middle ear. You may experience this after a middle ear infection, while for others it may develop due to a blocked eustachian tube—the passage that connects the back of your nose to your middle ear. When the fluid builds, bacteria can grow and ultimately lead to an ear infection. This can cause mild to moderate hearing loss, cracking sounds when you swallow, and fullness in the ear.
- Chronic ear infections: Chronic otitis media may mean you experience a repetition of symptoms and a repeat infection if, for example, you develop a cold. This can be disruptive to your daily life, with chronic, ongoing bouts of headaches, drainage from the ear, hearing loss, and fatigue.
Ear Infection Causes
Any bacterial or viral respiratory infection can lead to an ear infection. It may start out as a seemingly benign cold or a respiratory infection.
The virus or bacteria can then travel up through the eustachian tube to the middle ear, and the tube can become inflamed as a result. This inflammation and swelling can result in blockage in the tube, with fluid retained in the middle ear rather than draining out.
Potential Link to COVID-19
As of yet, there are no conclusive studies showing that COVID-19 and its developing variants directly cause ear infections. There are some reported connections, however.
A 2022 review concluded that COVID-19 infection can affect middle ear function, since the virus has been found in the middle ear of some people with COVID-19. The same review found that COVID-19 can also contribute to middle ear problems like ear infections.
A small 2022 study in children with ear infections concluded that ear infections and COVID-19 could happen at the same time, though researchers also noted it was unclear whether the SARS-CoV-2 virus was responsible for the infections.
Ear Infection Diagnosis
Your medical provider will examine your ear with an instrument called an otoscope. As they are testing your ear, they will assess whether it’s a healthy eardrum, which will be pinkish grey and clear, or one that has an infection. An infected eardrum might look reddish in color, swollen, and puffy with inflammation.
A pneumatic otoscope is a device that blows air into the eardrum, causing it to move back and forth. This is to assess if the fluid retention is in the middle ear. The eardrum won’t move back and forth with ease if fluid has built up.
Tympanometry may also be employed. It is a test that uses air pressure to check for fluid retention in the middle ear.
These tests do not examine hearing quality. If your provider thinks it is necessary, they will have a separate hearing test performed by an audiologist to see if you have hearing loss. This would be important if you have chronic ear infections or fluid that refuses to drain away.
Ear Infection Treatment
A range of treatments are available for ear infections. They vary depending on the severity of the infection, symptoms, age of the person being treated, and amount of fluid retention. If the infection is mild, your provider may ask you to wait a few days to see if the infection goes away on its own. If not, they may prescribe treatments to help with your symptoms.
You may be prescribed antibiotic medications to treat an ear infection. In general, your provider will assess your medical history, interactions with other medications, and age before prescribing a medication to treat your ear infection.
The American Academy of Pediatrics outlines the following recommendations for treating children:4
- Children 6 months or older who have an ear infection in one or both ears should be prescribed an antibiotic if symptoms are moderate to severe for at least 48 hours or their temperature is 102.2 F or higher.
- An antibiotic will be prescribed to a child 6 to 23 months old if an infection is in both ears and they have shown mild symptoms for less than 48 hours and a fever of less than 102.2 F.
- Children 6 to 23 months with an infection in one ear with mild symptoms for less than 48 hours and a fever of less than 102.2 F should receive an antibiotic or be observed, unless their symptoms don’t improve within 48 to 72 hours.
- Children 24 months or older with an infection in one or both ears who possess mild symptoms for less than 48 hours and a fever of less than 102.2 F are recommended to either be observed or treated with an antibiotic. If observed, they should be given medication if their symptoms don’t improve within 48 to 72 hours.
Amoxicillin is generally the common antibiotic of choice to treat an ear infection that won’t go away after observation. If you or your child has an allergy to penicillin, you will want to consult with your provider about an alternate medication. Ear drops with a topical anesthetic may also be prescribed.14
Home Treatment and Procedures
You may use over-the-counter (OTC) medications to relieve the pain that comes with an ear infection. These include ibuprofen (Advil or Motrin) or acetaminophen (Tylenol). Always follow the instructions from your provider about the best way to go about taking OTC treatments and review what would be the best dosage and course of treatment for you or your child.4
Chronic ear infections that recur often or that present consistent fluid buildup in the middle ear may require treatment with ear tubes, which are small cylinders that are positioned through the eardrum to allow easy passage of air into the middle ear. They are inserted during an outpatient surgical procedure known as a myringotomy.
COVID-19 and ear infections cause similar symptoms like headaches and fevers, but they also have different symptoms. For example, COVID-19 causes shortness of breath, while ear infections do not. If you have any symptoms of COVID-19, it’s important for you to get tested and make sure you don’t spread it to others. Ear infections may go away on their own, but if they don’t, you will need antibiotics and other treatments from your healthcare provider.