COVID-19 symptoms could be driven by stress and anxiety

Since the onset of the pandemic, reports of symptoms such as tinnitus and hearing loss have been potentially linked to COVID-19 however, there may be a psychosocial origin as well

Referred to as “ringing in the ears,” tinnitus is the perception of sound when no actual external noise is present, and can severely affect the overall quality of life.

According to a study led by the University of Manchester, and the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC), COVID-19 symptoms could be influenced by stress and anxiety.

In a YouGov poll in 2019, over 10,000 people were asked whether they had experienced hearing difficulty and/or tinnitus, these same people were then asked to be contacted again about symptoms they had experienced during the pandemic – YouGov received 6881 responses.

This second survey asked about the onset and changes in three symptoms:

• Type one: loss of smell, memory/concentration issues, persistent fatigue which have known association with COVID-19.
• Type two: auditory symptoms (hearing difficulty and tinnitus) which have an indeterminate association with COVID-19.
• Type three: toothache, a red herring with no established association with COVID-19.

Although there were twice as many reports of new hearing difficulties and tinnitus in people with confirmed and suspected COVID-19, compared to people who hadn’t had COVID-19, they found:

• The onset of new auditory symptoms coincided with COVID-19 in only a third of the people reporting the symptoms; a third didn’t know when their symptoms began; and a third said their symptoms began before the pandemic, even though all had said they didn’t have auditory symptoms in March 2019.
• More than 60 per cent of people with confirmed or suspected COVID-19 said that their toothache had also been affected by COVID-19 despite there being no evidence of an association.
• As expected, Type one symptoms were reported most commonly by the people with confirmed COVID-19. But Type two and Type three symptoms were reported most commonly by the people who suspected they had COVID-19.

The relationship between COVID-19, stress and anxiety

The study also asked about the challenges the participants had experienced during the pandemic- such as feelings of loneliness, anxiety, lack of exercise, space at home and caring for others.

According to the results, the number of challenges reported were higher per the number of symptoms reported.

Dr Gabrielle Saunders from The University of Manchester, who manages Manchester BRC’s Hearing Device Centre, was the lead author of the study. She said: “Although there were more reports of auditory symptoms in people with confirmed or suspected COVID-19, our study provides evidence that psychosocial factors influenced what our respondents felt.”

“We also found that respondents were inconsistent with their reporting of hearing symptoms over time. We think this is in part because their answers were affected by the context in which the question was asked. That is why we need to take great care in attributing any symptom to the effect of the virus, especially if we lack baseline data.”

“We feel that studies which include control groups and use audiometric measures (hearing tests) in addition to self-reporting, to investigate the change in auditory symptoms relative to pre-COVID-19, are urgently needed.”

Stress and the body

We already know that stress can affect the body in many different ways, and although everyone experiences stress on a daily basis – chronic stress can have disastrous effects on the human body. Symptoms of chronic stress can include irritability, anxiety, depression, headaches, insomnia which can all, in turn, result in further medical complications. The impact of stress and anxiety on the body cannot be overlooked and its relation to COVID-19 needs to be investigated further.

According to the Professor of Psychological Medicine at the University of Oxford, Professor Michael Sharp: “Whilst investigators found some evidence of an association between hearing problems and having had COVID-19 infection, further analysis suggested the link was not a simple one.”

Sharp went on to explain, “these findings remind us that many factors influence symptoms and we should not conclude that all symptoms reported after COVID-19 are a direct result of infection. A number of additional factors such as stress and worry can also contribute. Awareness of this is important because it offers additional ways to help those suffering from persistent symptoms in the context of the COVID-19 pandemic.”