Prevalence of Dizziness, Tinnitus and Headache Among COVID-19 Patients at Sultan Qaboos University Hospital, Muscat
1
College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
2
Department of Surgery, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
3
Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat 123, Oman
*
Author to whom correspondence should be addressed.
J. Oman Med. Assoc. 2025, 2(2), 14; https://doi.org/10.3390/joma2020014
Submission received: 11 June 2024
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Revised: 24 July 2025
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Accepted: 19 August 2025
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Published: 5 September 2025
Abstract
Background: This cross-sectional study was conducted among adult Omani patients with a confirmed laboratory diagnosis of COVID-19 to determine the prevalence of dizziness, tinnitus and headache in the pre-, during and post-COVID-19 recovery phases. Methodology: The characteristics and severity of symptoms of dizziness, tinnitus and headache in the above three phases were determined by telephone interviews. The severity of symptoms was recorded using the visual analog score. Results: The total number of patients selected was n = 102 (M/F 50/50%; overall mean age = 33.52 ± 3.6 years). The pre-COVID-19 prevalence of dizziness was 16%, tinnitus 13% and headache 53%. During COVID, the prevalence of dizziness increased to 41%; for tinnitus, it remained the same; and for headache, it increased to 73%. Compared to the lower age group category (30–32 years); the pre-COVID-19 prevalence of dizziness was significantly higher in the 33–40 years age group. The severity of symptoms showed a significant correlation in different phases, pre- and post-COVID-19, for dizziness (r = 0.556), tinnitus (r = 0.714) and headache (r = 0.696), and tinnitus during and post-COVID-19 (r = 0.570). Conclusion: The prevalence of dizziness, tinnitus and headaches was high in COVID-19 patients. All symptoms pre-COVID-19 and during COVID-19 persisted post-COVID-19.
1. Introduction
The COVID-19 pandemic period documented extensive research about the effects of the SARS-CoV-2 virus on the central nervous system, but there is limited research about COVID-19; symptoms related to otoneurology, such as tinnitus and equilibrium disorders [1]; and the management and treatment of these symptoms. Viola et al. documented that about one-fourth of COVID-19 patients developed tinnitus, 18% developed equilibrium disorders and 7.6% developed both [1]. A recent meta-analysis concluded that an estimation of the real prevalence of tinnitus was not possible due to wide differences among the studies and the lack of clinical trials [2]. An online survey conducted on a German cohort (n = 1082) found a prevalence of 10% for tinnitus and 60% for dizziness or vertigo in adult long COVID patients after a mean period of 43.2 weeks [3]. In the Arabian Gulf region, there is only one case report on tinnitus and COVID-19 [4]. Hence, this study was conducted in a tertiary hospital in the Sultanate of Oman among adult (age: 30–40 years) Omani patients who had a confirmed laboratory diagnosis of COVID-19 to determine the prevalence of dizziness, tinnitus and headache in the pre-, during and post-COVID-19 recovery phases, and to study the correlation of their severity in the three phases.
2. Materials and Methods
This cross-sectional study used telephone interviews to identify the presence of dizziness, tinnitus and headache in COVID-19 patients. Patients between the ages of 30–40 years, alive and who have a confirmed laboratory diagnosis of COVID-19 at the Sultan Qaboos University Hospital (SQUH) from January 2021 until July 2021 were included. The interview was conducted in either English or Arabic according to the preferences of the subjects. The interview questions were based on an online questionnaire on a similar study topic in Italy [1]. Patients who had subjective hearing loss in at least one ear before COVID-19 were excluded.
Ethical approval was granted by the Ethical Committee, MREC Ref. No. SQU-EC/520/2021 MREC#2512, College of Medicine and Health Sciences.
Patient names, hospital ID, phone number and demographic parameters such as age, gender and nationality were obtained from the Hospital Information System (HIS) of SQUH per the inclusion criteria.
For our study, we used the following definitions to create our working definitions and posed them as questions to the respondents.
Dizziness is a non-specific term that describes a range of sensations such as light-headedness, unsteadiness or a feeling of faintness. It can also include vertigo, which is the false sensation of movement, typically spinning [5]. The working definition/question asked for dizziness was as follows: Do you experience light-headedness or loss of body balance or feeling like fainting or sensation of the spinning around you?
Tinnitus is the perception of sound, such as ringing, buzzing or hissing, in the absence of an external auditory stimulus. It can be subjective (heard only by the patient) or objective (rare, can be heard by the examiner) [6]. The working definition/question asked for tinnitus was as follows: Do you ever hear any ringing, buzzing, or hissing inside your ears when in reality there was no such ringing, buzzing or hissing from any outside source?
Headache is a pain located in the head or upper neck. It can be primary, such as a tension-type headache, migraine or cluster headache, or secondary to other medical conditions [7]). The working definition/question asked for headache was as follows: Do you ever experience any type of routine headache or some different type of headache associated with or without pain in the upper neck?
In the telephone interview, patients were asked about the characteristics and severity of symptoms of dizziness, tinnitus and headache for the three phases: pre-COVID-19, during COVID-19, and post-recovery from COVID-19. The post-recovery COVID-19 period was from 3 to 12 months.
A visual analog score was used to record the severity of symptoms. Patients chose a number from 0 to 10, with 0 being no severity at all and 10 meaning maximum severity. If a range was given by patients, the average was taken, and those who answered ‘variable’ were given a score of 5.
The sample size required for the present study was calculated for a single proportion and an absolute precision of 5% using nMaster software, Version 2.0. We assumed the prevalence of about 18% for equilibrium disorders and 23% for tinnitus. For a confidence level of 95%, the minimum number required is between 227 and 272 subjects. We decided to recruit a larger number.
The Statistical Packages for Social Sciences (SPSS) version 23 was used for analysis. Based on the median, age was categorized into two groups: 30–32 years and 33–40 years. The associations of symptoms in all three phases with gender and age group were tested using the chi-square test. The correlation between continuous variables was determined by Pearson’s correlation coefficient. The statistical significance was set at p ≤ 0.05.
3. Results
This study planned to recruit no less than 272 subjects to be interviewed based on the sample size calculations, but for reasons stated in the Limitations Section of the Discussion, we could only study 102 subjects (Males: n = 51; 50%). The average age of the cohort was 33.52 (SD 3.6) years. Both genders had similar ages (males 33.45 ± 3.56; females 33.59 ± 3.66 years; p = 0.84).
3.1. Pre-, During, and Post-COVID-19 Prevalence
The pre-COVID-19 prevalence of dizziness was 16%, tinnitus 13% and headache 53%. During COVID, the prevalence of dizziness increased to 41%; for tinnitus, it remained the same at 13%; and for headache, it increased to 73%. The post-COVID-19 prevalence of dizziness was 24%, tinnitus 12% and headache 54%.
Compared to the lower age group category (30–32 years), the pre-COVID-19 prevalence of dizziness was significantly higher in the 33–40 years age group (p = 0.048), while for headache, it was significantly lower in the same age group during the same period (p = 0.041).
During COVID-19, females had a significantly higher proportion of headache (82.35%) compared to males (62.74%) (p = 0.045) [Table 1]. However, the prevalence of dizziness and tinnitus was similar in both genders.
3.2. Severity of Symptoms and Their Association
The severity of symptoms showed a moderate to strong correlation in different phases, as seen in Table 2: dizziness pre-COVID-19 with dizziness after recovery (r = 0.556; p < 0.001); tinnitus in pre- and post-recovery phases (r = 0.714; p < 0.001); tinnitus during COVID-19 and after (r = 0.570; p < 0.001); and headache before and after COVID-19 (r = 0.696; p < 0.001). A significant but mild correlation was noted for tinnitus before and during COVID-19 (r = 0.311; p = 0.001); tinnitus and headache before COVID-19 (r = 0.422; p < 0.001); tinnitus and headache during (r = 0.352; p < 0.001); and headache during and headache after (r = 0.433; p < 0.001).
A small percentage of patients experience all three symptoms together (pre-COVID-19: n = 5, 4.9%; during COVID-19: n = 8, 7.8%; and after recovery from COVID-19: n = 3, p = 2.9%).
4. Discussion
This study noted that headache was the most prevalent symptom in all three phases of COVID-19 compared to dizziness and tinnitus. The prevalence of dizziness, tinnitus and headache increased during COVID-19, was nearly similar in both genders and persisted even 3–12 months after recovery. Although when taken together, the prevalence of dizziness, tinnitus, and headache increased during COVID-19, according to the data provided, tinnitus on its own decreased.
Similar results were found in a prospective study performed in Turkey on 239 patients, which found that headache was the most common neurological finding [8]. Another study performed in Europe on 1420 patients [9] and a study performed in Iran on 891 patients [10] also found that headache was the most common symptom among COVID-19 patients.
This study showed that a lower proportion of patients experienced tinnitus during COVID-19 compared to other studies, which found that 23.3% [1] and 39% [11] of patients experienced tinnitus during COVID-19. However, it is higher than the pooled prevalence of 8% quoted in a systematic review [11]. A meta-analysis on six papers demonstrated an occurrence rate of 4.50% (CIs: 0.012–0.153) for tinnitus in patients with COVID-19 [12]. Our lower prevalence could be due to the subjective information we obtained, rather than using audiometric testing results. The prevalence of tinnitus showed no differences in both age groups in all three COVID-19 phases. A survey on 185 patients with positive PCR nasopharyngeal swabs reported that tinnitus started after COVID-19 diagnosis in 23.2% of cases [13]. Emotional factors, stress, anxiety and poor sleep quality experienced during the course of the disease can play a relevant role in developing or enhancing this symptom [13,14].
The significant correlations between the severity of dizziness after COVID-19 and the severity of dizziness before and during COVID-19 can be explained as follows: if someone had severe dizziness before and during COVID-19, they are likely to also have severe dizziness after COVID-19. This pattern of findings was also true for tinnitus and headache severity. This study showed a significant correlation between tinnitus after COVID-19 and both pre-COVID-19 tinnitus and tinnitus during COVID-19. There have been few reports on the persistence of tinnitus after recovery from COVID-19 [4,14]. During COVID-19, headache, dizziness and tinnitus were associated with each other. The small percentage of patients who experienced all three symptoms together in all three phases may suggest a common pathophysiology of these three audio-vestibular difficulty-related symptoms. This observation needs further evaluation.
It has been established that SARS-CoV-2 traverses the olfactory epithelium and lamina cribrosa to reach the olfactory bulb. The inflammatory process seen in the auditory cortex and olfactory area is directly caused by SARS-CoV-2 [2]. The reduction in symptoms with the use of steroids provides supportive evidence that the virus probably affects olfactory and auditory areas simultaneously. Saniasiaya et al. propose that the vertigo/dizziness seen in patients with COVID-19 could be explained by the same underlying pathology, i.e., alteration of the blood flow in the cochlea and vestibule due to thrombosis in the audio-vestibular artery [12]. It is likely that hearing disturbances may be experienced more often by patients than equilibrium disorders due to the vestibular compensative mechanism [2]. It is also proposed that direct attack by SARS-CoV-2 and damage to hair cells in the inner ear may result in the tinnitus and sensorineural hearing loss observed in COVID-19 patients [12]. Diseases of central origin, like multiple sclerosis, are known to cause vestibular disorders; hence, it is reasonable that SARS-CoV-2 spreading in the vestibular pathways may be responsible for the equilibrium disorders observed in COVID-19 patients [2].
Our study noted that in the pre-COVID-19 phase, in the older age group, the prevalence of dizziness was significantly higher, and the prevalence of headache was significantly lower. These differences were not observed in both age groups during recovery and after recovery. The pathophysiological explanation of this reversal is beyond the scope of our study and may warrant a future detailed investigation. Nejad et al. also found that the prevalence of headaches decreased in older patients during COVID-19 [10]. During COVID-19, females had a significantly higher proportion of headaches compared to males. The probable reason could be that females provided more complete descriptions of their symptoms than males.
Some general symptoms of long-term COVID include fatigue that does not improve with rest, heart palpitations, shortness of breath, cough, anosmia, headache, mental fatigue, dizziness, vertigo and anxiety/depression [9]. Our study similarly found persistent symptoms of tinnitus, dizziness and headache three to six months after recovery from COVID-19. The proposed mechanism for long COVID-19 symptoms, such as fatigue, dizziness and vertigo, involves inflammatory responses and increased levels of cytokines harming the vestibulocochlear apparatus; this is supported by signs of inflammation in inner ear vessels and the stria vascularis [9]. It is hypothesized that this mechanism may cause tinnitus in COVID-19 and long COVID-19 patients.
4.1. Strength
The strength of the study lies in determining the prevalence of dizziness, tinnitus and headache in the pre-, during and post-COVID-19 recovery phases among a sample of laboratory-confirmed COVID-19 Omani patients, and correlation with age, gender and severity of disease
4.2. Limitations
The WHO’s Vaccine Adverse Effect Reporting System (VAERS) documented cases of tinnitus following COVID-19 vaccination [15] prior to our study. However, during the design stage, we were not sure whether a telephonic interview would allow us to determine whether the outcomes of our study were due to the infection, vaccination or both. Hence, we decided not to analyze vaccination-related questions. We fully accept that this is one of the major limitations of our study. Our inability to conduct a face-to-face interview posed difficulty in explaining some of the terms to the patients and could have affected their responses. Many patients did not understand the severity scale and the perception of it, which took time to explain and elaborate. Recall bias could pose a problem in studies like ours. It was difficult to contact some patients as their personal contact numbers were not documented in their hospital records, and we had to approach them via the available listed phone numbers, which mostly belonged to relatives. This also explains the low response rate.
5. Conclusions
Our study found that the prevalence of otoneurological symptoms such as dizziness, tinnitus and headache was high in COVID-19. Dizziness, headache and tinnitus that occurred pre-COVID-19 and during COVID-19 persisted post-COVID-19. Females and the older age group are more vulnerable to experiencing these symptoms. The coexistence of headache, tinnitus and dizziness in our study and the association of otoneurologic symptoms with age and gender would definitely help clinicians to better evaluate and manage patients. Medical professionals should be aware that tinnitus, headache and dizziness may need more attention following the pandemic or after experiencing COVID-19. In-depth studies are further needed to confirm the relation of such viral infections with dizziness, vertigo and tinnitus after considering the role of vaccination in order to avoid unnecessary laboratory investigations of these symptoms.
Author Contributions
Conceptualization, D.J.; methodology, D.J. and R.K.S.A.A.; software, D.J. and N.T.B.A.; validation, D.J., N.T.B.A. and R.K.S.A.A.; formal analysis, D.J.; investigation, N.T.B.A.; resources, R.K.S.A.A., and N.T.B.A.; data curation, N.T.B.A.; writing—original draft preparation, N.T.B.A. and D.J.; writing—review and editing, D.J.; visualization, D.J.; supervision, R.K.S.A.A.; project administration, D.J.; funding acquisition, Not applicable. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Ethical approval was granted by the Ethical Committee, MREC Ref. No. SQU-EC/520/2021 MREC#2512, College of Medicine and Health Sciences, obtained 21 July 2021.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study over the telephone.
Conflicts of Interest
The authors declare no conflicts of interest.
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Table 1.
Association of age categories and gender with dizziness, tinnitus and headache in the three phases of COVID-19.
Table 1.
Association of age categories and gender with dizziness, tinnitus and headache in the three phases of COVID-19.
| Age Categories (Years) | Chi-Square p Value | Gender | Chi-Square p Value | |||||
|---|---|---|---|---|---|---|---|---|
| 30 to 32 | 33 to 40 | Male | Female | |||||
| Dizziness | Before COVID-19 | No | 57 | 29 | 0.048 | 45 | 41 | 0.415 |
| Yes | 6 | 10 | 6 | 10 | ||||
| During COVID-19 | No | 36 | 24 | 0.685 | 33 | 27 | 0.314 | |
| Yes | 27 | 15 | 18 | 24 | ||||
| Post-recovery COVID-19 | No | 49 | 29 | 0.811 | 39 | 39 | 1.000 | |
| Yes | 14 | 10 | 12 | 12 | ||||
| Tinnitus | Before COVID-19 | No | 57 | 32 | 0.236 | 43 | 46 | 0.554 |
| Yes | 6 | 7 | 8 | 5 | ||||
| During COVID-19 | No | 58 | 31 | 0.075 | 44 | 45 | 1.000 | |
| Yes | 5 | 8 | 7 | 6 | ||||
| Post-recovery COVID-19 | No | 59 | 31 | 0.054 | 45 | 45 | 1.000 | |
| Yes | 4 | 8 | 6 | 6 | ||||
| Headache | Before COVID-19 | No | 35 | 13 | 0.041 | 26 | 22 | 0.552 |
| Yes | 28 | 26 | 25 | 29 | ||||
| During COVID-19 | No | 19 | 9 | 0.499 | 19 | 9 | 0.045 | |
| Yes | 44 | 30 | 32 | 42 | ||||
| Post-recovery COVID-19 | No | 30 | 16 | 0.681 | 25 | 21 | 0.427 | |
| Yes | 33 | 22 | 25 | 30 | ||||
Table 2.
Correlation between severity of dizziness, tinnitus and headache in the pre-, during and post-recovery COVID-19 phases [Pearson’s correlation r (p value)].
Table 2.
Correlation between severity of dizziness, tinnitus and headache in the pre-, during and post-recovery COVID-19 phases [Pearson’s correlation r (p value)].
| Severity of | Severity of Symptoms | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Dizziness Before COVID-19 | Dizziness During COVID-19 | Dizziness After COVID-19 | Tinnitus Before COVID-19 | Tinnitus During COVID-19 | Tinnitus After COVID-19 | Headache Before COVID-19 | Headache During COVID-19 | Headache After COVID-19 | |
| Dizziness before COVID-19 | --- | r = 0.131 (0.174) | r = 0.556 (<0.001) | r = 0.235 (0.017) | r = 0.167 (0.093) | r = 0.181 (0.068) | r = 0.163 (0.101) | r = 0.049 (0.628) | r = 0.189 (0.056) |
| Dizziness during COVID-19 | --- | --- | r = 0.447 (<0.001) | r = 0.051 (0.614) | r = 0.246 (0.013) | r = 0.036 (0.719) | r = 0.024 (0.807) | r = 0.230 (0.020) | r = 0.124 (0.214) |
| Dizziness after COVID-19 | --- | --- | --- | r = 0.135 (0.175) | r = 0.194 (0.051) | r = 0.044 (0.658) | r = 0.071 (0.476) | r = 0.138 (0.168) | r = 0.242 (0.014) |
| Tinnitus before COVID-19 | --- | --- | --- | --- | r = 0.311 (0.001) | r = 0.714 (<0.001) | r = 0.422 (<0.001) | r = 0.083 (0.408) | r = 0.270 (0.006) |
| Tinnitus during COVID-19 | --- | --- | --- | --- | --- | r = 0.570 (<0.001) | r = 0.179 (0.071) | r = 0.352 (<0.001) | r = 0.116 (0.245) |
| Tinnitus after COVID-19 | --- | --- | --- | --- | --- | --- | r = 0.299 (0.002) | r = 0.191 (0.054) | r = 0.141 (0.157) |
| Headache before COVID-19 | --- | --- | --- | --- | --- | --- | --- | r = 0.358 (<0.001) | r = 0.696 (<0.001) |
| Headache during COVID-19 | --- | --- | --- | --- | --- | --- | --- | --- | r = 0.433 (<0.001) |
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MDPI and ACS Style
Ahmed, N.T.B.; Al Abri, R.K.S.; Jaju, D. Prevalence of Dizziness, Tinnitus and Headache Among COVID-19 Patients at Sultan Qaboos University Hospital, Muscat. J. Oman Med. Assoc. 2025, 2, 14. https://doi.org/10.3390/joma2020014
AMA Style
Ahmed NTB, Al Abri RKS, Jaju D. Prevalence of Dizziness, Tinnitus and Headache Among COVID-19 Patients at Sultan Qaboos University Hospital, Muscat. Journal of the Oman Medical Association. 2025; 2(2):14. https://doi.org/10.3390/joma2020014
Chicago/Turabian StyleAhmed, Nazik Tayfour Babiker, Rashid Khalfan Salim Al Abri, and Deepali Jaju. 2025. "Prevalence of Dizziness, Tinnitus and Headache Among COVID-19 Patients at Sultan Qaboos University Hospital, Muscat" Journal of the Oman Medical Association 2, no. 2: 14. https://doi.org/10.3390/joma2020014
APA StyleAhmed, N. T. B., Al Abri, R. K. S., & Jaju, D. (2025). Prevalence of Dizziness, Tinnitus and Headache Among COVID-19 Patients at Sultan Qaboos University Hospital, Muscat. Journal of the Oman Medical Association, 2(2), 14. https://doi.org/10.3390/joma2020014
