Long COVID and vertigo – What we know so far

Most people who contract Covid-19 will feel a lot better in a few weeks. However, it is thought that 1 in 10 people will go on to develop Long Covid. Long Covid is the presence of signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for 12 weeks or more and are not explained by an alternative diagnosis (NICE, 2020). There is an extensive list of symptoms associated with Long Covid. Included in this list is vertigo or dizziness.


We know symptoms like vertigo and dizziness are associated with several viral infections (Cohen et al, 2014). The mechanisms behind why someone may experience these symptoms following an infection of COVID 19 is not fully understood. It is thought to be because of a few processes. One study has shown that the inner ear contains receptors that are necessary for the COVID 19 virus to affect the inner ear (Jeong et al, 2021).  This suggests that the virus can directly cause damage to the inner ear leading to symptoms.  Another explanation that has been posited is that the inner ear can become damaged because of blockages in the tiny blood vessels around the inner ear due to the increased tendency for the blood to form clots that is often seen in patients with COVID-19 (Smadj et al, 2021).

A recent study in Germany collected data from 1,082 participants aged 18 years and over with symptoms more than 4 weeks after being infected with COVID-19, confirmed by either a PCR, antibody, or antigen test (Cohen et al, 2022).  They were asked what symptoms they had experienced since they were infected with COVID-19 and how severe the symptoms were.  60% of the participants suffered from some degree of vertigo or dizziness.  24.6% of the participants also suffered from tinnitus. The participants were asked to mark the severity of their symptoms out of 10 where 0 represents the absence of symptoms.  The average self-reported severity of symptoms for vertigo and dizziness was 4.6 and 20% of patients reported their symptom severity as 8 or higher.  In a survey conducted of 5,163 COVID survivors, 37.6% of Long COVID patients reported dizziness for an average of 80 days (Lambert et al, 2021).

There is still a lot of research to be done in this area. For example, it has not been determined whether receiving vaccinations before the infection affects the likelihood of developing Long COVID symptoms. It is also unknown whether different variants of the virus will differ in terms of what symptoms patients will experience. This is particularly difficult to ascertain as most people do not receive any information on what variant they are detected with.

In terms of my practice, the high prevalence of vertigo in patients who have been infected with COVID-19 means that this is something that I expect to start seeing more frequently in the clinic as the rates of infection again start to rise.

If you are noticing any symptoms of vertigo having previously had Covid-19, contact Lee Chambers our specialist physio in treating patients with dizziness, vertigo and balance disorders.

• National Institute for Health and Care Excellence. (2020). COVID-19 rapid guideline: managing the longterm effects of COVID-19
• Degen CV, Mikuteit M, Niewolik J, Schröder D, Vahldiek K, Mücke U, Heinemann S, Müller F, Behrens GMN, Klawonn F, Dopfer-Jablonka A and Steffens S (2022) Self-reported Tinnitus and Vertigo or Dizziness in a Cohort of Adult Long COVID Patients. Front. Neurol. 13:884002. doi: 10.3389/fneur.2022.884002
• Cohen BE, Durstenfeld A, Roehm PC. Viral causes of hearing loss: a review for hearing health professionals. Trends Hear. (2014) 1:18. doi: 10.1177/2331216514541361. 
• Jeong M, Ocwieja KE, Han D, Wackym PA, Zhang Y, Brown A, et al. Direct SARS-CoV-2 infection of the human inner ear may underlie COVID19-associated audiovestibular dysfunction. Commun Med. (2021) 1:44. doi: 10.1038/s43856-021-00044-w.
• Smadja DM, Mentzer SJ, Fontenay M, Laffan MA, Ackermann M, Helms J, et al. COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects. Angiogenesis. (2021) 24:755–88. doi: 10.1007/s10456-021-09805-6.
• Lambert N, Corps S, El-Azab SA, Ramrakhiani NS, Barisano A, Yu L, et al. COVID-19 survivors’ reports of the timing, duration, and health impacts of Post-Acute Sequelae of SARS-CoV-2 (PASC) infection. medRxiv. (2021)