Background: The directional nature of the link between anxiety and tinnitus has not been verified. COVID-19 has added stress to involved residents and provided a good opportunity to discover if anxiety/stress plays a causative/promotive role to tinnitus. Methods: A retrospective research design was used to compare the tinnitus clinics between the patients in 2020 under COVID-19 and those from the matching period in 2019. While anxiety was quantified using the Zung’s Self-rating Anxiety Scale (SAS), tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI) questionnaire and the test of minimum masking level (MML). The assessments were repeated after two months of therapy with sound therapy + educational counselling (STEC) or EC alone. Results: A large increase in anxiety was evident in 2020 in both case rate and SAS. The treatment of both methods was less effective in 2020. SAS, THI and MML were all deteriorated after the EC alone treatment in 2020, while an improvement was seen in 2019. Discussion: The differences between years and between treatment methods suggest that EC alone could not counteract the stress by COVID-19 at all, and the stress, if not managed well, can significantly increase the severity of tinnitus and associated anxiety.Conclusions: By using the EC subgroup in virtual control, we conclude that anxiety can serve as a promoting factor to tinnitus. We believe that this is the first study report that confirm the causative/promotive role of anxiety on tinnitus