Introduction: To date, no study has reported the various otologic conditions associated with coronavirus disease 2019 (COVID-19) using population-based design. The aim of this study was to investigate the incidence and risk of audio-vestibular disorders (benign paroxysmal positional vertigo, sudden sensorineural hearing loss, Meniere’s disease, vestibular neuritis, and tinnitus) increasing after COVID-19 infection. Methods: This retrospective population-based study was conducted using the National Health Insurance Service (NHIS)-COVID-19 cohort database of South Korea. We identified participants in the COVID-19 group using real-time reverse transcription-polymerase chain reaction tests. A matched cohort without COVID-19 was randomly selected in a 1:1 ratio. Benign paroxysmal positional vertigo, sudden sensorineural hearing loss, Meniere’s disease, vestibular neuritis, and tinnitus were defined using diagnostic, medication, and procedure codes. The incidence and risk of these disorders were assessed in both groups using univariate and multivariate Cox proportional hazard analyses. Results: In total, 4,976,589 COVID-19 patients and an equivalent number of matched non-infected controls were analyzed. COVID-19 patients faced an increased risk of developing benign paroxysmal positional vertigo, sudden sensorineural hearing loss, vestibular neuritis, and tinnitus compared to controls in univariate and multivariate Cox hazard analyses. COVID patients were at an increased risk of Meniere’s disease in the univariate analysis; however, the risk of Meniere’s disease after COVID-19 did not reach statistical significance in the multivariate analysis. Conclusion: COVID-19 infection may increase the risk of benign paroxysmal positional vertigo, sudden sensorineural hearing loss, vestibular neuritis, and tinnitus.

1.
Guan
W-J
,
Ni
Z-Y
,
Hu
Y
,
Liang
W-H
,
Ou
C-Q
,
He
J-X
, et al
.
Clinical characteristics of coronavirus disease 2019 in China
.
N Engl J Med
.
2020
;
382
(
18
):
1708
20
.
2.
Rezel-Potts
E
,
Douiri
A
,
Sun
X
,
Chowienczyk
PJ
,
Shah
AM
,
Gulliford
MC
.
Cardiometabolic outcomes up to 12 months after COVID-19 infection. A matched cohort study in the UK
.
PLoS Med
.
2022
;
19
(
7
):
e1004052
.
3.
Lim
SH
,
Ju
HJ
,
Han
JH
,
Lee
JH
,
Lee
W-S
,
Bae
JM
, et al
.
Autoimmune and autoinflammatory connective tissue disorders following COVID-19
.
JAMA Netw Open
.
2023
;
6
(
10
):
e2336120
20
.
4.
Martora
F
,
Villani
A
,
Fabbrocini
G
,
Battista
T
.
COVID-19 and cutaneous manifestations: a review of the published literature
.
J Cosmet Dermatol
.
2023
;
22
(
1
):
4
10
.
5.
Cohen
BE
,
Durstenfeld
A
,
Roehm
PC
.
Viral causes of hearing loss: a review for hearing health professionals
.
Trends Hear
.
2014
;
18
:
2331216514541361
.
6.
Marom
T
,
Pitaro
J
,
Shah
UK
,
Torretta
S
,
Marchisio
P
,
Kumar
AT
, et al
.
Otitis media practice during the COVID-19 pandemic
.
Front Cell Infect Microbiol
.
2021
;
11
:
749911
.
7.
Zhang
X
,
Chen
L
,
Guan
B
.
Clinical utility of inflammatory biomarkers in COVID-19-related sudden sensorineural hearing loss
.
Immun Inflamm Dis
.
2023
;
11
(
10
):
e1055
.
8.
Maslovara
S
,
Košec
A
.
Post-COVID-19 benign paroxysmal positional vertigo
.
Case Rep Med
.
2021
;
2021
:
9967555
4
.
9.
Picciotti
PM
,
Passali
GC
,
Sergi
B
,
De Corso
E
.
Benign Paroxysmal Positional Vertigo (BPPV) in COVID-19
.
Audiol Res
.
2021
;
11
(
3
):
418
22
.
10.
Doweck
I
,
Yanir
Y
,
Najjar-Debbiny
R
,
Shibli
R
,
Saliba
W
.
Sudden sensorineural hearing loss during the COVID-19 pandemic
.
JAMA Otolaryngol Head Neck Surg
.
2022
;
148
(
4
):
373
5
.
11.
Lovato
A
,
Frosolini
A
,
Marioni
G
,
de Filippis
C
.
Higher incidence of Ménière’s disease during COVID-19 pandemic: a preliminary report
.
Acta Otolaryngol
.
2021
;
141
(
10
):
921
4
.
12.
Chao
C-H
,
Young
Y-H
.
Evolution of incidence of audiovestibular disorders during the pandemic COVID-19 period
.
Eur Arch Otorhinolaryngol
.
2022
;
279
(
7
):
3341
5
.
13.
Lough
M
,
Almufarrij
I
,
Whiston
H
,
Munro
KJ
.
Revised meta-analysis and pooled estimate of audio-vestibular symptoms associated with COVID-19
.
Int J Audiol
.
2022
;
61
(
8
):
705
9
.
14.
Ong
KMC
,
Cruz
TLG
.
Otologic and vestibular symptoms in COVID-19: a scoping review
.
World J Otorhinolaryngol Head Neck Surg
.
2022
;
8
(
4
):
287
96
.
15.
Tan
M
,
Cengiz
DU
,
Demir
I
,
Demirel
S
,
Çolak
SC
,
Karakaş
O
, et al
.
Effects of Covid-19 on the audio-vestibular system
.
Am J Otolaryngol
.
2022
;
43
(
1
):
103173
.
16.
Jafari
Z
,
Kolb
BE
,
Mohajerani
MH
.
Hearing loss, tinnitus, and dizziness in COVID-19: a systematic review and meta-analysis
.
Can J Neurol Sci
.
2022
;
49
(
2
):
184
95
.
17.
Beukes
EW
,
Baguley
DM
,
Jacquemin
L
,
Lourenco
MP
,
Allen
PM
,
Onozuka
J
, et al
.
Changes in tinnitus experiences during the COVID-19 pandemic
.
Front Public Health
.
2020
;
8
:
592878
.
18.
Freni
F
,
Meduri
A
,
Gazia
F
,
Nicastro
V
,
Galletti
C
,
Aragona
P
, et al
.
Symptomatology in head and neck district in coronavirus disease (COVID-19): a possible neuroinvasive action of SARS-CoV-2
.
Am J Otolaryngol
.
2020
;
41
(
5
):
102612
.
19.
Dorney
I
,
Bobak
L
,
Otteson
T
,
Kaelber
DC
.
Prevalence of new-onset tinnitus after COVID-19 vaccination with comparison to other vaccinations
.
Laryngoscope
.
2023
;
133
(
7
):
1722
5
.
20.
Kyoung
D-S
,
Kim
H-S
.
Understanding and utilizing claim data from the Korean National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA) database for research
.
J Lipid Atheroscler
.
2022
;
11
(
2
):
103
10
.
21.
Cheol Seong
S
,
Kim
Y-Y
,
Khang
Y-H
,
Heon Park
J
,
Kang
H-J
,
Lee
H
, et al
.
Data resource profile: the national health information database of the National Health Insurance Service in South Korea
.
Int J Epidemiol
.
2017
;
46
(
3
):
799
800
.
22.
Jung
I
,
Kwon
H
,
Park
SE
,
Han
K-D
,
Park
Y-G
,
Kim
Y-H
, et al
.
Increased risk of cardiovascular disease and mortality in patients with diabetes and coexisting depression: a nationwide population-based cohort study
.
Diabetes Metab J
.
2021
;
45
(
3
):
379
89
.
23.
Byun
H
,
Chung
JH
,
Lee
SH
,
Park
CW
,
Kim
EM
,
Kim
I
.
Increased risk of benign paroxysmal positional vertigo in osteoporosis: a nationwide population-based cohort study
.
Sci Rep
.
2019
;
9
(
1
):
3469
.
24.
Kim
SK
,
Hong
SM
,
Park
I-S
,
Choi
HG
.
Association between migraine and benign paroxysmal positional vertigo among adults in South Korea
.
JAMA Otolaryngol Head Neck Surg
.
2019
;
145
(
4
):
307
12
.
25.
Ko
HY
,
Nam
HJ
,
Kim
MH
.
A nationwide population-based study for the recurrence and comorbidities in sudden sensorineural hearing loss
.
Laryngoscope
.
2024
;
134
(
3
):
1417
25
.
26.
Kim
MH
.
Population-based study for the comorbidities and associated factors in Ménière’s disease
.
Sci Rep
.
2022
;
12
(
1
):
8266
.
27.
Seidel
DU
,
Park
JJ-H
,
Sesterhenn
AM
,
Kostev
K
.
Demographic data and seasonal variation in peripheral vestibular disorders in ENT practices in Germany
.
J Vestib Res
.
2019
;
29
(
4
):
181
90
.
28.
Kim
SY
,
Song
YS
,
Wee
JH
,
Min
C
,
Yoo
DM
,
Choi
HG
.
Association between Ménière’s disease and thyroid diseases: a nested case–control study
.
Sci Rep
.
2020
;
10
(
1
):
18224
.
29.
Lee
HM
,
Han
KD
,
Kong
SK
,
Nam
EC
,
Park
SN
,
Shim
HJ
, et al
.
Epidemiology of clinically significant tinnitus: a 10-year trend from nationwide health claims data in South Korea
.
Otol Neurotol
.
2018
;
39
(
6
):
680
7
.
30.
Lin
C-E
,
Chen
L-F
,
Chou
P-H
,
Chung
C-H
.
Increased prevalence and risk of anxiety disorders in adults with tinnitus: a population-based study in Taiwan
.
Gen Hosp Psychiatry
.
2018
;
50
:
131
6
.
31.
Zaubitzer
L
,
Ludwig
S
,
Berkemann
M
,
Walter
B
,
Jungbauer
F
,
Held
V
, et al
.
The effects of COVID-19 on the vestibular system
.
Front Neurol
.
2023
;
14
:
1134540
.
32.
Pazdro-Zastawny
K
,
Dorobisz
K
,
Misiak
P
,
Kruk-Krzemień
A
,
Zatoński
T
.
Vestibular disorders in patients after COVID-19 infection
.
Front Neurol
.
2022
;
13
:
956515
.
33.
Gerb
J
,
Huppert
D
,
Becker-Bense
S
,
Zwergal
A
.
Vestibular syndromes after COVID-19 vaccination: a prospective cohort study
.
Eur J Neurol
.
2022
;
29
(
12
):
3693
700
.
34.
Reynard
P
,
Thai-Van
H
.
Drug-induced hearing loss: listening to the latest advances
.
Therapie
.
2024
;
79
(
2
):
283
95
.
35.
Picciotti
PM
,
Di Cesare
T
,
Tricarico
L
,
De Corso
E
,
Galli
J
,
Paludetti
G
.
Is drug consumption correlated with Benign Paroxysmal Positional Vertigo (BPPV) recurrence
.
Eur Arch Otorhinolaryngol
.
2020
;
277
(
6
):
1609
16
.
36.
Ciccone
MM
,
Cortese
F
,
Pinto
M
,
Di Teo
C
,
Fornarelli
F
,
Gesualdo
M
, et al
.
Endothelial function and cardiovascular risk in patients with idiopathic sudden sensorineural hearing loss
.
Atherosclerosis
.
2012
;
225
(
2
):
511
6
.
37.
Fiani
B
,
Covarrubias
C
,
Desai
A
,
Sekhon
M
,
Jarrah
R
.
A contemporary review of neurological sequelae of COVID-19
.
Front Neurol
.
2020
;
11
:
640
.
38.
Kim
J-Y
,
Lee
JW
,
Kim
M
,
Kim
MJ
,
Kim
D-K
.
Association of idiopathic sudden sensorineural hearing loss with affective disorders
.
JAMA Otolaryngol Head Neck Surg
.
2018
;
144
(
7
):
614
21
.
39.
Chae
H
,
Lee
HS
,
Lee
JH
,
Kim
M
,
Park
SY
,
Seo
YJ
.
Usefulness of stress-related hormones as predictors and prognostic factors for idiopathic sudden sensorineural hearing loss
.
Acta Otolaryngol
.
2021
;
141
(
7
):
695
701
.
40.
Park
S
,
Kim
MH
,
Choi
I
.
Autonomic nervous function in patients with sudden sensorineural hearing loss and its association with prognosis and disease severity
.
Audiol Neurootol
.
2021
;
26
(
5
):
303
9
.
41.
Jin
L
,
Fan
K
,
Tan
S
,
Liu
S
,
Wang
Y
,
Yu
S
.
Analysis of the characteristics of outpatient and emergency diseases in the department of otolaryngology during the “COVID-19” pandemic
.
Sci Prog
.
2021
;
104
(
3
):
00368504211036319
.
42.
Nondahl
DM
,
Cruickshanks
KJ
,
Wiley
TL
,
Klein
R
,
Klein
BE
,
Tweed
TS
.
Prevalence and 5-year incidence of tinnitus among older adults: the epidemiology of hearing loss study
.
J Am Acad Audiol
.
2002
;
13
(
06
):
323
31
.
43.
Jafari
Z
,
Kolb
BE
,
Mohajerani
MH
.
Age-related hearing loss and tinnitus, dementia risk, and auditory amplification outcomes
.
Ageing Res Rev
.
2019
;
56
:
100963
.
44.
Biehl
R
,
Boecking
B
,
Brueggemann
P
,
Grosse
R
,
Mazurek
B
.
Personality traits, perceived stress, and tinnitus-related distress in patients with chronic tinnitus: support for a vulnerability-stress model
.
Front Psychol
.
2019
;
10
:
3093
.
45.
Hackenberg
B
,
Döge
J
,
O’Brien
K
,
Bohnert
A
,
Lackner
KJ
,
Beutel
ME
, et al
.
Tinnitus and its relation to depression, anxiety, and stress: a population-based cohort study
.
J Clin Med
.
2023
;
12
(
3
):
1169
.
46.
Degen
CV
,
Mikuteit
M
,
Niewolik
J
,
Schröder
D
,
Vahldiek
K
,
Mücke
U
, et al
.
Self-reported tinnitus and vertigo or dizziness in a cohort of adult long COVID patients
.
Front Neurol
.
2022
;
13
:
884002
.
47.
Peng
K
,
Li
X
,
Yang
D
,
Chan
SC
,
Zhou
J
,
Wan
EY
, et al
.
Risk of autoimmune diseases following COVID-19 and the potential protective effect from vaccination: a population-based cohort study
.
EClinicalMedicine
.
2023
;
63
:
102154
.
48.
Oprea
Y
,
Ferastraoaru
D
.
Association between IgE levels and COVID-19 mortality
.
J Allergy Clin Immunol
.
2022
;
149
(
2
):
AB128
.
49.
Kim
SY
,
Song
YS
,
Wee
JH
,
Min
C
,
Yoo
DM
,
Choi
HG
.
Association between Meniere's disease and thyroid diseases: a nested case-control study
.
Sci Rep
.
2020
;
10
(
1
):
18224
.
50.
Moleon
M-D-C
,
Martinez-Gomez
E
,
Flook
M
,
Peralta-Leal
A
,
Gallego
JA
,
Sanchez-Gomez
H
, et al
.
Clinical and cytokine profile in patients with early and late onset Meniere disease
.
J Clin Med
.
2021
;
10
(
18
):
4052
.
51.
Thygesen
LC
,
Ersbøll AKJEjoe
.
When the entire population is the sample: strengths and limitations in register-based
.
Epidemiology
.
2014
;
29
(
8
):
551
8
.
You do not currently have access to this content.