Auditory complications of COVID-19 infection and vaccination: a TriNetX retrospective cohort study

PURPOSE: To assess the incidence of new-onset tinnitus and hearing loss following COVID-19 infection or vaccination using a large, real-world electronic health record database. METHODS: A retrospective cohort study utilizing the TriNetX Global Collaborative Network (180 + million records). Adults without prior tinnitus or hearing loss were grouped by exposure: COVID-19 infection, mRNA vaccination, viral vector vaccination, and unexposed controls. Outcomes included tinnitus (ICD-10-CM: H93.1) and hearing loss (ICD-10-CM: H90) within six months post-index. Propensity score matching controlled for confounding and odds ratios (ORs) were calculated. RESULTS: mRNA vaccination was associated with increased odds of tinnitus (OR 1.220; 95% CI: 1.189-1.252) and hearing loss (OR 1.214; 95% CI: 1.189-1.240), with small absolute risk differences (0.143% and 0.215%, respectively; p < 0.0001). Viral vector vaccination showed increased tinnitus odds (OR 1.269; 95% CI: 1.114-1.447) but not hearing loss. COVID-19 infection was not associated with tinnitus (OR 1.022; 95% CI: 0.997-1.048) and showed modestly reduced odds of hearing loss (OR 0.930; 95% CI: 0.911-0.950) versus controls. Compared directly, infection conferred lower tinnitus odds and higher hearing loss odds than mRNA vaccination ([OR 0.856; 95% CI: 0.833-0.879] and [OR 1.313; 95% CI: 1.285-1.343], respectively). CONCLUSION: COVID-19 infection was not associated with tinnitus or hearing loss. mRNA and viral vector vaccines showed small but significant increases in new-onset tinnitus, with mRNA vaccines also associated with hearing loss. While absolute risks remained low, findings support continued surveillance and research to inform counseling and promote understanding of potential otologic effects.