A Nationwide Population-Based Study for Audio-Vestibular Disorders following COVID-19 Infection

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.