Sudden Hearing Loss Following Vaccination Against COVID-19

Abstract

Importance: Spontaneous adverse reaction reports of sudden hearing loss have been observed, and a population-based cohort study conducted in Israel showed an increase in the incidence of sudden sensorineural hearing loss (SSNHL) following vaccination with messenger RNA COVID-19 vaccine BNT162b2 (Pfizer-BioNTech). However, in this setting, the possibility of confounding remained.

Objective: To assess a potential association between COVID-19 vaccinations and SSNHL.

Design, setting, and participants: This register-based country-wide retrospective cohort study of 5.5 million Finnish residents was conducted from January 1, 2019, to April 20, 2022, and included all individuals who were identified from the population information system who were alive or born during the study period except individuals who had SSNHL during 2015 to 2018 according to specialized care derived diagnosis codes for SSNHL (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code H91.2) as a primary or secondary diagnosis.

Exposures: The a priori primary risk period was 0 to 54 days following each COVID-19 vaccination. The risk periods for different vaccine doses did not overlap so that a later vaccine exposure ended the previous risk period. The secondary risk period was from 55 days following each COVID-19 vaccination until a subsequent COVID-19 vaccination. A secondary analysis included a risk time from 0 to 54 days following a positive polymerase chain reaction test result for SARS-CoV-2.

Main outcomes and measures: The incidences of SSNHL following COVID-19 vaccination were compared with the incidences before the COVID-19 epidemic in Finland. The Poisson regression model included calendar time, age, sex, diabetes, cardiovascular disease, other chronic diseases, and the number of visits in primary health care.

Results: For the 5.5 million Finnish residents included in the study, the comparison time comprised 6.5 million person-years, the primary risk time of 1.7 million person-years, and the secondary risk time of 2.1 million person-years. Before the COVID-19 epidemic in Finland, 18.7/100 000 people received a diagnosis of SSNHL annually. The study data suggested no increased risk for SSNHL following any COVID-19 vaccination. In particular, adjusted incidence rate ratios with 95% confidence intervals for the BNT162b2 vaccine's 3 doses were 0.8 (95% CI, 0.6-1.0), 0.9 (95% CI, 0.6-1.2), and 1.0 (95% CI, 0.7-1.4), respectively. There was no association between SARS-CoV-2 infection and an increased incidence of SSNHL.

Conclusions and relevance: The results of this cohort study show no evidence of an increased risk of SSNHL following COVID-19 vaccination. The study accounted for previous disease and other potential confounding factors. These results are based on diagnosis codes in specialized care but still need to be verified in settings that are capable of evaluating the degree of hearing loss.

Figure 1.. Incidence of Sudden Sensorineural Hearing Loss Before and During the Study Period in Finland

Incidence per 100 000 person-years of sudden sensorineural hearing loss in specialized care by calendar month. Vertical whiskers indicate 95% CIs, assuming a Poisson distribution of the monthly counts. The follow-up for the current study started January 1, 2019, and the epidemic in Finland started in March 2020.

Figure 2.. Incidence of Sudden Sensorineural Hearing Loss and Time from Dose of COVID-19 Vaccines

Incidence per 100 000 person-years of sudden sensorineural hearing loss in specialized care by days from the vaccinations. An individual case may be represented in adjacent panels if interdose interval was fewer than 100 days. The primary risk time, 0 to 54 days from a vaccine dose, is in orange, with other periods in blue. The numbers 1 to 3 indicate vaccine dose number. AZD indicates ChAdOx1, ChAdOx-1 S (recombinant), Vaxzevria, adenoviral vector vaccine, AstraZeneca; BNT, BNT162b2, Comirnaty, messenger RNA (mRNA) vaccine, BioNTech/Pfizer; MOD, mRNA.1273, Spikevax, mRNA vaccine, Moderna.