{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:13:53Z","timestamp":1788401633657,"version":"build-2803163510"},"reference-count":72,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Otologic adverse events (AEs) have been occasionally reported as sequalae of COVID-19 vaccination, although their incidence in comparison with that of preexisting vaccines with high uptake remains unclear. This study compared the rates of new-onset otologic AEs among matched adults receiving mRNA COVID-19 vaccination versus influenza vaccination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study used electronic health records (EHR) data from Stanford Health Care to identify adults aged 50\u201389\u202fyears with no history of otologic disorders prior to first Pfizer\/Moderna COVID-19 vaccine (December 2020\u2013January 2022) or any pre-pandemic influenza vaccine (January 2016\u2013December 2019). Patients were categorized by vaccination into FluVax or COVIDVax cohorts. A 90-day history pre-vaccination (baseline period) and \u22656\u202fmonths follow-up post-vaccination were required. Event rates of new-onset hearing loss (HL), sudden HL, tinnitus, vertigo\/dizziness, aural fullness, and otalgia in the 6\u202fmonths post-vaccination were compared between groups after high-dimensional propensity score (hdPS) matching. A sensitivity analysis was conducted among patients with no COVID-19 infection at any time. Odds ratios (ORs) were calculated using logistic regression for the hdPS matched cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After hdPS matching, 20,325 patients were included into the FluVax and COVIDVax cohorts, respectively (mean age: 65.5 and 65.2\u202fyears; 53.1 and 53.8% females). The rates of otologic AEs in the 6\u202fmonths post-vaccination were similarly low for the FluVax and COVIDVax cohorts: 1.16% vs. 1.16% for any HL, 0.01% vs. 0.02% for sudden HL, 0.41% vs. 0.47% for tinnitus, 1.96% vs. 1.59% for vertigo, 0.27% vs. 0.25% for otalgia, and 0.09% vs. 0.2% for aural fullness. COVIDVax patients had lower odds of vertigo [OR 95% CI: 0.81 (0.70, 0.94)] and higher odds of aural fullness [2.16 (1.25\u20133.72)] than the FluVax patients (both <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). The results of the sensitivity analysis limited to patients with no COVID-19 infection at any time (<jats:italic>N<\/jats:italic>\u202f=\u202f17,530 each cohort) were consistent with the primary results, but aural fullness was the only AE with statistically higher risk in the COVIDVax vs. FluVax cohort [OR (95% CI): 1.90 (1.09\u20133.31); <jats:italic>p<\/jats:italic>\u202f=\u202f0.021].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>New-onset otologic AEs were rare among a large cohort of hdPS-matched patients who received mRNA COVID-19 or pre-pandemic flu vaccination at a single institution. Although aural fullness was statistically more common in the COVIDVax vs. FluVax cohort, regardless of COVID-19 infection status, it remained extremely rare (&amp;lt;0.22%) in any cohort. These results indicate a similar otologic safety profile of the two vaccines, although future research is recommended in larger EHR databases to corroborate the findings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1637870","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T04:11:55Z","timestamp":1754539915000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of the rates of emergent otologic adverse events following mRNA COVID-19 versus influenza vaccination: a matched cohort 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