{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T22:06:21Z","timestamp":1776117981605,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Audiology Research"],"abstract":"<jats:p>Background: Numerous studies have demonstrated the beneficial effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on cardiovascular and renal outcomes in patients with heart failure and chronic kidney disease. However, whether SGLT2 inhibitors are also associated with a reduced risk of tinnitus has not been investigated. Objective: This study aimed to investigate the association between SGLT2 inhibitor therapy and the incidence of tinnitus in patients with type 2 diabetes. Methods: This retrospective cohort study was based on data from a nationally representative database of primary care practices in Germany from 2012 to 2023. Patients with type 2 diabetes who were treated with metformin and additionally received either an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP4) inhibitor were included. Patients with a previous diagnosis of tinnitus were excluded. The primary outcome was the first tinnitus diagnosis documented by a primary care physician. The SGLT2 and DPP4 cohorts were compared for tinnitus incidence using Kaplan\u2013Meier analysis and multivariable Cox regression. Results: 66,750 patients with SGLT2 inhibitors and 82,830 with DPP4 inhibitors were analyzed. The cumulative 5-year incidence of tinnitus was 1.9% in both groups. The multivariable regression analysis did not show a significant association between SGLT2 therapy and the occurrence of a tinnitus diagnosis (HR: 1.04; 95% CI: 0.89\u20131.21). Conclusion: There was no difference in tinnitus incidence between patients with SGLT2 or DPP4 inhibitors. The causes could lie in the heterogeneous, not purely vascular, etiology of tinnitus in general practitioners\u2019 practices. Future studies should include further clinical data, including confirmed hearing impairments.<\/jats:p>","DOI":"10.3390\/audiolres15040102","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T08:10:32Z","timestamp":1754899832000},"page":"102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between SGLT2 Inhibitor Therapy and the Incidence of Tinnitus in Patients with Type 2 Diabetes: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5193-2446","authenticated-orcid":false,"given":"David Ulrich","family":"Seidel","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Facial Plastic Surgery, Klinikum Oberberg, 51643 Gummersbach, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Bode","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Facial Plastic Surgery, Klinikum Oberberg, 51643 Gummersbach, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-7227","authenticated-orcid":false,"given":"Karel","family":"Kostev","sequence":"additional","affiliation":[{"name":"University Hospital, Philipps University, 35043 Marburg, Germany"},{"name":"Epidemiology, IQVIA, 60549 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1001\/jamaneurol.2022.2189","article-title":"Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta-analysis","volume":"79","author":"Jarach","year":"2022","journal-title":"JAMA Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1002\/ohn.599","article-title":"Association Between Hearing Loss and Cardiovascular Disease: A Meta-analysis","volume":"170","author":"Tan","year":"2024","journal-title":"Otolaryngol.-Head Neck Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1080\/00015385.2024.2324222","article-title":"The association between tinnitus and risk of cardiovascular events and all-cause mortality: Insight from the UK Biobank","volume":"79","author":"Zhang","year":"2024","journal-title":"Acta Cardiol."},{"key":"ref_4","first-page":"104611","article-title":"Systematic review and meta-analysis of the correlation between tinnitus and mental health","volume":"46","author":"Jiang","year":"2025","journal-title":"Am. J. Otolaryngol.-Head Neck Med. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1097\/MAO.0000000000003579","article-title":"Association between Tinnitus and Hypertension: A Cross-Sectional Analysis of the National Health and Nutrition Examination Survey","volume":"43","author":"Patel","year":"2022","journal-title":"Otol. Neurotol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s12070-015-0845-4","article-title":"Increased Atherosclerosis Correlates with Subjective Tinnitus Severity","volume":"70","year":"2018","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"156","DOI":"10.3349\/ymj.2022.0626","article-title":"The Association between Serum Lipid Levels and Tinnitus Prevalence and Severity in Korean Elderly: A Nationwide Population-Based Cross-Sectional Study","volume":"65","author":"Lee","year":"2024","journal-title":"Yonsei Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1097\/MAO.0000000000002161","article-title":"Risk Factors for Tinnitus in 37,692 Patients Followed in General Practices in Germany","volume":"40","author":"Kostev","year":"2019","journal-title":"Otol. Neurotol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s10162-022-00874-y","article-title":"Low Evidence for Tinnitus Risk Factors: A Systematic Review and Meta-analysis","volume":"24","author":"Biswas","year":"2023","journal-title":"JARO-J. Assoc. Res. Otolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00125-018-4766-0","article-title":"Type 2 diabetes and the risk of incident hearing loss","volume":"62","author":"Gupta","year":"2019","journal-title":"Diabetologia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/00129492-200305000-00006","article-title":"The effect of diabetes on sensorineural hearing loss","volume":"24","author":"Kakarlapudi","year":"2003","journal-title":"Otol. Neurotol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1007\/s00125-018-4670-7","article-title":"SGLT2 inhibitors and mechanisms of cardiovascular benefit: A state-of-the-art review","volume":"61","author":"Verma","year":"2018","journal-title":"Diabetologia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"618","DOI":"10.7326\/M23-1490","article-title":"Newer Pharmacologic Treatments in Adults with Type 2 Diabetes: A Systematic Review and Network Meta-analysis for the American College of Physicians","volume":"177","author":"Drake","year":"2024","journal-title":"Ann. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S2213-8587(19)30256-6","article-title":"SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: A systematic review and meta-analysis","volume":"7","author":"Neuen","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"F32","DOI":"10.1152\/ajprenal.00119.2025","article-title":"Gliflozins in Hypertension: Basic Mechanisms and Clinical Insights","volume":"329","author":"Rieg","year":"2025","journal-title":"Am. J. Physiol.-Ren. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"459","DOI":"10.5414\/CP203320","article-title":"Basic characteristics and representativeness of the German Disease Analyzer database","volume":"56","author":"Rathmann","year":"2018","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1093\/eurheartj\/eht462","article-title":"Depression and cardiovascular disease: A clinical review","volume":"35","author":"Hare","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"818533","DOI":"10.3389\/fneur.2022.818533","article-title":"Cerebral Small Vessel Disease in Elderly Patients with Vestibular Neuritis","volume":"13","author":"Oussoren","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.anorl.2022.01.002","article-title":"Prevalence of cardiovascular risk factors in superior vestibular neuritis: A cross-sectional study following STROBE guidelines","volume":"139","author":"Charpiot","year":"2022","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1177\/0003489417718846","article-title":"Cardiovascular Risk Factors among Patients with Vestibular Neuritis","volume":"126","author":"Oron","year":"2017","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Coronel-Touma, G.S., Monopoli-Roca, C., Almeida-Ayerve, C.N., Marcos-Alonso, S., G\u00f3mez de la Torre-Morales, D., Serradilla-L\u00f3pez, J., Cruz-Ruiz, S.S., Batuecas-Caletr\u00edo, \u00c1., and S\u00e1nchez-G\u00f3mez, H. (2023). Influence of Age and Cardiovascular Risk Factors in Vestibular Neuritis: Retrospective Cohort Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12206544"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/S0140-6736(20)31824-9","article-title":"SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: A meta-analysis of the EMPEROR-Reduced and DAPA-HF trials","volume":"396","author":"Zannad","year":"2020","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"14791641221098168","DOI":"10.1177\/14791641221098168","article-title":"The association between sodium-glucose cotransporter 2 inhibitors and incident dementia: A nationwide population-based longitudinal cohort study","volume":"19","author":"Siao","year":"2022","journal-title":"Diabetes Vasc. Dis. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e240946","DOI":"10.1001\/jamanetworkopen.2024.0946","article-title":"Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients with Diabetes and CKD","volume":"7","author":"Hu","year":"2024","journal-title":"JAMA Netw. 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