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Cited by 2Vestibular and auditory disordersHearing, Cochlea, Tinnitus, GeneticsHearing Loss and Rehabilitation

Acute Respiratory Tract Infection and Sudden Sensorineural Hearing Loss: A Multinational Cohort Study

Open access
Weng, Chien-Hsiang, Lin, Jun-Fu, Wang, Jing-Jie·2025·Diagnostics
DOI 10.3390/diagnostics15121462PMC PMC12191787
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Abstract

Background/Objectives: Sudden sensorineural hearing loss (SSNHL) is an acute condition with unclear etiology, commonly hypothesized to be associated with viral infections. Acute respiratory tract infections (RTIs), particularly those of viral origin, have been implicated in SSNHL through proposed mechanisms such as cochlear invasion and immune-mediated damage. However, robust large-scale epidemiological evidence examining this association remains limited. This study aimed to investigate the potential association between acute RTIs and subsequent risk of developing SSNHL across diverse populations. Methods: We conducted a multinational retrospective cohort study using data from the TriNetX Global Collaborative Network. Adults diagnosed with acute RTIs between 1 January 2012 and 30 June 2023 were compared to matched controls without RTI exposure. Patients with predisposing conditions for SSNHL were excluded. Propensity score matching (1:1) was performed by age and sex. SSNHL diagnoses within 60 days post index were analyzed using Cox proportional hazards models. Subgroup and sensitivity analyses were conducted by race, sex, and age strata. Results: Among 37 million patients analyzed, individuals with acute RTIs had a lower incidence of SSNHL compared to matched controls. Hazard ratios (HRs) for SSNHL were significantly reduced across all racial groups: Whites (HR: 0.572), Blacks (HR: 0.563), and Asians (HR: 0.409). Subgroup analyses revealed stronger inverse associations in males and younger age groups, particularly those aged 18–25 years. Conclusions: Contrary to prior assumptions, acute RTIs were associated with a lower incidence of SSNHL in a large, diverse cohort. While the findings raise the possibility of immunological or physiological factors influencing this association, the results should be interpreted with caution due to unmeasured confounding and the observational nature of the study.

AI snapshot

Written from the paper’s full text.

TL;DR

In a multinational retrospective cohort of 37,157,115 adults in the TriNetX Global Collaborative Network, acute respiratory tract infections were associated with a lower, not higher, incidence of sudden sensorineural hearing loss (SSNHL) within 60 days. The authors interpret the inverse association as hypothesis-generating, given unmeasured confounding and the observational design.

Key findings

  • Across all racial groups, RTI exposure was associated with significantly reduced SSNHL risk after 1:1 propensity score matching: Whites HR 0.572 (95% CI 0.527–0.620; 954 vs. 1534 cases), Blacks HR 0.563 (95% CI 0.446–0.710; 115 vs. 186 cases), Asians HR 0.409 (95% CI 0.289–0.578; 46 vs. 105 cases), all p < 0.001.
  • Incidence rates per 100,000 during follow-up: Whites 16.4 (RTI) vs. 26.4 (control); Blacks 8.6 vs. 14.0; Asians 12.4 vs. 28.2.
  • Sex-stratified analyses showed stronger inverse associations in males: Whites male HR 0.553 (0.484–0.632) vs. female 0.738 (0.653–0.835); Asians male HR 0.317 (0.165–0.608) vs. female 0.643 (0.365–1.132, nonsignificant). Among Blacks, male HR 0.642 (0.386–1.070) and female HR 1.284 (0.854–1.929) were both nonsignificant.
  • Age-stratified analyses showed the strongest inverse association at ages 18–25 (Whites HR 0.348, 95% CI 0.256–0.473) and weaker or nonsignificant associations at ≥66 years (e.g., Blacks HR 2.460, 95% CI 0.867–6.984).
  • E-value sensitivity analysis: E-values of 2.89 (Whites), 2.95 (Blacks), and 4.32 (Asians), indicating an unmeasured confounder would need risk ratios of that magnitude with both exposure and outcome to explain away the findings.
  • Note: the Discussion reports different HRs (Caucasians 0.623, African Americans 0.619, Asians 0.439) than the Results/Table 2 (0.572, 0.563, 0.409); the text does not reconcile this discrepancy.

Methods

  • Retrospective multinational cohort using the TriNetX Global Collaborative Network (66 healthcare organizations; data accessed 10 July 2024). Adults ≥18 years with ambulatory ICD-10-CM diagnoses of acute RTI between 1 January 2012 and 30 June 2023 were compared with matched controls without RTI; patients with prior ear diseases (otitis media, otosclerosis, BPPV, cranial nerve neoplasms, tinnitus) and metabolic comorbidities (hypertension, diabetes, dyslipidemia) were excluded.
  • Primary outcome was incident SSNHL (ICD-10-CM H90.4, H90.5, H91.2, H91.8X1, H91.8X2) within 60 days of the index date. Analyses were run separately by self-reported race (Whites, Blacks, Asians) due to computational constraints.
  • 1:1 propensity score matching without replacement on age (continuous) and sex (binary), nearest-neighbor with caliper 0.1 SD of the logit; balance assessed by SMD < 0.1. Cox proportional hazards models estimated HRs and 95% CIs, with prespecified subgroup analyses by sex and age (18–25, 26–65, ≥66) and interaction terms; sensitivity analyses varied caliper widths and adjusted for healthcare utilization. Analyses in R 4.2.1 and SAS 9.4.

Limitations

  • Stated by the authors: no stratification by RTI severity or pathogen; no data on RTI treatments (antibiotics, antivirals, corticosteroids) that could independently affect SSNHL risk; COVID-19-related RTIs were not analyzed separately; the 60-day follow-up may miss delayed SSNHL; residual unmeasured confounding (genetic susceptibility, environmental/occupational noise exposure) and possible healthcare-seeking/surveillance bias; findings are hypothesis-generating rather than conclusive.
  • Evident from the text: propensity score matching was limited to age and sex because multivariable logistic regression was not feasible at data extraction, leaving substantial residual confounding; the Discussion's HRs differ from those in the Results and Table 2; several subgroup estimates rest on very small case counts (≤10 in some cells), producing wide and nonsignificant confidence intervals.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/diagnostics15121462

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 6 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation
    § 1. Introduction · p. 2

    Large-scale epidemiological data on the association between acute RTIs and SSNHL are lacking.

    “These studies generally suggest an increased risk of SSNHL following viral infections, but their findings are inconsistent, and large-scale epidemiological data are lacking [8].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] De Luca, P., Scarpa, A., Ralli, M., Tassone, D., Simone, M., De Campora, L., Cassandro, C., and Di Stadio, A. (2021). Auditory Disturbances and SARS-CoV-2 Infection: Brain Inflammation or Cochlear Affection? Systematic Review and Discussion of Potential Pathogenesis. Front. Neurol., 12. source

      The Results (Study Characteristics; page unavailable) identify only 11 case reports and one case series concerning SSNHL in patients with SARS-CoV-2 infection. The Results (Limits of the Study; page unavailable) call the overall sample of 204 patients small and note weaknesses in the study designs. This supports a lack of large-scale evidence for SARS-CoV-2, but the review does not establish that epidemiological data are lacking for acute respiratory tract infections generally. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Study design and conductown data
    § 4.2. Confounding Factors and Unaddressed Variables · p. 9

    The study conducted an E-value analysis to assess robustness to unmeasured confounding.

    “To further assess the robustness of our findings to potential unmeasured confounding, we conducted an E-value analysis, a quantitative method for sensitivity analysis in observational research [31].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] VanderWeele, 2017, Sensitivity Analysis in Observational Research: Introducing the E-Value, Ann Intern Med source
  • Premisecitation
    § 1. Introduction · p. 2

    Previous investigations into the association between acute RTIs and SSNHL have largely been limited to case reports, small cohort studies, or single-center experiences, often without adequate control for confounding factors.

    “Previous investigations into the association between acute RTIs and SSNHL have largely been limited to case reports, small cohort studies, or single-center experiences, often without adequate control for confounding factors.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] De Luca, P., Scarpa, A., Ralli, M., Tassone, D., Simone, M., De Campora, L., Cassandro, C., and Di Stadio, A. (2021). Auditory Disturbances and SARS-CoV-2 Infection: Brain Inflammation or Cochlear Affection? Systematic Review and Discussion of Potential Pathogenesis. Front. Neurol., 12. source

      The Results (Study Characteristics; page unavailable) identify 11 case reports and one case series on SSNHL in patients with SARS-CoV-2 infection. The Limits of the Study section (page unavailable) also notes small samples, uncontrolled designs, and insufficient detail about control groups. The review does not establish that these limitations characterize investigations of acute respiratory tract infections generally, or that the studies were predominantly single-center. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Findingown data
    § 4. Discussion · p. 7

    The hazard ratio for SSNHL was 0.623 (95% CI: 0.574-0.675) in Caucasians.

    “The hazard ratio (HR) for SSNHL was 0.623 (95% CI: 0.574-0.675) in Caucasians”
    Quote in the paperSubstantial claim
  • Findingown data
    § Acute Respiratory Tract Infection and Sudden Sensorineural Hearing Loss: A Multinational Cohort Study · p. 1

    Among Whites, the hazard ratio for SSNHL associated with acute RTI exposure was 0.572 (95% CI: 0.527-0.620).

    “Whites (HR: 0.572)”
    • Also stated in: § 3. Results · p. 5 · plain
      “The hazard ratio (HR) was 0.572 (95% CI: 0.527-0.620).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.
  • Classified as probably not a substantial claim. 24
  • May combine two claims. 15

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 1. Introduction · p. 2

    Acute respiratory tract infections are predominantly viral in origin.

    “Acute respiratory tract infections (RTIs), which include both upper and lower respiratory tract illnesses, are among the most common infectious diseases worldwide and are predominantly viral in origin. Pathogens such as influenza, respiratory syncytial virus (RSV), rhinovirus, and coronaviruses are frequent culprits [6].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Chen, 2019, Role of viral infection in sudden hearing loss, J. Int. Med. Res. source

      The Introduction and Abstract discuss viral infection as a possible cause of sudden sensorineural hearing loss, not the causes of acute respiratory tract infections. Searches for respiratory tract infections and the named respiratory viruses found no passage establishing that RTIs are predominantly viral. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data
    § 3. Results · p. 6

    In Whites, male patients had an HR of 0.553 (95% CI: 0.484-0.632), compared to 0.738 (95% CI: 0.653-0.835) among females.

    “In Whites, male patients had an HR of 0.553 (95% CI: 0.484-0.632), compared to 0.738 (95% CI: 0.653-0.835) among females.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 3. Results · p. 5

    A total of 37,157,115 patients were included for analysis: 29,068,910 Caucasians, 6,083,378 African Americans or Blacks, and 2,004,827 Asians.

    “A total of 37,157,115 patients were included for analysis: 29,068,910 Caucasians, 6,083,378 African Americans or Blacks, and 2,004,827 Asians.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • May combine two claims.

    Findingown data
    § 3. Results · p. 6

    Among Blacks, male patients had an HR of 0.642 (95% CI: 0.386-1.070), and Black females had an HR of 1.284 (95% CI: 0.854-1.929).

    “Among Blacks, male patients had an HR of 0.642 (95% CI: 0.386-1.070), although the confidence interval crossed 1, indicating a lack of statistical significance; for Black females, the HR was 1.284 (95% CI: 0.854-1.929), suggesting no protective effect (Table 2).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • May combine two claims.

    Findingown data
    § 4. Discussion · p. 7

    Older individuals (≥ 66 years) exhibited less variation in SSNHL incidence, with some estimates being non-significant, particularly in Black patients.

    “older individuals ( ≥ 66 years) exhibited less variation in SSNHL incidence, with some estimates being non-significant, particularly in Black patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 3. Results · p. 6

    In Asians, males had an HR of 0.317 (95% CI: 0.165-0.608), while females showed a nonsignificant HR of 0.643 (95% CI: 0.365-1.132).

    “In Asians, males had an HR of 0.317 (95% CI: 0.165-0.608), while females showed a nonsignificant HR of 0.643 (95% CI: 0.365-1.132).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • May combine two claims.

    Findingown data
    § 3. Results · p. 5

    The incidence rate of SSNHL during follow-up was lower in the RTI group than in controls for Whites (16.4 vs 26.4 per 100,000), Blacks (8.6 vs 14.0 per 100,000), and Asians (12.4 vs 28.2 per 100,000).

    “When expressed as incidence rates, the SSNHL rate among Whites with RTI was approximately 16.4 per 100,000 during the follow-up period, compared to 26.4 per 100,000 in controls. Similar trends were seen among Blacks (RTI group: 8.6 per 100,000 vs. control group: 14.0 per 100,000) and Asians (RTI group: 12.4 per 100,000 vs. control group: 28.2 per 100,000) (Table 2).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • May combine two claims.

    Findingown data
    § 4.2. Confounding Factors and Unaddressed Variables · p. 9

    Among White patients, the observed HR for SSNHL associated with acute RTI was 0.572, yielding an E-value of 2.89.

    “among White patients, the observed HR for SSNHL associated with acute RTI was 0.572, yielding an E-value of 2.89.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning
    § 4. Discussion · p. 8

    Demographic factors, immune responses, and possibly genetic predisposition may play a significant role in SSNHL susceptibility.

    “These findings suggest that demographic factors, immune responses, and possibly genetic predisposition may play a significant role in SSNHL susceptibility.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § 3. Results · p. 6

    The inverse association between RTI and SSNHL appears strongest among younger individuals, particularly in White patients, and is less evident among older populations.

    “Thus, the inverse association between RTI and SSNHL appears strongest among younger individuals, particularly in White patients, and is less evident among older populations.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § 4.2. Confounding Factors and Unaddressed Variables · p. 9

    The study did not differentiate COVID-19-related RTIs.

    “In our study, we did not differentiate COVID-19-related RTIs”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 1. Introduction · p. 2

    Herpes simplex virus, cytomegalovirus, and influenza viruses are suspected of direct cochlear invasion or immune-mediated cochlear damage.

    “Herpes simplex virus, cytomegalovirus, and influenza viruses are among the agents suspected of direct cochlear invasion or immune-mediated cochlear damage [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Schreiber, 2010, Sudden sensorineural hearing loss, Lancet source

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § 3. Results · p. 7

    All results were calculated after propensity score matching.

    “All results were calculated after propensity score matching.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning
    § 2.2. Patient and Data Selection · p. 3

    Multivariable logistic regression modeling was not feasible at the data extraction stage due to extensive sample size and platform limitations, so propensity score matching based on limited demographic covariates was employed.

    “Given the extensive sample size and platform limitations, multivariable logistic regression modeling was not feasible at the data extraction stage. Therefore, propensity score matching (PSM) based on limited but critical demographic covariates was employed in subsequent analyses.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § 2.5. Statistical Analyses · p. 5

    Sensitivity analyses were performed including restriction to patients without prior otologic diagnoses, alternative PSM strategies, and adjustment for healthcare utilization frequency.

    “Sensitivity analyses were performed, which included (1) restricting the analysis to patients without prior otologic diagnoses beyond those already excluded, (2) applying alternative PSM strategies with variable caliper widths, and (3) adjusting for healthcare utilization frequency in the sensitivity Cox models.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § 2.5. Statistical Analyses · p. 5

    Subgroup analyses were prespecified and interaction terms were used to formally test for heterogeneity across subgroups.

    “Prespecified subgroup analyses stratified by sex and age category (18-25 years, 26-65 years, ≥ 66 years) were conducted to assess potential effect modification. Interaction terms were incorporated into Cox models to formally test for heterogeneity across subgroups.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 1. Introduction · p. 2

    Viral infections have long been considered a key factor in SSNHL.

    “Among the hypothesized causes, viral infections have long been considered a key factor.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Schreiber, 2010, Sudden sensorineural hearing loss, Lancet source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § 4.2. Confounding Factors and Unaddressed Variables · p. 8

    The study did not stratify by RTI severity.

    “One notable limitation is the lack of stratification based on RTI severity.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning
    § 2.4. Sudden Sensorineural Hearing Loss (SSNHL) · p. 3

    Patients with a documented SSNHL diagnosis prior to the index date or within the baseline period were excluded to ensure incident cases only.

    “Patients with a documented SSNHL diagnosis prior to the index date or within the baseline period were excluded to ensure incident cases only (Figure 1).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § 4.2. Confounding Factors and Unaddressed Variables · p. 9

    The follow-up window was relatively short (60 days post RTI).

    “Another limitation is the relatively short 60-day follow-up window post RTI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductreasoning
    § Acute Respiratory Tract Infection and Sudden Sensorineural Hearing Loss: A Multinational Cohort Study · p. 1

    The results should be interpreted with caution due to unmeasured confounding and the observational nature of the study.

    “While the findings raise the possibility of immunological or physiological factors influencing this association, the results should be interpreted with caution due to unmeasured confounding and the observational nature of the study.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning
    § 2.3. Acute Respiratory Tract Infections (RTIs) · p. 3

    Only ambulatory care RTI diagnoses were included to ensure consistent diagnostic settings and reduce misclassification with hospital-acquired infections.

    “Only diagnoses recorded during ambulatory care visits were included to ensure consistent diagnostic settings and reduce misclassification with hospital-acquired infections.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning
    § 2.1. Data Source · p. 2

    The global scope and diversity of the TriNetX network enhance the generalizability of findings across populations and care settings.

    “The global scope and diversity of the network enhance the generalizability of findings across populations and care settings.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data
    § 2.5. Statistical Analyses · p. 4

    Propensity score matching was used to address confounding by baseline demographics, and balance was assessed using standardized mean differences with SMD < 0.1 considered acceptable.

    “To address confounding by baseline demographics, 1:1 propensity score matching without replacement was conducted separately for each racial cohort. Age (continuous) and sex (binary) were used as covariates for matching. A nearest-neighbor matching algorithm with a caliper width of 0.1 standard deviations of the logit of the propensity score was employed to optimize matching precision. The balance”
    Quote in the paperSubstantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § 2.6. Ethical Considerations · p. 5

    The study qualified for exemption from IRB oversight because data were fully de-identified.

    “As all information accessed through the TriNetX platform is fully de-identified in accordance with Section §164.514(a) of the HIPAA Privacy Rule, and no protected health information (PHI) was accessed, this study qualifies for exemption from Institutional Review Board (IRB) oversight.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.

  • May combine two claims.

    Study design and conductown data
    § 3. Results · p. 5

    After 1:1 propensity score matching based on age and sex, balance between groups was achieved, with standardized mean differences below 0.1 for matching variables.

    “After 1:1 PSM based on age and sex, balance between groups was achieved, with standardized mean differences below 0.1 for matching variables (Table 1).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § 2.4. Sudden Sensorineural Hearing Loss (SSNHL) · p. 3

    The 60-day follow-up window was selected to capture both immediate and subacute SSNHL presentations while limiting potential confounding from unrelated events occurring long after RTI exposure.

    “The 60-day follow-up window was selected to capture both immediate and subacute SSNHLpresentations while limiting potential confounding from unrelated events occurring long after RTI exposure.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § 2.5. Statistical Analyses · p. 4

    The proportional hazards assumption was tested through Schoenfeld residuals and inspection of log-minus-log plots.

    “The proportional hazards assumption was tested through Schoenfeld residuals and inspection of log-minus-log plots.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning
    § 2.3. Acute Respiratory Tract Infections (RTIs) · p. 3

    Control index dates were randomly assigned based on healthcare encounter dates to mirror the temporal distribution of RTI index dates, minimizing biases related to healthcare utilization patterns.

    “Index dates for the control group were randomly assigned based on healthcare encounter dates to mirror the temporal distribution of index dates in the RTI group, minimizing potential biases related to healthcare utilization patterns.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § 4.2. Confounding Factors and Unaddressed Variables · p. 9

    The study did not measure the impact of treatments for RTIs.

    “Another unmeasured factor is the impact of treatments for RTIs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § 4.2. Confounding Factors and Unaddressed Variables · p. 9

    The study did not account for genetic susceptibility.

    “We also acknowledge that genetic susceptibility might contribute to variations in SSNHL risk across racial groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § 5. Conclusions · p. 10

    Informed consent was exempt because the study was a retrospective secondary analysis of de-identified data.

    “This retrospective study is exempt from informed consent as it involves a secondary analysis of existing data without intervention or interaction with human subjects, and all data are de-identified per the de-identification standard outlined in Section §164.514(a) of the HIPAA Privacy Rule.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning
    § 5. Conclusions · p. 10

    IRB review was not required because the data were de-identified and HIPAA-compliant.

    “As the data comply with HIPAA standards and pose no risk of disclosure, review by an Institutional Review Board (IRB) was not required.”
    Quote in the paperNot a substantial claim
33 of 33

  • The paper relies on this without support.

    Prior research has rarely addressed potential demographic modifiers such as age, sex, and race in the association between acute RTIs and SSNHL.

    “Furthermore, prior research has rarely addressed potential demographic modifiers, such as age, sex, and race, which could influence SSNHL risk and immune responses to infections.”

  • The paper relies on this without support.

    TriNetX data undergo rigorous quality control processes ensuring accuracy and consistency.

    “TriNetX aggregates de-identified clinical data directly from HCOs' electronic health records (EHRs) and undergoes rigorous quality control processes, including data completeness, standardization, and validity assessments to ensure accuracy and consistency.”

  • The paper relies on this without support.

    ICD-10-CM diagnostic codes accurately identify acute RTIs and SSNHL cases.

    “Patients with documented diagnoses of acute RTIs between 1 January 2012 and 30 June 2023 were identified using ICD-10-CM diagnostic codes indicative of viral and bacterial respiratory infections (B00, B01, B02.21, B05, B20, B25, B26, J01-J06, J09-J18, U07.1, U09.9, Z20.822, Z11.52, Z86.16) (Supplement Table S2).”
    “SSNHL events were identified using ICD-10-CM codes H90.4, H90.5, H91.2, H91.8X1, and H91.8X2.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Discussion changes the White hazard ratio

    Major

    The Discussion gives a White/Caucasian HR of 0.623, whereas the Results and Table 2 give 0.572 for the overall matched cohort.

  • Discussion changes the Black hazard ratio

    Major

    The Discussion gives a Black/African American HR of 0.619, whereas the Results give 0.563 for the overall matched cohort.

  • White control cases do not sum across sexes

    Major

    The White control total is 1534 hearing-loss cases, while its female and male rows sum to 573 + 581 = 1154.

    Reported 1534 · recomputed 1154

  • White RTI cases do not sum across sexes

    Major

    Table 2 reports 954 hearing-loss cases among White RTI patients, but its female and male rows report only 454 + 340 = 794.

    Reported 954 · recomputed 794

  • Discussion changes the Asian hazard ratio

    Major

    The Discussion gives an Asian HR of 0.439, whereas the Results and Table 2 give 0.409 for the overall matched cohort.

5 of 5

Cites

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Authors
Weng, C.-H., Lin, J.-F., & Wang, J.-J.
Affiliations
  • Brown University (US)
  • Taichung Veterans General Hospital (TW)
  • National Yang Ming Chiao Tung University (TW)
Corresponding author
Wang, Jing-Jie
ORCID
Venue
Diagnostics
Publisher
MDPI AG
Published
2025-06-09
Volume
15
Issue
12
Pages
1462
ISSN
2075-4418 (ISSN-L)
DOI
10.3390/diagnostics15121462
PMC
PMC12191787
OpenAlex
W4411158168
Semantic Scholar
fe88b8fdab80fac6e2436605ef75e5bf99372e3c
Cited by
2
References
34
Citations by year
2026: 1 · 2025: 1
FWCI
0.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Diagnostics (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
Keywords
sudden sensorineural hearing loss, acute respiratory infections, viral infection, racial differences, sex differences, age differences, TriNetX

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-22.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-22.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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