Periodontal Procedure Intensity and Incident Tinnitus in Korean Adults: A Nationwide Cohort Study.

Background and

Objectives

This study investigated the association between periodontal procedure intensity, serving as an indirect proxy for periodontal disease burden, and incident tinnitus in Korean adults. Materials and

Methods

Using the Korean National Health Insurance Service-National Health Screening Cohort (2002-2019), we included adults aged ≥40 years who had a diagnosis of periodontal disease (International Classification of Diseases, 10th Revision [ICD-10] code K05), had undergone relevant periodontal treatment, and had available health-screening data. Because direct clinical periodontal measures were unavailable, participants were classified according to treatment intensity into: a mild procedure group (scaling or root planing only) and a moderate-to-severe procedure group (subgingival curettage, extraction, periodontal flap surgery, bone grafting, or guided tissue regeneration). Incident tinnitus was defined as an ICD-10 H93.1 diagnosis recorded during two or more outpatient visits to a neurology or otolaryngology department to improve diagnostic specificity. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models adjusted for demographic, socioeconomic, cardiometabolic, and behavioral factors.

Results

Among 132,808 participants (76,844 mild; 55,964 moderate-to-severe), the incidence rate of tinnitus was higher in the moderate-to-severe group than in the mild group (4.38 vs. 3.87 per 1000 person-years). After adjustment, the moderate-to-severe group showed a significantly higher risk of tinnitus (HR 1.24, 95% CI 1.17-1.30). These associations were consistent across sex- and age-stratified analyses and in sensitivity analyses using stricter tinnitus definitions.

Conclusions

Greater periodontal procedure intensity was associated with a modestly higher incidence of tinnitus in this nationwide cohort. Because procedure intensity serves only as an indirect surrogate for periodontal disease burden, and because auditory confounders and short-term procedure-related factors were unavailable, causality and a specific inflammatory mechanism cannot be established. Further studies incorporating direct periodontal measurements, audiological data, and prespecified lag-time analyses are warranted to confirm these findings.