SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Viral Immunology
Relationship Between COVID-19 and "Three Inflammations and One Deafness": A Systematic Review and Meta-Analysis
Provisionally accepted
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Background The relationship between "three inflammations and one deafness" (allergic rhinitis, pharyngitis, otitis media, tinnitus and deafness) and coronavirus disease 2019 (COVID-19) is currently unclear. This study aims to investigate the correlation. Methods We searched the relevant literature of the three databases (Embase, Cochrane Library, and PubMed) from the establishment to July 2024, which was strictly reviewed by the investigator according to the screening criteria to determine the included literature. We extracted relevant data information and conducted the quality assessment and meta-analysis. Results From 5,950 records screened, five cohort studies were included. The pooled analysis using a random-effects model showed no statistically significant association between COVID-19 and "three inflammations and one deafness" (OR=1.03, 95%CI: 0.85-1.26, P=0.74), with substantial heterogeneity (I²=89%, P<0.001). Critically, subgroup analyses revealed that the diagnostic criteria for "three inflammations and one deafness" were a key source of this heterogeneity. A significant association was observed in studies using physician-diagnosed outcomes (OR=1.30, 95% CI: 1.08-1.56, P=0.006, I²=0%), whereas no significant association was found in studies based on self-reported symptoms (OR=0.89, 95%CI: 0.69-1.15, P=0.38, I²=96%). Analyses by specific conditions yielded mixed results: No significant association was observed for hearing loss (OR=0.93, 95% CI: 0.69-1.25, P=0.62). For allergic rhinitis (OR=1.19,95% CI: 0.47-3.02,P=0.71) and tinnitus (OR=1.11,95% CI: 0.88-1.39,P=0.38), the point estimates suggested potential positive trends, but the associations were not statistically significant, and confidence intervals were wide. Subgroup analyses by some regions and COVID-19 diagnostic criteria did not reveal consistent significant associations. Conclusions This meta-analysis found no consistent association between COVID-19 and "three inflammations and one deafness," primarily due to significant heterogeneity. Evidence suggests a link between COVID-19 and physician-diagnosed "three inflammations and one deafness," which strongly depends on the rigor of outcome assessment, highlighting the need for standardized clinical diagnoses in future research.
Keywords: allergic rhinitis, COVID-19, Meta-analysis, Otitis Media, Pharyngitis, tinnitus and deafness
Received: 25 Sep 2025; Accepted: 06 Feb 2026.
Copyright: © 2026 Liu, Zhao, Qiao, Liu, Tao and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Shengli Wei
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