ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutritional Epidemiology
This article is part of the Research TopicWomen's Health in an Interdisciplinary Dimension – Determinants of Nutritional Disorders: Volume IIView all 7 articles
Iron Deficiency Anemia and the Risk of New-Onset Tinnitus in Female Patients: A Cohort Study
Provisionally accepted
- 1Chi Mei Medical Center, Tainan, Taiwan
- 2E-Da Hospital, Yanchao District, Taiwan
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Abstract Background: Iron deficiency anemia (IDA) may compromise auditory function through cochlear hypoxia and altered hemodynamics; however, longitudinal evidence linking IDA to tinnitus remains limited. This study investigated the association between IDA and new-onset tinnitus in female patients using a large-scale cohort design. Methods: This retrospective cohort study utilized the TriNetX electronic health records network (2010-2022) to identify female patients with and without IDA, focusing exclusively on women to minimize occupational noise exposure confounding. We defined IDA as hemoglobin below 12 g/dL and ferritin below 30 ng/mL recorded within three months, while controls had levels above these thresholds. The primary outcome was new-onset tinnitus, and the secondary outcome was pulsatile tinnitus, both assessed at one and three years after the index date. After employing propensity score matching to balance baseline characteristics, we calculated the hazard ratio (HR) using Cox proportional hazards models and performed pre-specified subgroup analyses examining dose-response relationships by hemoglobin severity and age-stratified effects. Results: IDA was associated with a significantly higher risk of tinnitus at one year (HR 3.78, 95% confidence interval [CI]: 2.60–5.50; incidence 15.7 vs. 4.2 per 10,000 person-years) and at three years (HR 2.52, 95% CI 2.11–3.02; 18.6 vs. 7.4 per 10,000 person-years). Pulsatile tinnitus risk was similarly elevated at three years (HR 2.25, 95% CI 1.42-3.57). A clear dose-response relationship emerged, with severe IDA (hemoglobin <10 g/dL) conferring highest one-year risk (HR 5.74, 95% CI 3.24-10.16). Age-stratified analysis revealed differential vulnerability: older women (>45 years) showed greater susceptibility to general tinnitus (HR 4.55 vs 3.26), while younger women demonstrated exclusive risk for pulsatile tinnitus. Conclusion: IDA showed a significant dose-dependent association with new-onset tinnitus in women. These findings support routine IDA screening in women presenting with tinnitus and suggest that timely iron repletion may help reduce the risk of potentially preventable auditory dysfunction.
Keywords: iron deficiency anemia, Tinnitus, nutrition, cohort study, hazard ratio
Received: 15 Sep 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Hung, Weng, Lai, Lin, Wu, Lin and Chen. 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: I-Wen Chen, cheniwena60912@gmail.com
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