Smoking as a Multifactorial Ototoxic Risk Factor: Associations with Elevated Hearing Thresholds, Tinnitus, and Vertigo

Objectives: This retrospective study evaluated the association between smoking, hearing loss, tinnitus, and vertigo in 443 patients evaluated between 2015 and 2025.The primary aim was comparing Pure-Tone Audiometry (PTA) thresholds between smokers and nonsmokers.Methods: Audiological data, including PTA thresholds, tinnitus, and vertigo presence, were analyzed after excluding patients with confounding otologic factors.Group comparisons utilized independent t-tests and Two-Way ANOVA to assess main and interaction effects.Results: Among 443 patients (218 smokers, 225 non-smokers), smokers exhibited significantly higher mean PTA thresholds in both better-hearing (22.1 vs. 18.0 dB; p<0.001) and worse-hearing ears (25.3 vs. 20.1 dB; p<0.001).Tinnitus prevalence was significantly higher in smokers (43.1%) compared to non-smokers (27.1%) (p<0.001), as was vertigo (27.5% vs. 20.4%;p=0.047).A positive correlation was observed between daily cigarette consumption and hearing thresholds. Conclusion:Smoking is significantly associated with elevated hearing thresholds and increased prevalence of tinnitus and vertigo.These findings confirm smoking as a multifactorial risk factor for auditory and vestibular dysfunction, underscoring the critical need for smoking cessation interventions.