Otological symptoms contribute to the disability of established Parkinson's disease (PD). We sought to evaluate whether prodromal onset may affect PD progression.A retrospective cohort design was used to compare time to advanced disease, defined as a HoehnYahr stage ≥3 in consecutive PD patients with history of auditory and/or vestibular symptoms appearing before versus after PD onset. Time from PD onset to HY ≥ 3 was determined using Cox proportional hazards, with adjusted results summarized as hazards ratio (HR).After adjusting for age at PD onset, there was a lower risk of progression to advanced disease in patients with prodromal otological symptoms compared to those with otological symptoms after PD onset (HR = 0.34; 95%CI: 0.15-0.75, p = 0.008). This association remained significant after adjusting for age at PD onset and MDS-UPDRS III (HR = 0.25; 95% CI: 0.10-0.63, p = 0.003) and propensity score-adjusted analysis (HR = 0.46; 95% CI: 0.24-0.91, p = 0.025).Prodromal otological symptoms might be associated with a reduced risk of motor progression in PD.
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