Introduction: Otological symptoms contribute to the disability of established Parkinson's disease (PD). We sought to evaluate whether prodromal onset may affect PD progression., Methods: A retrospective cohort design was used to compare time to advanced disease, defined as a Hoehn & Yahr 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 H&Y ≥ 3 was determined using Cox proportional hazards, with adjusted results summarized as hazards ratio (HR)., Results: 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)., Conclusion: Prodromal otological symptoms might be associated with a reduced risk of motor progression in PD., (Copyright © 2021 Elsevier Ltd. All rights reserved.)