Many people regularly take nonprescription pain relievers to manage or treat minor aches and pains. Yet some of these medications, when used regularly for an extended period of time, may increase the risk of hearing loss.
Interview with Brian M, Lin, MD
Today, approximately 48 million Americans suffer from some form of hearing loss, and the number of people affected has been on the rise,1 doubling from 2000 to 2015, according to the Hearing Health Foundation. People who experience hearing loss may face challenges in communicating, which, in turn, can adversely impact workplace productivity as well as lead to depression and social isolation.
“Our group is interested in modifiable risk factors for hearing loss,” Brian M. Lin, MD, lead author of a study examining women’s hearing following extended use of over-the-counter (OTC) analgesics,2 told Practical Pain Management. Dr. Lin is a resident in the department of otolaryngology at Massachusetts Eye and Ear Hospital/Harvard Medical School in Boston, MA.
“Previous literature suggests there may be an association between acetaminophen, nonsteroidal anti-inflammatory drugs(NSAIDs), aspirin, and hearing loss,3 but no study had prospectively investigated the relation between the duration of acetaminophen, NSAID, and aspirin use in hearing loss,” said Dr. Lin. This prompted his research team to look at how the risk of hearing loss might change with OTC usage over time, and was published in the American Journal of Epidemiology.
Duration Matters, So Does Type of Analgesic
While Dr. Lin’s group did not look at the mechanism of analgesics on hearing in his research, this connection has been studied by others4,5 who believe any loss of hearing may have occurred from changes that resulted from effects of pain relievers on the cochlea. Since OTC analgesics are among the most commonly used medications and are also contained in many cold and flu preparations, this relationship gives cause for concern.
“We hypothesized that greater duration of acetaminophen, NSAID, and aspirin use was associated with greater risk of hearing loss,” Dr. Lin said.
To test their hypothesis, Dr. Lin and colleagues looked at data from 55,850 women who participated in the Nurses’ Health Study with self-reported hearing loss. While other studies of hearing loss have focused on men, Dr. Lin looked at women who historically have a higher rate of analgesic use than males.
For the scope of this observational study, frequency of usage, defined as regular use of these analgesics was defined as twice a week or more. Three categories of pain relievers were explored: NSAIDs, acetaminophen, and aspirin.
The researchers found that women who used NSAIDs (ie, ibuprofen, naproxen) regularly over a 6-year period or longer had a 10% higher rate of reported hearing loss as compared to those who regularly used NSAIDs for less than a year.
Similarly, women who took acetaminophen, such as Tylenol, regularly over the same duration, 6 years or more were 9% more likely to experience hearing loss than those who took this pain reliever for less than a year.
However, the frequency of aspirin use did not lead to a perceptible change in hearing when compared with use for less than a year.
What Is the Clinical Takeaway?
While any increased risk posed by extended use of NSAIDs and acetaminophen was relatively small, Dr. Lin suggested that clinicians needn’t feel compelled to instruct patients not to use OTC pain relievers, rather they may want to make patients aware of a possible risk of hearing loss when these pain relievers are taken on a regular basis for an extended period of time, well over a year.
“The magnitude of the association was modest, but because the prevalence of use of these medications is high, there are important public health implications,” Dr. Lin said, pointing to their study findings,2 which can serve as a call to action for physicians to talk to their patients about analgesic use and frequency.
“These medications are useful and readily accessible since they are available over the counter. However, they are not without risk. Providers should have a discussion with their patients regarding whether they need to be taking these medications regularly,” Dr. Lin to Practical Pain Management.
The next step for this research team is to look at a larger group of subjects who represent a broader cross-section of the population, including men.
- Hearing Loss and Tinnitus Statistics. Hearing Health Foundation. Accessed on Jan. 8, 2016. Available at:http://hearinghealthfoundation.org/statistics.
- Lin BM,Curhan SG, Wang M. Duration of Analgesic Use and Risk of Hearing Loss in Women. Am J Epidemiol. 2017;185(1):40-47.
- Lowthian JA, Britt CJ, Rance G. Slowing the progression of age-related hearing loss: Rationale and study design of the ASPIRIN in HEARING, retinal vessels imaging and neurocognition in older generations (ASPREE-HEARING) trial. Contemp Clin Trials.2016;46:60-66.
- Yorgason JG1, Luxford W, Kalinec F. In vitro and in vivo models of drug ototoxicity: studying the mechanisms of a clinical problem.Expert Opin Drug Metab Toxicol. 2011;7(12):1521-34.
- Yorgason JG, Fayad JN, Kalinec F. Understanding drug ototoxicity: molecular insights for prevention and clinical management.Expert Opin Drug Saf. 2006;5(3):383-99.