Most everyone takes an aspirin or other pain reliever from time to time, and these drugs are very safe when taken in low doses or infrequently. But with an increased usage there is the potential risk of ototoxicity, or hearing loss as measured by several research studies.
Hearing loss is a common sensory disorder, effecting up to a third of the population in their forties, and is the sixth most common disorder affecting us as we age. Even a slight loss of hearing can make it difficult to understand normal speech in the presence of background noise or several speakers. Hearing loss is highly associated with social isolation and depression.
Common analgesics include aspirin, ibuprofen, and acetaminophen and are used for the temporary relief of fever, pain or soreness, and as a prophylactic treatment of some heart and stroke problems. Generally these drugs are non-steroidal anti-inflammatory (NSAID) analgesics that work through several mechanisms to reduce inflammation in the body. Inflammation is a natural response by the body to rid cells of injury or infection and is commonly felt or seen as pain, heat, redness, swelling, and loss of function. Overuse of NSAIDs can produce a number of different problems including gastrointestinal, blood clotting, neurological and renal issues.
In the Health Professional Follow-up Study men ages 50 and younger that used aspirin on a regular basis were 33% more likely to experience some hearing loss than infrequent users. Ibuprofen users were 61% more likely, and acetaminophen users 99% more likely. The 26,000 male patients involved in the study were tracked every two years over a span of 18 years.
Women were also studied in a separate research program, and the results were similiar with a 13% increase in self-reported hear loss when using ibuprofen two to three days per week. If the usage increased to an avearge of four to five days a week, the reported hear loss increased to 21%, and for users taking a dose greater than six times a week the increase was 24%. For acetaminophen, the corresponding relative risks were slightly lower, but showed the same rates of increase over the increase in the number of days the drug was taken.
There are a couple of important issues to know about these studies. The self-reporting of hearing loss was done by the patients themselves, and the relationship between analgesics and hearing loss is correlational and may not be fully causitive. Many factors were controlled within the study such as age, race, smoking and other lifestyle choices, prior medical history and so on, but some environmental factors such as long-term exposure to background noise, which is a known cause of hearing loss was not measured.
The mechanism of hearing loss by taking NSAIDs is thought to be the result of the blocking of binding sites within the cochlea, the bony part of the inner ear where sound waves are converted to electrical signals by thousands of small hairs. In some cases the hearing loss can be complete, or results in tinnitus, a ringing in the ears.
A patient who experiences tinnitus in one or both ears, a change in the instensity or pitch of tinnitus, a feeling of fullness in the ears not caused by sinus or other infection or a loss of hearing should seek the advise of their physician. Especially important is to tell their doctor about their use of aspirin, NSAIDs, and other analgesic medications.
Dr. Fandos is a pain management physician from Long Island, NY.
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