Hearing loss and pain relievers

[Jeff Lebowski]

I want to hear from the docs on this one. New study seems to provide solid (shockingly so, IMO) link between over-the-counter pain relievers and hearing loss. From a summary:

Regular use of pain-relief medicine appears to increase men's risk of hearing loss, especially among middle-aged men, according to an American Journal of Medicine study. Researchers surveyed nearly 27,000 men every two years from 1986 to 2004; about one-fourth of the men said they had been diagnosed with hearing loss. Men who used pain relievers at least twice a week were more likely than non-users to be diagnosed. Aspirin users were 12% more likely, those on ibuprofen-like drugs were 21% more likely and users of acetaminophen, 22% more likely. Men from 45 to 50 years old at the start of the study faced the greatest risk—a 33% increase for aspirin, 61% for ibuprofen and 99% for acetaminophen. Previous nonhuman research has found some substances in pain-relievers can decrease blood flow to the cochlea, the part of the inner ear that converts waves sound into brain signals.

The original article:

http://www.amjmed.com/article/S0002-...795-5/fulltext

I have ringing in my ears and have noticed a significant amount of hearing loss in recent years. I don't use a lot of pain relievers, but I am wondering if I should cut them out completely. I also take a baby aspirin each night since I have been led to believe that it is good for my heart and circulation.

How significant is this study? What are you docs going to recommend to your patients?

[Jarid in Cedar]

Nice find, JL. I am not sure what to think about it. The study was a prospective observational study which depends on self reporting. self reporting has some substantial issues regarding accuracy of the data. In their study if 7% of those who reported infrequent use(<2 times a week) were actually using 3+ times a week, many of the CI would straddle 1.0, this making the findings nonsignificant. it also reported the findings as relative risk(RR), which gives less information than absolute risk. I tried to see if they listed any AR info, but they have not.



As far as your question of low dose aspirin, it depends on your vascular disease risks. If you have know vascular disease or diabetes, your risk of a vascular event(heart attack or stroke) is 6.7% you take aspirin and 8.2% if you do not. This gives an absolute risk reduction(ARR) of 1.5% and a RRR of 18%.

If you do not have known vascular disease then your risk is 0.51% of a vascular event if you take aspirin and 0.57% if you don't. ARR=0.06% and RRR=10.5%.

Given the severity of vascular disease versus hearing loss. I would absolutely recommend that anyone with vascular disease/diabetes continue taking low dose aspirin despite the potential risks of hearing loss, and I would probably not change that recommendation for primary prevention, but I would counsel about the risks of hearing loss, esp for people who professionally are high risk for sound mediated damage.