Can Acetaminophen Contribute to Hearing Loss? Unpacking the Research


Acetaminophen, commonly known by the brand name Tylenol®, is a prevalent choice for pain relief and fever reduction in many households. It effectively manages mild to moderate pain, including headaches, muscle aches, backaches, and menstrual cramps. Acetaminophen also reduces fever by affecting the brain’s temperature control. However, recent research has raised questions about the potential risks associated with acetaminophen and hearing loss. 


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Pain Relievers and Hearing Loss: A Closer Look at the Studies


Hearing loss, a widespread sensory issue often lacks data on modifiable risk factors. Analgesics, or pain relievers, the most frequently used drugs in the US, might pose a risk to auditory health. Recent studies indicate that medications like aspirin, ibuprofen, and acetaminophen could contribute to hearing loss.


Aspirin, Ibuprofen, Acetaminophen and Hearing Loss In Men


One significant study tracked 26,917 men aged 40-74 from 1986 onward, using detailed biennial questionnaires to assess their health and medication use. The research aimed to identify new cases of hearing loss that occurred post-1986.


The findings were telling. Over the ensuing years, 3,488 new cases of hearing loss were reported. Analysis showed that regular use of pain relievers—defined as two or more times per week—was linked to an increased risk of developing hearing loss. Specifically, compared to infrequent users, regular users of aspirin, NSAIDs, and acetaminophen had higher risks of hearing impairment, with hazard ratios of 1.12 for aspirin, 1.21 for NSAIDs, and 1.22 for acetaminophen.


The risk appeared to escalate with the duration of regular use, particularly for NSAIDs and acetaminophen. Moreover, the impact of these medications was more pronounced in younger men. For those under 50, the hazard ratios soared to 1.33 for aspirin, 1.61 for NSAIDs, and an alarming 1.99 for acetaminophen.


These results underscore the potential auditory risks associated with regular and long-term use of common pain relievers. Men, especially younger ones, might face a higher risk of hearing loss from frequent use of medications like acetaminophen and NSAIDs. This research highlights the importance of monitoring and limiting the use of these drugs to mitigate the risk of hearing damage.

A woman holds her head in pain while lying on a couch.

Pain Relievers and Hearing Loss in Women


The most commonly used medications in the United States are Ibuprofen, acetaminophen, and aspirin. Remarkably, over 80% of women aged 25 and older have reported using nonprescription pain relievers within the last month. While these medications are widely trusted for their efficacy, their potential for causing ototoxicity—a type of damage to the ear that can impair hearing—should not be overlooked.


Previous research has demonstrated that high doses of salicylates and NSAIDs can damage the ear through several mechanisms. These include impairing the function of the outer hair cells, blocking enzymes essential for protecting the ear, and reducing blood flow to the cochlea. Acetaminophen, too, may lead to hearing damage by depleting glutathione, a compound crucial for shielding the cochlea from noise-induced harm.


Focusing on the effects on women, this research analyzed data from 62,261 women, assessing the impact of their analgesic use on hearing loss. This study, the first of its kind to prospectively examine this relationship in women, found significant findings. Regular use of ibuprofen or acetaminophen—defined as two or more days per week—correlates with an increased risk of hearing loss. Interestingly, the risk escalates with the frequency of use. However, we observed no significant connection between aspirin use and hearing loss in women.


Women, Acetaminophen and Hearing Loss


Study Details and Participant Profile


A comprehensive longitudinal cohort study was conducted as part of the Nurses’ Health Study II from 1995 to 2017. It included 69,455 women aged 31–48 who did not experience tinnitus at the start. The study gathered data via biennial questionnaires, focusing on analgesic use and the onset of tinnitus.


Findings on Analgesics and Tinnitus Risk

Persistent tinnitus is a common yet challenging condition to treat. While high-dose aspirin is known to precipitate tinnitus, data on typical doses and other analgesics like acetaminophen and NSAIDs have been limited.

After tracking 1,120,936 person-years, the study reported 10,452 new cases of persistent tinnitus. The analysis revealed that frequent low-dose aspirin users did not face an increased risk of developing persistent tinnitus. However, women under 60 who frequently used moderate-dose aspirin exhibited a higher risk compared to older participants.


Specifically, the risk for women using moderate-dose aspirin 6–7 days per week was significantly higher, with a multivariable-adjusted hazard ratio (MVHR) of 1.16. Regarding NSAIDs and acetaminophen, frequent use correlated with an elevated risk across all age groups. For NSAIDs, the MVHR for usage 4–5 days per week was 1.17, and for acetaminophen 6–7 days per week, it was 1.18.


Limitations and Further Research Needs


It’s important to note that this study relied on self-reported data, which might affect the accuracy of the findings regarding tinnitus and analgesic use. Additionally, the study focused solely on women, particularly those who are not non-White, highlighting a gap in research that needs addressing for broader demographic inclusivity.


Concluding Insights


The study concluded that while low-dose aspirin does not increase tinnitus risk, moderate doses in younger women and frequent use of NSAIDs and acetaminophen in all women are linked with a higher likelihood of developing persistent tinnitus. These findings suggest a potential risk factor in the use of common pain relievers, emphasizing the need for cautious use and further investigation into the causal relationships between these medications and tinnitus.


The Role of Dosage: How Much Is Too Much?


Research indicates a correlation between frequent, prolonged use of these pain relievers and an increased risk of hearing loss. Higher doses are particularly concerning, showing a stronger association with this risk. It’s essential to recognize that these findings come from observational studies, which highlight correlations but do not confirm causation. Not everyone who uses these medications regularly will experience hearing loss.

A man cups his ear as if he can’t hear.

How Pain Relievers May Affect Hearing


Scientists are still studying the potential mechanism behind this link. Theories include reduced blood flow to the inner ear and damage to the hair cells that convert sound waves into electrical signals. The type of hearing loss associated with these medications is generally sensorineural, affecting the inner ear or auditory nerve and possibly leading to symptoms like faint sound perception, muffled speech, or tinnitus.


Understanding NSAID-Induced Ototoxicity


Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen, and naproxen (Aleve), are known for their effectiveness in pain relief and reducing inflammation. Recent studies, however, raise concerns about the ototoxic effects of long-term, high-dose NSAID use.


The Dose-Response Relationship


The risk of NSAID-induced hearing loss appears to be dose-dependent:


  • Higher Doses, Greater Risk: Extended use of high NSAID doses can lead to higher concentrations in the bloodstream, increasing the inner ear’s exposure to potential damage.
  • Duration Matters: The longer the duration of high-dose NSAID use, the greater the potential risk of ototoxicity.


Factors Influencing Individual Risk


Several factors may affect an individual’s risk of NSAID-induced ototoxic effects:


  • Pre-existing Conditions: Those with existing hearing loss or inner ear damage are more susceptible to further impairment.
  • Age Considerations: The inner ear’s susceptibility to damage increases with age, potentially exacerbating the effects of NSAIDs in older adults.
  • Kidney Function: Since kidneys are responsible for flushing out NSAIDs, impaired kidney function can slow this process, increasing the drug’s concentration and its ototoxic potential.


Exploring the Mechanism of Damage


While the exact process is still under study, potential mechanisms for NSAID-induced ototoxicity include:


  • Reduced Blood Flow: NSAIDs may decrease blood flow to the inner ear, depriving hair cells of necessary oxygen and nutrients.
  • Direct Toxicity: There could be a direct harmful effect on the inner ear’s hair cells, resulting in damage or loss.


Understanding these risks and mechanisms is vital for anyone using these common medications, especially those taking them frequently or in high doses.


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Pain Relievers and Hearing Loss: Reducing the Risks


While studies link regular use of pain relievers like acetaminophen to hearing loss, they show correlation, not causation. Nonetheless, taking preventive measures is prudent.


Adhering to Dosage Guidelines


Always follow the dosage instructions on your medication’s label. Exceeding the recommended amount can raise the risk of adverse effects, including potential hearing loss.


Considering Alternative Pain Relief Options


Explore non-medicinal pain relief methods for minor aches, such as heat therapy, massage, or relaxation techniques. These can provide relief without the risks associated with pain relievers.


Consulting with Healthcare Professionals


If you frequently use pain relievers for chronic pain, discuss this with your doctor. They can help devise a safe, effective pain management plan that minimizes reliance on medications.

A man gets his hearing checked.

Protecting Your Hearing


Taking care of your ears is essential, especially if you’re concerned about the impact of pain relievers.


  • Limit Exposure to Loud Noises: To protect your hearing, wear earplugs or noise-canceling headphones in noisy environments like concerts, construction sites, or workplaces.
  • Moderate Volume Levels: Listen to music and use electronics at safe volumes to prevent long-term hearing damage.
  • Regular Hearing Assessments: Schedule hearing check-ups with an audiologist to catch any signs of hearing loss early and ensure timely treatment.


Prioritizing Early Detection


Early detection through regular hearing tests is critical. If you suspect using pain relievers could affect your hearing, consult with your healthcare provider. They can offer guidance tailored to your specific health needs, ensuring you maintain both effective pain management and good hearing health.


Concerned About Acetaminophen and Hearing Loss? 


The link between long-term use of pain relievers like acetaminophen and hearing loss highlights the importance of cautious medication use. While the connection isn’t definitive, being proactive about your hearing health is vital.


Choose safe practices and consult your doctor about any concerns with pain relievers. Always explore alternative relief methods and adhere to dosage recommendations to minimize risks.


Protect your ears from loud environments, keep volumes moderate, and, most importantly, schedule regular hearing evaluations. Early detection is key to effectively managing and preventing hearing loss.


If you’re concerned about how your use of pain relievers may impact your hearing, or if it’s just time for a check-up, visit American Hearing + Audiology today. Don’t wait—book your hearing consultation to ensure your ears are as healthy as they can be.