Pharmacist warns OTC medicines may raise risk of tinnitus and hearing loss

A British pharmacist is warning that routinely taking over-the-counter painkillers could raise the risk of hearing problems, including tinnitus. Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association, said medicines that are widely available without a prescription can affect hearing and balance, with the level of risk influenced by dose and how long they are used. She noted that tinnitus affects an estimated 7.6 million people in the UK, and that the risk appears higher when such medicines are used regularly or at high doses.

According to Dr Hannbeck, regular use of non-steroidal anti-inflammatory drugs such as ibuprofen and aspirin, as well as paracetamol, could raise the risk of tinnitus by about a fifth in some cases. One 2022 US study found that daily acetaminophen was associated with an 18% increased risk of tinnitus. Frequent use of NSAIDs raised the risk by around 17%, and a daily dose of aspirin around 100 mg was linked to about a 16% increase in risk for tinnitus, while a daily aspirin dose of less than 100 mg was not associated with increased risk. Dozens of other common medications, including analgesics and some blood pressure drugs, were cited as potentially increasing the likelihood of hearing problems when used inappropriately or over long periods.

British research has shown that more than 50% of patients who require multiple rounds of intravenous aminoglycosides may experience hearing loss. Alongside antibiotics such as aminoglycosides, other drugs—including certain pain relievers and antibiotics—have been linked to hearing loss, according to Dr Hannbeck. Gentamicin is one commonly used aminoglycoside administered intravenously to treat severe infections, and while it can be given in pill form, studies suggest it may damage the sensory cells inside the ear needed for balance and hearing. In the BMJ, researchers noted that even at recommended dosages, aminoglycosides can lead to rapid, profound, and irreversible hearing loss, and in patients with a particular genetic mutation, a single dose can cause permanent hearing loss.

Dr Hannbeck added that some blood pressure medicines that can reduce blood flow to the eardrum and some diuretics (water pills) can also impact hearing in some people. She also noted that certain opioids and medications for acne have been linked to hearing effects in some individuals. She stressed that people should not stop prescribed medicines because of concerns about side effects and should speak with a pharmacist or doctor if they have questions. "There are many medicines that cause side effects that affect the hearing and balance, but in most cases this depends on the dose and length of use. Research also suggests paracetamol and NSAIDs including ibuprofen could raise the risk of tinnitus by almost a fifth," she said.

The discussion highlights how a common set of medicines—when used at typical doses or for extended periods—may be associated with increased risks of tinnitus or hearing loss, though most people do not experience these side effects. Health professionals emphasize following labeled dosing guidelines and consulting a clinician if new hearing symptoms arise or if medications are being used regularly over a long period.