Analgesic Use and the Risk of Hearing Loss in Women

Sharon G. Curhan; Josef Shargorodsky; Roland Eavey; Gary C. Curhan


Am J Epidemiol. 2012;176(6):544-554. 

In This Article

Abstract and Introduction


Use of analgesics is common and is associated with increased risk of hearing loss in men; however, the relation has not been examined prospectively in women. The authors prospectively examined the relation between frequency of aspirin, ibuprofen, and acetaminophen use and risk of hearing loss among 62,261 women aged 31–48 years at baseline (1995) in Nurses' Health Study II. The outcome was self-reported hearing loss (n = 10,012), and the follow-up period was 1995–2009. Cox proportional hazards regression was used to adjust for potential confounders. During 764,247 person-years of follow-up, ibuprofen use and acetaminophen use were independently associated with increased risk of hearing loss, but aspirin use was not. For ibuprofen, the multivariate-adjusted relative risk of hearing loss was 1.13 (95% confidence interval (CI): 1.06, 1.19) for use 2–3 days/week, 1.21 (95% CI: 1.11, 1.32) for use 4–5 days/week, and 1.24 (95% CI: 1.14, 1.35) for use ≥6 days/week (P-trend < 0.0001), compared with use less than once per week. For acetaminophen, the corresponding relative risks were 1.11 (95% CI: 1.02, 1.19), 1.21 (95% CI: 1.07, 1.37), and 1.08 (95% CI: 0.95, 1.22), respectively (P-trend = 0.0007). In this study, use of ibuprofen or acetaminophen (but not aspirin) 2 or more days per week was associated with an increased risk of hearing loss in women.


Hearing loss is a common and disabling chronic condition. According to recent data from the National Health and Nutrition Examination Survey (NHANES), over 50% of US adults suffer from high-frequency hearing loss by age 60 years.[1] Although the prevalence is higher in men, one-third of women in their 50s and almost two-thirds of women in their 60s suffer from hearing loss.[1] Even mild hearing loss impairs communication and social interaction, adversely affecting work productivity, social connectivity, and quality of life.[2,3] The World Health Organization ranks adult-onset hearing loss as the sixth most common disease burden in high-income countries.[4] Hearing loss represents an important public health concern, yet there are limited data on potentially modifiable risk factors for adult hearing loss.

Ibuprofen, acetaminophen, and aspirin are the 3 most commonly used medications in the United States.[5] In NHANES III (1988–1994), more than 80% of women aged 25 years or older reported having used nonprescription analgesic agents within the past month.[6] Potential ototoxicity (damage to the cochlea or auditory nerve) due to high doses of salicylates and nonsteroidal antiinflammatory drugs (NSAIDs) has been previously described[7–11] and may result from several mechanisms, such as impaired outer hair cell function, inhibition of prostaglandin-forming cyclooxygenase, and reduced cochlear blood flow. Potential ototoxicity from acetaminophen may be due to the depletion of glutathione,[12] which has been shown to protect the cochlea from noise-induced damage.[13,14] Previously, we found that regular use (≥2 times/week) of NSAIDs, acetaminophen, or aspirin was associated with an increased risk of hearing loss in men.[15]

To our knowledge, the relation between regular analgesic use and hearing loss in women has not been prospectively examined. Given that use of analgesics by women is so common, we prospectively analyzed the association between analgesic use and the risk of hearing loss in 62,261 women.