Duration of Analgesic Use and Risk of Hearing Loss in Women

Brian M. Lin; Sharon G. Curhan; Molin Wang; Roland Eavey; Konstantina M. Stankovic; Gary C. Curhan

Disclosures

Am J Epidemiol. 2017;185(1):40-47. 

In This Article

Abstract and Introduction

Abstract

Aspirin, nonsteroidal antiinflammatory drugs (NSAID), and acetaminophen are commonly used. Frequent use of analgesics has been associated with a higher risk of hearing loss. However, the association between duration of analgesic use and the risk of hearing loss is unclear. We investigated the relationship between duration of analgesic use and self-reported hearing loss among 55,850 women in the Nurses' Health Study. Cox proportional hazards regression was used to adjust for potential confounders. During 873,376 person-years of follow-up (1990–2012), longer durations of NSAID use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.10, 95% confidence interval: 1.06, 1.15; P for trend < 0.001) and acetaminophen use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.09, 95% confidence interval: 1.04, 1.14; P for trend < 0.001) were associated with higher risks of hearing loss. Duration of aspirin use was not associated with hearing loss (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.01, 95% confidence interval: 0.97, 1.05; P for trend = 0.35). In this cohort of women, longer durations of NSAID and acetaminophen use were associated with slightly higher risks of hearing loss, but duration of aspirin use was not. Considering the high prevalence of analgesic use, this may be an important modifiable contributor to hearing loss.

Introduction

Hearing loss is common among adults in the United States. According to the National Health and Nutrition Examination Survey (NHANES), two-thirds of women in their sixties have hearing loss.[1] Hearing loss can have a significant impact on quality of life; thus, identifying potential modifiable risk factors may help reduce the burden of this condition.[2,3]

Aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), and acetaminophen are the most commonly used medications in the United States.[4] Previous studies have suggested that use of high-dose NSAIDs or salicylates (aspirin) may be ototoxic. Ototoxicity may be mediated by several different mechanisms, including impariment of outer hair cell function, reduced vascular supply to the cochlea, and inhibition of cyclooxygenase.[5–9] It is hypothesized that depletion of cochlear glutathione by acetaminophen[10] may result in greater susceptibility of the cochlea to noise-induced damage.[11,12] Furthermore, in rodent models, it has been demonstrated that acetaminophen and a metabolite of acetaminophen may cause ototoxicity through oxidative stress mechanisms.[13]

In a cohort of younger women, we found that regular use (≥2 days/week) of ibuprofen and acetaminophen was associated with a higher risk of hearing loss.[14] We therefore decided to examine this question in a cohort of older women and determine whether a longer duration of regular analgesic use was associated with the risk of hearing loss. Given the mechanisms by which analgesics are theorized to cause hearing loss, we hypothesized that longer duration of exposure to analgesics would be more likely to result in hearing loss. We investigated the relationship between duration of analgesic use and risk of hearing loss among participants in the Nurses' Health Study (NHS) I.

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