Is the new bilateral buzzing tinnitus in a 60-year-old man associated with Wegovy (semaglutide)?

Tinnitus is not a documented adverse effect of Wegovy (semaglutide)

Based on FDA labeling and clinical trial data, bilateral buzzing tinnitus is not an established side effect of Wegovy, though emerging case reports suggest possible otologic complications related to rapid weight loss from GLP-1 receptor agonists.

Evidence from FDA Drug Labeling

The official Wegovy prescribing information does not list tinnitus among its adverse reactions 1. The documented side effects focus primarily on:

• Gastrointestinal effects (nausea, vomiting, diarrhea - most common)
• Cardiovascular effects (heart rate increases of 1-4 bpm)
• Metabolic complications (hypoglycemia, acute kidney injury)
• Serious but rare events (pancreatitis, gallbladder disease, diabetic retinopathy complications)

Emerging Otologic Concerns

However, recent research reveals a potential indirect mechanism. A 2025 systematic review of the FDA Adverse Event Reporting System (FAERS) identified 958 otologic adverse events (0.99% of all GLP-1 RA reports), including 93 cases of tinnitus 2. The breakdown showed:

• 515 cases of hearing loss
• 203 cases of vertigo
• 93 cases of tinnitus
• 2 cases of ear fullness
• 0 cases of autophony (though case reports exist)

The proposed mechanism is rapid weight loss causing loss of peritubal adipose tissue, leading to Eustachian tube dysfunction (ETD) or patulous ETD (PETD) 2, 3. This is well-established after bariatric surgery and may occur with GLP-1 RA-induced weight loss.

Clinical Evaluation Algorithm

For this 60-year-old man with new bilateral buzzing tinnitus on Wegovy:

1. Perform otoscopic examination - Look for retrotympanic masses, middle ear effusion, or cerumen impaction 4, 5

2. Assess for Eustachian tube dysfunction:

   • Ask about aural fullness, autophony (hearing own voice/breathing)
   • Document weight loss velocity and total amount
   • Consider nasal endoscopy to evaluate ET cushion bulk 2

3. Audiometric testing - Rule out asymmetric hearing loss that would require imaging 4, 5

4. Imaging is NOT indicated for bilateral, nonpulsatile tinnitus without focal neurologic deficits or asymmetric hearing loss per ACR Appropriateness Criteria 4, 5

Management Recommendations

If examination is normal and tinnitus is bilateral/nonpulsatile:

• Do not discontinue Wegovy solely for tinnitus - The cardiovascular and metabolic benefits (20% reduction in MACE, significant weight loss) outweigh this uncommon side effect 6, 7

• Conservative management for possible ETD/PETD:

  • Increase hydration
  • Intranasal saline irrigation
  • Avoid decongestants (can worsen PETD)
  • Monitor for resolution as weight stabilizes 3

• Consider slowing weight loss velocity if symptoms are bothersome - though this is not formally studied

Critical Caveats

Red flags requiring immediate evaluation:

• Unilateral or asymmetric tinnitus → requires MRI to exclude vestibular schwannoma 4, 5
• Pulsatile tinnitus → requires vascular imaging (CTA/MRA) 4, 5
• Associated neurologic deficits → requires urgent neuroimaging
• Sudden hearing loss → requires urgent audiometry and possible MRI

The association between GLP-1 RAs and tinnitus remains poorly characterized. While not listed in FDA labeling, the mechanism via rapid weight loss and ETD is biologically plausible. Clinicians should maintain awareness of this potential complication but should not routinely discontinue highly effective cardiometabolic therapy for isolated bilateral tinnitus without other concerning features.