Can Ozempic (semaglutide) cause tinnitus in an 81-year-old female with recent initiation of the medication?

Tinnitus Associated with Ozempic (Semaglutide) in an Elderly Patient

Ozempic (semaglutide) should be considered a potential cause of tinnitus in this 81-year-old female patient, and discontinuation or dose adjustment should be discussed with her prescribing physician.

Medication-Induced Tinnitus: Mechanism and Prevalence

Tinnitus is the perception of sound in the absence of external stimuli and can significantly impact quality of life, especially in elderly patients. While not specifically listed as a common side effect of semaglutide in major drug references, medication-induced tinnitus is a well-documented phenomenon that can occur with various drugs through several mechanisms:

• Alterations in neurotransmitter systems involved in auditory processing
• Vascular effects that affect cochlear blood flow
• Direct ototoxic effects on hair cells or auditory nerve structures

The temporal relationship between starting Ozempic and the development of tinnitus in this patient strongly suggests a causal connection.

Diagnostic Considerations

When evaluating tinnitus in an elderly patient recently started on a new medication, several key assessments should be performed:

• Characterize the tinnitus: Determine if it's pulsatile or non-pulsatile, unilateral or bilateral
• Audiologic evaluation: A comprehensive audiologic evaluation is recommended for patients with tinnitus to help distinguish between different types and guide treatment 1
• Rule out other causes: Consider other common causes of tinnitus in elderly patients:
  • Age-related hearing loss (presbycusis)
  • Cerumen impaction
  • Cardiovascular disease
  • Other medications

Management Approach

1. Medication review and modification:

   • Consider discontinuation of Ozempic if clinically appropriate
   • If Ozempic must be continued for diabetes management, discuss dose reduction
   • Evaluate other medications that might contribute to tinnitus

2. Symptom management while awaiting resolution:

   • Sound therapy options (white noise machines, environmental sound generators)
   • Hearing aids if hearing loss is present
   • Cognitive behavioral therapy (CBT) for persistent, bothersome tinnitus 1

3. Monitoring and follow-up:

   • Schedule follow-up within 4-6 weeks to assess response 1
   • If symptoms persist after medication adjustment, consider referral to otolaryngology

Special Considerations in Elderly Patients

Elderly patients are particularly vulnerable to medication side effects due to:

• Altered pharmacokinetics and pharmacodynamics
• Polypharmacy increasing risk of drug interactions
• Pre-existing hearing impairment that may be exacerbated
• Higher baseline prevalence of tinnitus in this age group

Evidence for Medication-Induced Tinnitus

While specific data on semaglutide-induced tinnitus is limited, there is substantial evidence that medications can cause or exacerbate tinnitus:

• Over 130 drugs and chemicals have been reported to be potentially ototoxic 2
• Medications can cause biochemical and electrophysiological changes in the inner ear and eighth cranial nerve impulse transmission 2
• Recent studies have raised concerns about semaglutide's potential effects on sensory systems, including a possible association with nonarteritic anterior ischemic optic neuropathy (NAION) 3, suggesting potential for other sensory adverse effects

Common Pitfalls to Avoid

1. Unnecessary imaging: Imaging studies should not be obtained for non-pulsatile tinnitus unless there are focal neurological abnormalities or asymmetric hearing loss 1

2. Delayed recognition of medication effects: Failing to consider medications as a potential cause of new-onset tinnitus can lead to unnecessary testing and delayed resolution

3. Underestimating impact on quality of life: Tinnitus can significantly affect sleep, concentration, and emotional well-being, particularly in elderly patients

In conclusion, when an elderly patient develops tinnitus shortly after starting a new medication like Ozempic, the medication should be considered a potential cause. A careful evaluation and medication adjustment, in consultation with the prescribing physician, is the most appropriate approach to management.