Association Between Aspirin and Tinnitus/Hearing Loss
Aspirin is associated with tinnitus and hearing loss, particularly at higher doses, with moderate-dose aspirin (6-7 days/week) increasing the risk of persistent tinnitus by 16% in women under 60 years of age. 1
Mechanism of Action
Aspirin (acetylsalicylic acid) can affect hearing through several mechanisms:
- Competitive inhibition of prestin: Salicylate, the active component of aspirin, acts as a competitive antagonist at the anion-binding site of prestin, the motor protein of outer hair cells, which explains aspirin-induced hearing loss 2, 3
- NMDA receptor activation: Salicylate-induced tinnitus is mediated by cochlear NMDA receptors through the inhibition of cyclooxygenase activity 2
- Outer hair cell function: While chronic salicylate treatment can enhance outer hair cell electromotility, it can paradoxically impair auditory neural activity 4
Dose-Response Relationship
The risk of developing tinnitus or hearing loss from aspirin depends on dosage:
- Low-dose aspirin: No elevated risk of persistent tinnitus 1
- Moderate-dose aspirin: Associated with 16% higher risk of tinnitus among women under 60 years when used 6-7 days per week 1
- High-dose aspirin: Can cause temporary hearing loss as great as 40 dB and exacerbate temporary threshold shifts from noise exposure 5, 3
Risk Factors and Special Populations
Certain factors increase the risk of aspirin-induced tinnitus or hearing loss:
- Age: Women under 60 years appear more susceptible to moderate-dose aspirin-induced tinnitus 1
- Noise exposure: Aspirin can potentiate temporary hearing loss induced by intense sounds 5
- Dose and duration: Higher doses and longer duration of use increase risk 5, 3
Clinical Manifestations
Aspirin-related auditory effects typically present as:
- Bilateral sensorineural hearing loss: Usually mild to moderate 3
- Tinnitus: Often described as a ringing or buzzing sound 6
- Reversibility: Effects are usually reversible within 2-3 days after discontinuation 3
- Absent otoacoustic emissions: During acute intoxication, returning as effects resolve 3
Other NSAIDs and Acetaminophen
Other analgesics also show associations with tinnitus:
- NSAIDs: Frequent use (4-5 days/week) associated with 17% higher risk of persistent tinnitus 1
- Acetaminophen: Use 6-7 days/week associated with 18% higher risk of persistent tinnitus 1
Clinical Implications and Management
For patients experiencing aspirin-induced tinnitus or hearing loss:
- Discontinuation: Effects typically resolve within 2-3 days after stopping aspirin 3
- Dose adjustment: Consider reducing dose if continued aspirin therapy is necessary
- Alternative medications: For patients requiring analgesics but experiencing tinnitus, consider alternatives with lower risk profiles
- Audiological monitoring: For patients requiring long-term high-dose aspirin therapy
Prevention
To minimize risk of aspirin-induced auditory effects:
- Avoid high doses when possible, especially in patients with risk factors
- Caution with noise exposure: Patients taking aspirin should avoid exposure to intense sounds 5
- Monitor for early symptoms: Address tinnitus promptly as it may be an early indicator of ototoxicity
In summary, while aspirin is associated with tinnitus and hearing loss, these effects are typically dose-dependent and reversible. Clinicians should be aware of this potential adverse effect, especially when prescribing moderate to high doses of aspirin or when treating patients with pre-existing auditory conditions.