Can beta blockers (beta-adrenergic blocking agents) cause hearing loss?

Beta Blockers and Hearing Loss

Carvedilol is the only beta blocker that has been significantly associated with hearing loss, while other beta blockers like metoprolol and atenolol have not shown this association. 1

Evidence on Beta Blockers and Hearing Loss

The relationship between beta blockers and hearing loss is not extensively documented in major clinical guidelines. However, a 2018 cross-sectional study provides important insights:

• Carvedilol was found to be significantly associated with hearing loss 1
• Other beta blockers including metoprolol and atenolol showed no association with hearing loss 1
• Age, gender, and carvedilol use were identified as statistically significant predictors for hearing loss severity 1

This finding is particularly important as carvedilol is commonly used in heart failure and hypertension management.

Beta Blocker Selection Considerations

When selecting beta blockers, several factors should be considered:

Beta Blocker Properties

• Selectivity: Beta-1 selective agents (like metoprolol and atenolol) have fewer systemic side effects than non-selective agents (like propranolol and carvedilol) 2
• Lipophilicity: Hydrophilic beta blockers (like atenolol) have limited penetration into the brain and are less likely to cause central nervous system effects 3

Other Potential Side Effects of Beta Blockers

1. Cardiovascular effects: Bradycardia, heart block, hypotension 2
2. Respiratory effects: May worsen bronchial asthma (especially non-selective agents) 2
3. Metabolic effects: Weight gain, which could exacerbate conditions like obstructive sleep apnea 2
4. Central nervous system effects: Sleep disturbances with lipophilic agents 3

Clinical Approach to Beta Blocker Selection When Hearing Concerns Exist

Based on the available evidence, the following approach is recommended:

1. Avoid carvedilol in patients with:

   • Pre-existing hearing loss
   • Risk factors for hearing loss
   • Occupations requiring optimal hearing

2. Preferred alternatives when hearing concerns exist:

   • Atenolol or metoprolol, which have not been associated with hearing loss 1
   • These beta-1 selective agents also have better side effect profiles for many patients

3. Monitoring recommendations for patients on beta blockers:

   • Consider baseline audiometric testing before starting carvedilol in high-risk patients
   • Monitor for subjective hearing changes in patients on carvedilol
   • Consider periodic audiometric follow-up for long-term carvedilol users

Common Medications Known to Cause Hearing Loss

For context, drugs commonly associated with hearing loss include:

• Aminoglycoside antibiotics
• Platinum-based chemotherapy agents (especially cisplatin)
• Loop diuretics (furosemide)
• Non-steroidal anti-inflammatory drugs
• Salicylates 4, 5

Clinical Implications

The association between carvedilol and hearing loss has important implications for clinical practice:

• When multiple beta blockers could be appropriate for a patient's condition, consider the potential impact on hearing when making selections
• In patients with pre-existing hearing impairment, metoprolol or atenolol may be preferable to carvedilol
• For patients who require carvedilol specifically for its unique alpha-1 blocking properties or other benefits, the risk of hearing loss should be discussed and monitoring considered

The evidence suggests that hearing loss risk should be included in the risk-benefit assessment when selecting beta blockers, particularly for patients with pre-existing hearing concerns or those in professions where hearing is critical.