Can Ibuprofen Worsen Tinnitus?
Yes, ibuprofen can worsen tinnitus in some individuals, particularly with frequent use. According to clinical evidence, NSAIDs including ibuprofen are associated with potential central nervous system effects including tinnitus 1.
Mechanism and Risk Factors
- Tinnitus is recognized as a potential central nervous system adverse effect of NSAIDs, including ibuprofen 1
- The risk appears to increase with more frequent use of NSAIDs, as demonstrated in a longitudinal study showing that frequent NSAID use was associated with higher risk of incident persistent tinnitus 2
- Compared with women using NSAIDs <1 day/week, those using NSAIDs 4-5 days/week had a 17% increased risk of developing persistent tinnitus 2
Evidence on Different Analgesics and Tinnitus
- NSAIDs (including ibuprofen): Frequent use is associated with higher risk of developing persistent tinnitus 2
- Acetaminophen: Similar to NSAIDs, frequent acetaminophen use (6-7 days/week) was associated with an 18% increased risk of developing tinnitus compared to infrequent use 2
- Aspirin: Low-dose aspirin does not appear to increase tinnitus risk, but moderate-dose aspirin used frequently may increase risk, particularly in younger individuals (under 60 years) 2
Clinical Considerations
- Tinnitus from NSAIDs is reversible in many cases but may persist in some patients even after discontinuation 3
- Patients with pre-existing tinnitus should be cautioned that NSAIDs like ibuprofen might exacerbate their symptoms 1
- Individuals requiring pain management who experience tinnitus should be informed about the potential relationship between analgesic use and tinnitus 2
Management Recommendations for Patients with Tinnitus
- For patients with tinnitus who require pain management, consider using the lowest effective dose of NSAIDs for the shortest duration possible 1
- In patients with pre-existing tinnitus, monitor for worsening of symptoms when starting NSAID therapy 1
- For patients who develop tinnitus while on ibuprofen or other NSAIDs, consider alternative pain management strategies 4
- Acetaminophen may not be a safer alternative as it also shows association with tinnitus risk with frequent use 2
Special Populations
- Younger individuals (under 60 years) may be at higher risk for analgesic-associated tinnitus, particularly with moderate-dose aspirin 2
- Patients with hearing disorders or other risk factors for tinnitus should use NSAIDs with caution 1
While pharmacological treatments for tinnitus itself have been investigated, including anticonvulsants, antidepressants, and benzodiazepines, none have shown consistent evidence of efficacy 4, 5. Therefore, avoiding potential triggers like ibuprofen in susceptible individuals remains an important preventive strategy.