Can Tylenol Cause Tinnitus?
Yes, frequent acetaminophen (Tylenol) use is associated with an increased risk of developing persistent tinnitus, with the highest risk occurring in individuals using acetaminophen 6-7 days per week.
Evidence for Acetaminophen-Induced Tinnitus
The most robust evidence comes from a large longitudinal cohort study of 69,455 women followed over 22 years, which demonstrated that frequent acetaminophen use was independently associated with higher risk of incident persistent tinnitus 1. Specifically:
- Women using acetaminophen 6-7 days per week had an 18% increased risk of developing persistent tinnitus compared to those using it less than 1 day per week (hazard ratio 1.18,95% CI 1.07-1.29) 1
- The risk increased in a dose-dependent manner, with greater frequency of use correlating with higher tinnitus risk (p-trend=0.002) 1
- This association remained significant after adjusting for multiple confounding variables 1
Clinical Context and Mechanism
Acetaminophen is recognized as one of over 130 drugs and chemicals with potential ototoxic effects 2. The mechanism likely involves biochemical and electrophysiological changes in the inner ear and eighth cranial nerve impulse transmission 2. While the exact pathophysiology remains unclear, ototoxicity from anti-inflammatory agents (including acetaminophen) is well-documented in the medical literature 2, 3.
Risk Stratification by Usage Pattern
The risk profile varies significantly based on frequency of use:
- Low risk: Occasional use (<1 day/week) - no elevated risk demonstrated 1
- Moderate risk: Intermittent use (4-5 days/week) - modestly elevated risk 1
- Highest risk: Daily or near-daily use (6-7 days/week) - 18% increased risk 1
Important Clinical Considerations
Acetaminophen-induced tinnitus may be irreversible in some cases. While the longitudinal study examined incident tinnitus development rather than reversibility, case reports of other analgesic-induced ototoxicity (such as morphine) demonstrate that hearing-related adverse effects do not always resolve after drug discontinuation 4. One documented case required permanent hearing aid use despite stopping the offending medication 4.
Comparison with Other Analgesics
Acetaminophen is not unique in this risk - other commonly used analgesics also increase tinnitus risk 1:
- NSAIDs (non-aspirin): 17% increased risk with 4-5 days/week use, 7% increased risk with 6-7 days/week use 1
- Moderate-dose aspirin: 16% increased risk in women under 60 years using it 6-7 days/week 1
- Low-dose aspirin: No elevated risk even with frequent use 1
Clinical Recommendations
When prescribing or recommending acetaminophen for chronic pain management:
- Counsel patients about tinnitus risk, particularly those requiring daily or near-daily use 1
- Monitor for early symptoms of tinnitus (ringing, buzzing, roaring sounds lasting >3 months) 5
- Consider alternative analgesic strategies for patients requiring chronic pain management, weighing the specific risks of each agent 1
- Refer promptly to audiology if tinnitus develops, as early intervention may improve outcomes 5
Critical Caveat
The association between acetaminophen and tinnitus does not definitively prove causation - the study was observational and could not account for all potential confounders, including the underlying conditions requiring analgesic use 1. However, the dose-response relationship, biological plausibility through known ototoxic mechanisms, and consistency with other analgesic findings support a likely causal relationship 1, 2.