Frequent Use of Over-the-Counter Analgesics Linked to Persistent Tinnitus

Rendering of blue head with red radiating from ear, tinnitus concept

High doses of aspirin are well known to be associated with reversible tinnitus. Now, researchers at Brigham and Women’s Hospital have determined more typical doses of aspirin and other over-the-counter analgesics are associated with the risk of persistent tinnitus. However, the direction and magnitude differ for individual agents.

Sharon G. Curhan, MD, ScM, and Gary C. Curhan, MD, ScD, of the Channing Division of Network Medicine at Brigham and Women’s Hospital, and colleagues detail the findings in the Journal of General Internal Medicine.


The Conservation of Hearing Study (CHEARS) examines risk factors for hearing loss and tinnitus among participants in several large ongoing prospective cohort studies. The data source for this study was the Nurses’ Health Study II, established in 1989 with the enrollment of 116,430 female registered nurses aged 25 to 42. In this longitudinal cohort study, participants complete questionnaires every two years about demographic, health, and lifestyle factors, including medication use.

Information on tinnitus was collected in 2009, 2013, and 2017 by questionnaire, and tinnitus was defined as persistent if it occurred several days per week or more.


The associations of low-dose (≤100 mg) and moderate-dose (≥325 mg) aspirin differed by age (p-for-interaction, 0.003):

  • Among women age ≥60, frequent use of low-dose aspirin (6–7 days/week) was associated with a modestly lower risk (~10%) of persistent tinnitus
  • Among women under 60, frequent use of moderate-dose aspirin was associated with a 16% higher risk of persistent tinnitus


More frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) was independently and significantly associated with higher risk of persistent tinnitus, and the magnitude of the risk tended to be greater with increasing frequency of use (p-for-trend, 0.001).

  • Among frequent users of NSAIDs, the multivariable-adjusted relative risk for persistent tinnitus was up to 17% higher, compared with women who used NSAIDs <1 day/week
  • The association between NSAID use and tinnitus did not vary significantly by age

COX-2 Inhibitors

Use of cyclooxygenase-2 inhibitors on ≥2 or more days/week was associated with a 21% higher risk of persistent tinnitus compared with use <2 days/week.


More frequent use of acetaminophen was also independently and significantly associated with a higher risk of persistent tinnitus, and the magnitude of the risk tended to be greater with increasing frequency of use (p-for-trend, 0.002).

  • Compared with women who used acetaminophen <1 day/week, the multivariable-adjusted relative risk was 8% higher for use 4-5 days/week and 18% higher for use 6-7 days/week
  • The interaction between acetaminophen use and age was statistically significant but only clinically meaningful for use 4–5 days per week

Applying the Findings to the Clinic

This study cannot prove causality, but the results are biologically plausible. The influence of analgesics on auditory function may involve alterations in cochlear blood flow, response to inflammation, susceptibility to oxidative damage, and neurotransmission along central auditory pathways.

Patients should be monitored for ongoing use of over-the-counter and prescription analgesics, and ototoxicity should be considered when weighing the benefits of these medications against potential risks.

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