Opioid-Associated Hearing Loss: A 20-Year Review from the New Jersey Poison Center

Abstract

Background Opioid-associated ototoxicity is a known complication of opioid exposure, although the mechanism remains unclear. While historically most closely linked to heroin and oxycodone, evolving reports suggest that it may be a class effect of opioids. However, the evidence is limited to case reports. Methods A retrospective review of the New Jersey Poison Center records (ToxiCALL®) identified cases that included both hearing loss and recent opioid exposure between January 1, 1999, and September 21, 2018. Results Forty-one cases were identified, mean age 29.4 years, 51% (n = 21) were male. Reported heroin exposures comprised 51% (n = 22), 18 of which were heroin alone. The next most commonly cited opioids were oxycodone (n = 7), methadone, (n = 4), and tramadol (n = 3). Hearing loss was described as tinnitus in 24% of cases, hypoacusis in 37% of cases, deafness in 29% of cases, and mixed tinnitus/hypoacusis in 10% of cases. Only 34% (n = 14) of cases were associated with a potential hypoxic event.Of the cases that documented resolution data, 21% (n = 4 of 19) reported no improvement at time of hospital discharge. Discussion Opioid-associated ototoxicity appears to be a hypoxia-independent adverse effect since most of the reported cases did not involve a known contributory hypoxic event. It occurs with a wide array of opioids, which supports an opioid receptormediated mechanism. The ototoxic effect may be self-limited in many patients. Conclusion Opioid-associated ototoxicity was most commonly associated with heroin exposure and appeared independent of hypoxic events. Further investigation that clarifies the risk factors and long-term outcomes is needed.

Opioid receptor activation modulates the calcium current in the cochlear outer hair cells of the rat

“…This study investigated the opioid actions on isolated cochlear hair cells. Opioids have been proposed to protect the auditory system from possible damage because of intense stimulation, although their use for therapeutic or pleasurable purposes is associated with hearing impairment (Mozeika et al, 2020; Nguyen, Lopez, et al, 2014). Therefore, it is relevant to study the effect of opioids on the cochlea to define their functional expression and action mechanism.…”

Can You Repeat What You Just Said? A Case of Unusual Hearing Loss

“…Sensorineural hearing loss is another unusual complication of an opioid overdose. 12 Symptoms can be as mild as transient tinnitus and can be as severe as permanent deafness. It has been associated with several mu receptor agonists including heroin, oxycodone, methadone, and tramadol, among others.…”

“…The clear majority of opioid associated hearing loss cases are bilateral. 12 In a retrospective review of 41 cases reporting hearing loss after opioid overdose in New Jersey Poison Center records over the last two decades, 12 reported complete deafness, 15 reported hypoacusis, 10 reported tinnitus, and 4 cases reported mixed auditory dysfunction. Of these cases, 7 reported complete resolution, 8 reported partial resolution, 4 reported no resolution, with the remainder not including resolution data.…”

Drug-Induced Deafness: A Rare Case of Bilateral Sensorineural Hearing Loss Following Speedballing

“…Although the pathophysiology of opioid-associated hearing loss is unclear; numerous theories have been proposed. Two of the common theories are ischemic cochlear secondary to vasospasm or vasculitis and the direct effect of opioids on opioid receptors [ 13 ].…”