The Contribution of Ototoxic Medications to Hearing Loss Among Older Adults

Author(s): Joo, Yoonmee | Advisor(s): Wallhagen, Margaret | Abstract: Background: Age-related hearing loss effects negatively on an individual’s physical, psychosocial, and social status. Hearing loss may be accelerated in patients taking ototoxic medications. Given the high prevalence of hearing loss, drug-related ototoxicity among older adults may be a critical public health problem.Objectives: The aims of this dissertation were: 1) to identify risk factors of age-related hearing loss from a literature review; 2) to explore the prevalence of ototoxic medication use and the associated factors for ototoxic medication use; 3) to investigate the association of ototoxic medication use with incidence and progression of hearing loss.Methods: A search of the literature on risk factors for age-related hearing loss was performed using the electronic PubMed database. The research data were extracted from the Epidemiology of Hearing Loss Study datasets. The cohort was examined in 1993-1995 (n = 3753), 1998-2000 (n = 2800), and 2003-2005 (n = 2395) in Beaver Dam, Wisconsin. Medication use was obtained from the standardized questionnaire that was administered by the examiners. Hearing loss was defined as a pure tone average at 500, 1000, 2000, and 4000 Hz greater than 25 dB HL in either ear. Results: The Literature review revealed that the most consistently strong risk factors for age-related hearing loss across the studies were genetics, current smoking, diabetes, cardiovascular diseases, and obesity. The prevalence of any ototoxic medication use increased from 84% to 91% over the 10-year follow-up period. Non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and diuretics were common ototoxic medications taken by older adults. Hypertension, diabetes, cardiovascular diseases, and history of smoking were associated with ototoxic medication use. Participants who took loop diuretics had a high incidence of hearing loss for 10 years. Participants who took NSAIDs or a loop diuretic had worse progression of hearing loss over 10 years. Also, the use of concomitant ototoxic medications was associated with the incidence and severity of hearing loss.Conclusion: Ototoxicity may interact with aging leading to a more severe hearing loss than that associated with age alone. The findings suggest that ototoxic medications should be considered a potentially modifiable contributor to age-related hearing loss.