title: Impact of nonaspirin nonsteroidal anti-inflammatory agents and acetaminophen on sensorineural hearing loss: a systematic review.
abstract: OBJECTIVE
  To perform a systematic review evaluating the association between sensorineural hearing loss and (1) nonsteroidal anti-inflammatory drugs (NSAIDs) as a class, (2) NSAIDs available over the counter, (3) NSAIDs in short intravenous courses, (4) prescription NSAIDs utilized by patients without systemic inflammatory conditions, (5) prescription NSAIDs in patients with arthritides, and (6) acetaminophen with and without concomitant narcotic usage.
  
  
  METHODS
  Computerized searches of PubMed, EMBASE, and the Cochrane Library were updated through May 2014, along with manual searches and inquiries to topic experts.
  
  
  METHODS
  The systematic review was performed according to an a priori protocol. Data extraction was performed by 2 independent investigators, and it focused on relevant audiologic measurements, methodological elements related to risk of bias, and potential confounders.
  
  
  RESULTS
  The 23 criterion-meeting studies included a total of 92,532 participants, with mixed results. Sulindac was the only specific agent to have been studied with formal audiometry in a randomized double-blind placebo-controlled trial in which hearing was the reported primary outcome: Although an effect was seen in the unadjusted analysis (pure tone threshold>15 dB, 9.3% vs 2.9%; relative risk [RR], 3.2; confidence interval [CI], 1.09-9.55; P=.02), the effect dissipated in the adjusted analysis (P=.09). There was a significant effect on self-reported hearing loss from NSAIDs as a class (RR, 1.21; CI, 1.11-1.33), ibuprofen (RR, 1.13; CI, 1.06-1.19), and acetaminophen (RR, 1.21; CI, 1.11-1.33), but no formal audiometric data confirm or refute this suggested effect. Audiometry has demonstrated profound loss in some instances of acetaminophen-narcotic combination ingestions.
  
  
  CONCLUSIONS
  Data are varied regarding the impact of NSAIDs and acetaminophen on population hearing health.
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Meghann E
authors.initials: ME
authors.lastname: Kyle
authors.affiliation: Texas Tech Health Sciences Center, Lubbock, Texas.
authors.forename: James C
authors.initials: JC
authors.lastname: Wang
authors.affiliation: Harvard Medical School, Boston, Massachusetts jennifer_shin@meei.harvard.edu.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Shin
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001299:Audiometry; D006309:Hearing / Q000187:drug effects*; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D012307:Risk Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen
keywords: acetaminophen; diflunisal; fenoprofen; hearing loss; ibuprofen; indomethacin; ketorolac; naproxen; nonsteroidal anti-inflammatory drugs; piroxicam; pirprofen; sulindac