Hydrocodone use and sensorineural hearing loss

Pain Physician. 2007 May;10(3):467-72.


Background: The hydrocodone/acetaminophen combination is one of the most commonly used analgesic preparations. Isolated incidences of suspected association between hydrocodone abuse and rapidly progressive hearing loss have been reported. In this study, we describe the clinical characteristics of 5 patients presenting with progressive hearing loss and a history of hydrocodone use.

Methods: Patients presenting with rapidly progressive bilateral hearing loss who had a documented history of hydrocodone use were selected for the study. The presentation, audiologic findings, associated comorbidities, and treatment outcomes were reviewed.

Results: All patients displayed rapidly progressive sensorineural hearing loss without vestibular symptoms. Hearing loss was asymmetric in 3 patients at initial presentation, but progressed to profound loss, usually within months. Steroid treatment has no effect on the progression of the hearing loss. The admitted quantity of hydrocodone consumed ranged from 10 to 300 mg per day. Hepatitis C was the most common comorbidity, present in 60% of the patients. All patients underwent cochlear implantation with satisfactory results.

Conclusions: The chronic use of hydrocodone can be associated with progressive sensorineural hearing loss. Successful auditory rehabilitation can be achieved with cochlear implantation. Genetic polymorphisms of drug metabolizing enzymes as well as associated comorbidities such as hepatitis C infection may be significant in the development of hydrocodone ototoxicity, though additional investigations are necessary.

Publication types

  • Case Reports

MeSH terms

  • Acetaminophen / adverse effects
  • Adult
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / pharmacokinetics
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Cochlea / drug effects
  • Cochlea / physiopathology
  • Cochlear Implants
  • Comorbidity
  • Cytochrome P-450 CYP2D6 / genetics
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Hearing Loss, Sensorineural / chemically induced*
  • Hearing Loss, Sensorineural / physiopathology
  • Hepatitis C / epidemiology
  • Humans
  • Hydrocodone / adverse effects*
  • Hydrocodone / pharmacokinetics
  • Inactivation, Metabolic / genetics
  • Male
  • Middle Aged
  • Neurotoxins / adverse effects
  • Neurotoxins / pharmacokinetics


  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Neurotoxins
  • Acetaminophen
  • Hydrocodone
  • Cytochrome P-450 CYP2D6