Most conversations about opioid risk focus on the ones we already know — dependency, overdose, respiratory failure. Hearing rarely comes up. But a growing body of research points to a connection most patients, and even many providers, don’t expect: opioids can damage hearing, sometimes suddenly and permanently.
It’s not a widely known risk, and it’s not meant to be an alarming one. The research is nuanced — some studies find real cause for concern, others find no clear pattern at all, depending on dosage, duration, and how the medication is used. But for the families and providers navigating chronic pain management or recovery, it’s a connection worth understanding rather than discovering after the fact.
What the research shows
The clearest evidence comes from a 20-year review of records at the New Jersey Poison Control Center, published in the Journal of Medical Toxicology. Researchers at Rutgers identified 41 cases between 1999 and 2018 where opioid exposure was followed by hearing loss or tinnitus (ringing in the ears). Heroin was involved in just over half of those cases, followed by oxycodone, methadone, and tramadol. Notably, 88% of the cases involved only one substance — not a mix of drugs — which points toward the opioid itself as the cause rather than some other factor.
The effects varied. Some people experienced tinnitus. Others lost partial hearing acuity. Twelve of the 41 people in the study became completely deaf. Most cases affected both ears at once, and the hearing loss often set in suddenly rather than gradually.
Diane Calello, executive director of the NJ Poison Control Center and one of the study’s authors, has pointed to a possible mechanism: the inner ear has its own opioid receptors, and activating them may trigger injury in some patients. That would help explain why hearing loss has been linked to nearly every class of opioid, not just one or two specific drugs — this may be a broader class effect rather than an isolated quirk of a single medication.
Where opioids fit among ototoxic drugs
Opioids aren’t the only medications capable of harming hearing. The American Speech-Language-Hearing Association (ASHA) has identified more than 200 medications — prescription and over-the-counter — with the potential to damage hearing or balance, a category known as “ototoxic” drugs. Common mechanisms include disrupted blood circulation to the ear, which can damage the delicate hair cells responsible for converting sound into signals the brain can interpret.
Importantly, the picture isn’t uniformly alarming. A separate, tightly controlled clinical study on hydrocodone taken at prescribed doses — reviewed in The ASHA Leader — found no clear pattern of hearing damage over 12 weeks of monitored use. That study’s authors were careful to note what it didn’t answer: what happens with higher doses, longer-term use, or misuse. The risk profile for a short course of medication taken exactly as directed looks different from the risk profile for high-dose or prolonged opioid use, which is where most of the documented hearing-loss cases cluster.
A gap in how patients are screened
One of the more sobering findings comes from a literature review published in Audiology and Neurotology: there’s a real disconnect in how patients get asked about this connection at all. Physicians treating sudden hearing loss don’t always ask about substance use. Addiction medicine providers don’t always ask about hearing or balance symptoms. Emergency physicians, often the first to see a patient after an overdose, don’t typically screen for hearing changes either. The result is a connection that’s documented in the research but easy to miss in a real clinical encounter — on both sides of the conversation.
Why this matters for families and providers
For anyone managing chronic pain with opioid medication, or supporting a loved one through recovery from opioid use, hearing shouldn’t be an afterthought. A few things worth knowing:
- Sudden hearing loss or new tinnitus after opioid use is not something to wait out. It can be a medical emergency, and early evaluation gives the best chance of a favorable outcome.
- A baseline hearing test matters before long-term or high-dose opioid therapy begins, the same way it would before starting other ototoxic medications, so any later changes can be caught early.
- Providers across specialties — pain management, addiction medicine, primary care — benefit from routinely asking about hearing changes, and audiologists benefit from asking about medication and substance history.
At Gateway, our audiology team provides comprehensive hearing testing for both children and adults, including baseline evaluations for patients starting medications that carry ototoxic risk. If you or someone you love is managing chronic pain, opioid therapy, or recovery, a hearing evaluation is a simple, low-barrier way to catch a problem before it becomes permanent.
Learn more about Gateway Audiology or schedule an appointment at gatewaymaryland.org.
Sources
- Mozeika, A., Ruck, B., Nelson, L., & Calello, D. Opioid-Associated Hearing Loss: A 20-Year Review from the New Jersey Poison Center. Journal of Medical Toxicology, via PubMed: https://pubmed.ncbi.nlm.nih.gov/32468345/
- Rutgers University. Opioid Use Can Trigger Deafness. https://www.rutgers.edu/news/opioid-use-can-trigger-deafness
- ScienceDaily. Opioid use can trigger deafness. https://www.sciencedaily.com/releases/2020/08/200817144112.htm
- Healio. Opioid-associated hearing loss rare, but should be considered when prescribing. https://www.healio.com/news/primary-care/20200915/opioidassociated-hearing-loss-rare-but-should-be-considered-when-prescribing
- Hearing and Vestibular Loss with Misuse of Opioids and Illicit Drugs: A Review of the Literature. Audiology and Neurotology, Karger Publishers. https://karger.com/aud/article/27/4/271/821486/Hearing-and-Vestibular-Loss-with-Misuse-of-Opioids
- Do Opioids Hurt Hearing? A new study finds no such link when they’re taken as prescribed. The ASHA Leader Archive. https://leader.pubs.asha.org/doi/10.1044/leader.FTR2.23112018.50
- Ameritas. Hearing Loss: A Long-Term Side Effect of Opioid Use. https://www.ameritas.com/insights/drugs-cause-hearing-loss/
Learn More About Gateway Maryland
Gateway Maryland connects people to their worlds and aids individuals in their ability to understand and to be understood. Gateway Maryland has grown into an organization that serves more than 8,000 children and adults every year, helping them communicate more effectively. With programming both on our Baltimore campus and through community-based programming, we provide education, access, and medical support to anyone who needs it.
We envision a society where everyone can understand and be understood and where everyone is treated with integrity, compassion, and equity.
