by Neil Bauman, Ph.D.
A man asked,
If Ibuprofen (Advil), Aspirin, Naproxen (Aleve), and Acetaminophen (Tylenol) are ototoxic, what’s safe for over the counter pain relief?
I don’t keep track of all the over-the-counter (OTC) pain relievers or any other drugs for that matter. I just keep track of drugs with ototoxic side effects. As a result, I can’t tell you the drugs that are “safe to take”.
However, the above drugs you mention, although all ototoxic, when taken in low doses and for short periods are probably not going to cause severe or permanent ototoxic side effects. But taken in higher doses, for longer periods or taken regularly in lower doses over a period of months can and do damage ears.
Instead of taking drugs for pain, why don’t you first consider natural alternatives. These differ depending on the pain. For example, for minor pains, I just tough it out. Hot packs and cold packs work in many cases. Depending on the source of pain, I use a chiropractor. Then too, there are a number of herbs for pain—again depending on the source of pain—for example, Feverfew is good for headaches. Sometimes you really need bed rest. Other times you really need exercise. All these things are safer alternatives than drugs—and none of them cause ototoxic side effects.
Another man asked, “Please send me in order the ototoxicity ranking of the below drugs so if I have to take one I can consider my options. But first let me guess. I promise I haven’t goggled any of this. This is my own experience. In order of ototoxicity:
- Ibuprofen
- Excedrin
- Aspirin
- Aleve
- Tylenol”
That’s was a good attempt. It goes to show how everyone’s experience is different. However, on the average, here’s my order—from least ototoxic (Class 1) to most ototoxic (Class 5)
- Acetaminophen (Tylenol) (normally Class 2—but can be class 5)
- Acetylsalicylic acid (Aspirin, Excedrin) (Class 2)
- Ibuprofen (Advil, Motrin) (Class 3)
- Naproxen (Aleve) (Class 4)
Now let’s look at these drugs in more detail so you have a better understanding of their ototoxic ranking.
Acetylsalicylic acid (Aspirin) almost always causes temporary side effects (tinnitus and hearing loss). So if you take it and notice increased tinnitus and reduced hearing, when you get off it, your tinnitus should go away in 3 or 4 days and your hearing return in a week or so. Also, typically you need to take 6 or more Aspirin a day to get tinnitus (unless you are particularly sensitive to Aspirin). So if you don’t take too much per day, this is probably the way to go.
Acetaminophen (Tylenol) in normal doses for short periods (i.e. a couple of weeks or less) shouldn’t give you any problems. But recent research has shown that taking Acetaminophen regularly (say a couple of times a week for a year) increases your risk of hearing loss 99%. Thus if you only take it occasionally or for short periods at normal doses, it shouldn’t bother your ears much if at all. Note, taking Acetaminophen in very high doses for 2 or more months can cause massive hearing loss—hearing loss so bad you will need a cochlear implant, if it doesn’t kill your liver first.
If I were going to take one of the above drugs, it would be one of those two. Naproxen and Ibuprofen are more ototoxic and since their side effects can be permanent, I put them at the bottom of the list.
I have been researching for days on Google and just saw this page … I WISH I had seen it first. I have been so careful but have failed in my research. I am a 49 year old woman and I have had tinnitus for the past 4 months. I was so cautious and afraid to take any pain killers/muscle relaxers/anti inflammatories because they are ototoxic and I didn’t want to worsen this condition at all! I was told acetaminophen was not! I have been taking it the past 5 days …. and only one day I took the 4,000mg in a 24 hour period (the maximum dosage)… the other days, about 4 days I took between 2,000 – 3,000 in a 24 hr. period. Is that considered high dose? Last night I noticed the ringing got a bit louder, but don’t know if that’s my anxiety, if it happens temporarily or if I’ve done more damage…… What is your suggestion? Is this temporary or permanent? Did I overdo the dosage? Please advise. Thank you so much.
Hi Dina:
Up until 6 years ago, acetaminophen was thought not to be ototoxic. In the 2nd edition of my drug book, I still thought that. But in 2010 disturbing studies showed that acetaminophen is indeed ototoxic and can cause hearing loss. I included this information in the 3rd edition. Since then, I’ve discovered that acetaminophen can also cause tinnitus. So don’t beat yourself up over this–a lot of people don’t know this information yet.
To be sure, many people take it without having ototoxic side effects, but those that regularly take it run the risk of hearing loss and tinnitus.
If your body is more sensitive to this drug, then the doses you have taken may have caused the tinnitus, or like you said, it may be your anxiety making your tinnitus worse. Anxiety does that.
I can’t say whether your tinnitus is permanent or not–only time will tell. In the future, you probably should keep the doses down to a much lower level if you need to take acetaminophen–fly under the ototoxic radar so to speak.
You can’t do anything about the past, but you can do things now to stop your tinnitus from becoming worse. The thing you need to do is not worry about your tinnitus. Instead, you need to focus away from your tinnitus. Treat it as an inconsequential sound like the sound your fridge makes and totally and completely ignore it. That will allow it to fade into the background and not bother you.
Focusing on it will just make it worse and worse, so you don’t want to do that. So work on keeping your anxiety under control.
Cordially,
Neil
Tylenol for me is the worst offender for hearing loss and tinnitus! And while I appreciate all the holistic approaches to pain… What does one do for a very painful sinus infection?
Hi Kimberly:
Obviously, get rid of the infection, not treat one of the symptoms which doesn’t solve the basic problem. Have you been taking antibiotics for this sinus infection, or otherwise treating it? That’s what I’d do first.
Cordially,
Neil
Hi Dina, I too have suffered with tinnitus. As a matter of fact that is why I am writing this at 3 something in the morning. The ringing was so loud that it woke me up. I was wondering if you knew that there are also pollutants that cause tinnitus. I was researching the air pollution in our area and found that some of the pollution here can cause tinnitus. It is hard to find but the information is out there. Good luck with this. Connie
Hi Dina
I am the same age and I spoke to my Dr about Tylenol and he said the max dose is 3000. I don’t know about the damage being permanent. Hopefully that will help but also remember Tylenol is hard on the liver same as I ibuprofen is hard on the kidneys day in and day out!
Thanks for the information! Where can I find out more? Especially regarding the mechanism for which ototoxicity increases risk for noise induced hearing damage and the relative danger of the different drugs for it – thanks!
Hi John:
I have compiled all I know about the various ototoxic drugs and whether they are sensitive to noise, etc. into my book “Ototoxic Drugs Exposed” currently in its 3rd edition. So that is where you will find this kind of information (if it is known) in a easily readable format. You can get this book at http://hearinglosshelp.com/shop/ototoxic-drugs-exposed/.
Other than that, you can spend hours and hours searching the Internet for this kind of information, but it is not easy to ferret it all out.
Cordially,
Neil
Thank you for this information. I have been taking acetaminophen 1300 to 2600 mgms daily for past several weeks for persistent pain. I have noted an increase in tinnitus and variability in hearing at times lately. Also some worsening in balance at times (had a cerebellar stroke 9 months ago). I’m going to stop the acetaminophen and find other means for pain control such as boswellia and ashwaghandha and acupuncture.
Hello, I am taking 2 paracetamol 3 or 4 times a day for pain. I have been taking it for about 6 to 9 months. Would this cause my hearing loss and severe tinnitus? If I go off it now will my hearing and tinnitus improve? Please help me I am desperate.
Hi Barbara:
Taking Paracetamol (Acetaminophen) regularly for a number of months can certainly result in hearing loss and tinnitus. As far as I know, the hearing loss tends to be permanent.
However, there is some hope for preventing hearing loss while taking Paracetamol. Here is an excerpt from my book, “Ototoxic Drugs Exposed” (http://hearinglosshelp.com/shop/ototoxic-drugs-exposed/).
“Doctors now believe that Acetaminophen depletes glutathione, a powerful natural antioxidant that helps protect our hearing from the effects of free radicals that are produced when our ears are exposed to loud noise, to prescription drugs and to various chemicals. When glutathione levels are reduced, the free radicals floating around in the cochlea zap (kill) the hair cells, resulting in some degree of sensorineural hearing loss.
Since it appears that Acetaminophen does indeed deplete the body’s supply of glutathione, then it follows that taking glutathione at the same time as taking Acetaminophen, helps protect your ears from any resulting hearing loss, not to mention preventing or reducing damage to your liver. Note: since glutathione is not easily absorbed through your stomach, a good alternative is to take N-acetyl-cysteine (a major building block of glutathione) instead, and let your body convert it to glutathione.”
So that is something you might want to try.
Since tinnitus often accompanies hearing loss, if the hearing loss is permanent, then you tinnitus may also prove to be permanent. Even so, you don’t have to let your tinnitus ruin your life. You can take control of it so it won’t bother you much or at all. I explain how to do this in my book, “Take Control of Your Tinnitus” (http://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/ ) especially in Chapter 16.
Cordially,
Neil
Having bad headaches with tinnitus can I take an Excedrin I don’t like taking too much Tylenol will not take Excedrin too many times
So I can’t take a Tylenol for headaches and/or pains when I have ringing in my ear? What will I do?
Hi Tyler:
You could investigate non-ototoxic natural pain relief solutions. You can read more about it at http://hearinglosshelp.com/blog/twelve-natural-non-ototoxic-pain-relief-solutions/ .
Cordially,
Neil
Hi, I just started having tinnitus. I’m curious as to what the heck do I take to get it to stop.
Hi Bria:
It all depends on what caused it in the first place. Sometimes, if its caused by taking one of the hundreds and hundreds of drugs that can cause tinnitus, its as simple as stopping taking the drug. If your tinnitus is due to noise exposure, its not easy to stop it. Often, you have to learn how to habituate to it so it no longer bothers you and fades into the background. If it’s because your head, neck or jaw are out of proper alignment, then getting them adjusted so they are all in proper alignment is all it may take. If it was caused by excess stress or depression, then getting those under control can bring your tinnitus under control also.
So the first step is figuring out what likely caused it.
Cordially,
Neil
Hello Dr Bauman,
I am scheduled for a total knee replacement in early June and I’m very concerned about how to handle the pain that I am told occurs for the first 3 weeks post op. I have a profound hearing loss but I am still able to communicate via hearing aids + lip reading in quiet settings and very small groups. Can you please offer some suggestions?
Hi Pollie:
You’ll need to take some pain killers. But to reduce the possibility of damaging your ears you should take the lowest dose possible and take it for the shortest time possible. Doctors typically will prescribe narcotics and you don’t want to get hooked on them.
The pain may not be as bad as you imagine. I know when I recently had back surgery, I found I could stand the pain and used cold packs and rest as needed, rather than take any pain killers. It was a bit uncomfortable at first, but I never even took as much as a single aspirin.
You probably won’t be able to do that, but taking fewer drugs and in lower doses–just the minimum you really need will go a ways towards protecting your remaining precious hearing.
Cordially,
Neil
Is Excedrin pills for tension headaches ototoxic
Hi Ron:
Excedrin is just Aspirin and Aspirin is ototoxic to some degree. Typically it is dose dependent. Low doses typically don’t cause ototoxic side effects to appear, but higher doses can. The dividing line between low and high doses is somewhere around 5 or 6 adult aspirin a day. So, for example, taking one baby aspirin a day is highly unlikely to cause tinnitus or hearing loss, but taking 6 or 8 adult aspirin a day will often cause both tinnitus and hearing loss.
The good news is that when you stop taking aspirin, generally the tinnitus goes and your hearing comes back–but there are exceptions so you always want to be careful.
Cordially,
Neil
I developed T 2 weeks after being diagnosed with Covid. I’ve never had before and am now 1 month post and still having T. Do you think this is permanent?
Hi LaToya:
While Covid-19 can result in tinnitus, I don’t have any good information on the permanency of the resulting tinnitus. What you need to do is not focus or obsess over your tinnitus. Rather, ignore it by focusing on the loves of your life and let it fade into the background where it won’t bother you–so whether it ultimately goes away or not won’t matter.
Cordially,
Neil
What would you recommend as far as migraine medications go?
I have read that triptans are also quite ototoxic? I’ve avoided triptans due to this. My migraines will last 3 days so I need something I can take for 3 days that won’t exacerbate my already bad tinnitus.
Thank you!
Hi Linda:
I don’t know which medications doctors prescribe for migraines so can’t help you there. However, if you ask your doctor for a list of drugs that work for migraines, I can tell you which, in my opinion, is the least ototoxic.
Cordially,
Neil