by Neil Bauman, Ph.D.
© Sep 2016; revised May, 2019
The beta blocker drug Propranolol (Inderal) can mess up your correct perception of pitch.
One musician explained,
I am a musician and have occasionally taken Propranolol to deal with particularly stressful concerts. I gave up taking it as I found that the frequency with which I heard various pitches was affected.
Another musician reported,
I experimented using Propranolol to avoid stage fright (I play the guitar) and I noticed something very strange. When I take Propranolol, I don’t have stage fright, but I hear my guitar out of tune. (I thought it was either my guitar or the tuner, but not so.) In addition, the equalization is awful—something sounds wrong with the gain, but I can’t really explain it. It’s a double-edged sword because when I take the Propranolol, I don’t have stage-fright, but I can’t enjoy the music because it sounds so bad. The good news is that after a couple of days this gradually goes away and I hear my guitar at proper pitch once again. I think it’s something related with the 5-HT1A receptor (Propranolol is an antagonist) which is linked with some types of depression.
So far, I only know of this one beta-blocker that causes this sense of distorted pitch, but since all the drugs in a given class of drugs can have the same side effects, I wouldn’t be surprised if other beta-blockers are subsequently found to have this peculiar ototoxic side effect.
__________________________
Now, three years later it appears that besides Propranolol, three other beta blockers are also implicated in altering pitch perception–namely, Atenolol, Bisoprolol and Metoprolol.
Thus if you are taking one of the beta blockers–drugs ending in “olol”–and experience changes in pitch perception, that drug is very likely the culprit. If you stop taking that drug, hopefully your pitch will return to normal.
In addition to beta-blockers, another drug (in an unrelated drug class) that messes up pitch perception is Carbamazepine.
It happened to me with atenolol too. Just don’t remember well but I think that where 100 mg. On the other hand try 12,5 mg dose, didn’t happen the pitch problem but wasn’t enough to avoid well the stage fright. Tried pregabalin too and only sometimes caused this. Strange phenomenon… the brain is amazing, Scientists should study this thing and put some name… or does it have a name?
I’m taking metoprolol tart for high blood pressure. I’ve lost pitch also. Any relation to my med. and propranolol?
Hi Charles:
I don’t have any specific information that indicates that Metoprolol causes pitch distortion like Propranolol does, but because they are in the same drug class, I wouldn’t be at all surprised if it could also happen with the Metoprolol.
Cordially,
Neil
I take Atenolol daily for hypertension and I was wondering if this contributes to my loss of pitch (strangely bass notes only) when gigging in my rock band? I thought it was simply the stage volume doing this, but now I am not so sure
Hi Perry:
I don’t have any specific information on whether Atenolol can cause pitch distortion, but it wouldn’t surprise me if it did.
A few drugs seem to be known for doing this, but I’ve receiving more and more reports of other drugs doing this too. What makes you think it is the Atenolol?
Cordially,
Neil
I take a number of drugs for hypertension , cholesterol and one for pre-diabetes. Six months ago (or so) I noticed I was hearing music, piano or orchestra, 1/2 tone higher or lower. I am 86. Is there a cure for this? I do not take a beta-blocker.
Hi Larry:
If you listed the drugs you are taking, perhaps I can tell you which drug or drugs is the likely culprit in causing your change in proper pitch perception. There are several drugs with this characteristic. The obvious cure is to quit taking the drug that causes pitch to distort.
Cordially,
Neil
Thank God for you!!!
I experienced a sudden shift in pitch in both my ears (about 2 full notes down) while I was at work. I was very worried and was doing tons of google searching. I was starting to think I had to go to the ER to make sure I didn’t have any brain bleeding or a virus when I found this.
I took Propranolol (60mg) about 3 hours before. I’ve never taken 60mg before, but I have taken 50mg with no bad effects and few beneficial effects.
Incredibly frustrating and rather alarming.
Hello Dr Bauman
I have sudden ringing in ears and also high sensitivity to high pitch noise like water running, washing dishes, motorcycle and so on, I hear everything 10 times louder, I did go to ENT and they are trying but have not found any cause. I read your article and I wanted to let you know that I have been taking Metoloprol 100 mg twice a day for last 5 years and before that I took lopresor 100 mg twice a day too. Also My tinnitus increases after I take Triam/HCTZ 37.5-25 mg, I told about ti to mu dr but he insists I take this medicine for one week, also he has given me ativan .5 mg per night. Can you suggest what should I do, which medicine to stop or take, I used to take Aldactone but have stopped right now.
Thanks
Hi Ram:
Metoprolol and Lopresor are the same drug–just the generic and brand names respectively. Hundreds upon hundreds of people have reported to the FDA of getting tinnitus from taking Metoprolol so it is a well-known side effect. And double the number of reports of getting hearing loss from this same drug. Some people have also reported hyperacusis from taking this drug–and that is what you are experiencing when you say certain sounds seem 10 times louder. The good news is that some people find some of these side effects go away when they stop taking this drug.
Triamcinolone/Hydrochlorothiazide both also can cause tinnitus in some people.
Lorazepam (Ativan) can also cause tinnitus, hearing loss and hyperacusis. Since your ear problems came on suddenly AFTER you began taking the Ativan (is that correct), then I’d suspect the last drug you started taking, namely Ativan, and it fits the bill for what you are now experiencing. So that is the drug I’d suggest you consider stop taking and see what happens.
Cordially,
Neil
I am 93 years old, a retired music history professor, and have always enjoyed excellent hearing. I know probably thousands of pieces of music from all eras.
About two years ago I began to have a slight hearing loss and have used a hearing aid off and on since then.
However, the more serious and, to me, terribly frightenning and depressing thing which has occurred is that my pitch perception and ability to hear correctly any number of pieces has been totally comprimised.
As an example, permit me to quote the opening of the G major violin sonata, Opus 78, of Brahms in which the opening violin line is D-D-D-C-B-G-D, E-E-E- G. My ear hears the three Es as “D-D-D”. I even checked to see if, perhaps Brahms had written an earlier version using those pitches.
In addition, everything sounds distorted, with bass lines muddy and ensemble sounds totally distorted. It has become so completely disorieting that it has led me to have suicidal thoughts.
I’ve also been a fairly good organist, but now, when I pracitce I find that I must check my hands to see which intervals I’m producing. For example, when I play the interval of a fifth, it often sounds like a fourth!
For a number of years I’ve enjoyed presenting courses at our local Senior Center which seem to have been well received. However, now that I’ve got this problem I hesitate to continue, though I can still present theoretical concepts, historical developments and stylistic characteristics of works.
I know, in my mind, exactly how literally hundreds of works, Bach cantatas, Mozart, Haydn chamber music and symphonies, dozens of piano works, SHOULD SOUND, but my mind and/or ears are simply unable to PROCESS the sounds correctly.
In a fugal exposition, for example, after one voice has entered, by the time the second or third voice starts, the music begins to sound more and more like Babbitt, John Cage or Schoenberg, until it is just a jumble of non-sensical garbage!
I’ve been to a number of ENT specialists, one of whom simply told me: “Dr. Miller, you have to understand that the microphone is broken” and suggested I listen to Tschaikowsky instead of softer, more intimate music.
My wife is encouraging me to go to Mayo Clinic in Rochester and be examined by experts there to see what the explanation is. (I have no trouble driving.) I would give anything to be able to hear accurately again. Hearing aid people have no understanding of this problem, and simply want to sell me more expensive aids. Reading material on the subject suggested that, instead of digital hearing aids, which have only been available for about 25 years, I should try to get ahold of an older ANALOG hearing aid. I did, and it made absolutely no difference. The same problem was present.
What I find especially peculiar is that I have never seen this problem discussed or analized in print. (There is a recent book which my son recommended to me, by Oliver Sacks, called “Musicophilia” which deals only indirectly with my problem, and, in addition, has some incorrect statements.)
I can hear fairly well, even without the hearing aids and don’t really use them that much. The problem is not with the volume of the sound, but in the processing of the sounds.
Now, there is one issue here which also needs to be mentioned. I am hypertensive, and am on a number of blood pressure medications, including amlodopine, lovatatin and erbasartin. In addition, I’m on finesteride (prostate) and traxadone (for depession and sleep problems).
In discussing this with my physician, he has indicated that there is no evidence to indicate that these medications produced any side effects which would cause the problem I’m suffering.
I would give anything to be able to hear normally again. Is there no cure or treatment which could improve my condition?? I also have some tinnitus, which manifests itself as a low hum around 60 cycles quite often. In general, I suspect that this is a matter of the destruction of cilia in my inner ear. Is that accurate?
Please forgive me, Dr. Baumann, for such an unforgiveably lengthy email. I would be eternally grateful to you for any adivise or recommedations.
Dr. Franklin S. Miller
Associate Professor of Music
University of Wisconsin-Milwaukee
Hi Franklin:
If you can still remember thousands of pieces of music at 93, you are doing well.
Is your hearing the same in both ears? You just mention wearing one hearing aid. If your ears have different degrees of hearing loss, then you can have pitch and other distortions between them. Non-musicians might not even notice them, but with your trained ears, you notice it right away.
Another problem is that as we age, our brains don’t process sounds as well as they did before. This also results is problems with distortion of all kinds. As far as I know, there is nothing we can do for this problem. (Haven’t figured out how to become younger again!)
Digital hearing aids can be programmed linearly so that they basically act as analog hearing aids, and some elderly people like that sound much better than regular digital aids. Even better, is using old hearing trumpets and horns as they sound perfectly natural–just don’t have all that much amplification.
Part of the problem is that hearing aids can’t make up for brain deficiencies. Sort of look at it as a visual analogy. Think of it conceptually as a piece of glass separating your external ear from your internal ear/brain. If this piece of glass is perfectly clean on both sides, you see (hear) wonderfully well. However, if the glass is dirty you have problems.
Now since you have access to the outside of the glass you can clean and polish it till it is perfectly clear again (equivalent to having the best hearing aids there are–and in this case, assume they are “perfect”. Do this will only help you to hear better to a limited extent because now the problem is the dirty side of the window that you can’t touch. This is what we are up against when we have problems in how our ears/brain process sounds.
I agree with your doctor that the drugs you are on have not been reported to cause your exact problem, but that does not mean they can’t and don’t. All 5 of these drugs are ototoxic to some degree with the Amlodipine the worst by far. Thus, if you wanted to try something, you could get off the Amlodipine for 2 or 3 weeks and see whether your ears improve or not. It’s worth a try in my opinion–but run it by your doctor of course.
Your tinnitus could be from your hearing loss–that is true–and it quite likely is. But also, every one of the drugs you mentioned also have been reported to cause tinnitus, again with Amlodipine being the worst. So again, it might be worth it to get of the Amlodipine and see what happens. If your tinnitus is related to your hearing loss, then nothing will change–unless the Amlodipine is also responsible for your hearing problems.
Your email isn’t excessively long. The more information people give me, the better the chances I have of figuring out what the problems likely are and thus, the best way to try to fix them.
Cordially,
Neil
Dear Dr. Bauman:
I am grateful to you for having taking the time to reply to my inquiry.
I should have indicated that I do use both hearing aids. The hearing loss in the left ear is appreciably greater (called “profound” by the audiologist, whatever that is supposed to mean) than in the right ear.
I have written my doctor proposing exactly what you have indicated: that we stop taking one of the BP medications for a couple of weeks and see what happens. Since you indicate that the Amlodipine is probably the worst offender here, I’ll ask my doctor to experiment with that medication first.
If you would not mind, I’d like to contact you again in two or three weeks to report any kind of prognosis.
Again, many thanks for your kind assistance.
Franklin S. MIller
Hi Franklin:
Profound hearing loss means your hearing loss is 90 dB or greater. After that, you are deaf. My hearing is just on the borderline of profound now–so technically I still have a severe loss.
Sounds like a plan–dump the Amlodipine for a minumum of two weeks and see how your ears are doing.
Regarding hearing aids, here is an article I wrote that may help you better understand why they don’t work for everyone. The link is http://hearinglosshelp.com/blog/why-dont-my-new-hearing-aids-let-me-understand-speech-perfectly/
You can contact me–not a problem. You know where I am.
Cordially,
Neil
Dear Dr. Bauman–
My family physican has given me the go-ahead to temporarily stop the Amlodipine [a couple weeks], but has cautioned me that my systolic numbers may spike a bit. He says that if it is CONSISTENTLY above 160, as measured daily, he may add a very small amount of hydrochlorazide to stablize it until we’re able to determine if there is any improvement with my hearing.
Just thought I’d touch base with you to let you know where we’re at right now. I’ll be emailing you in a couple of weeks with any changes or improvements which might occur. Wish me luck!!
Dr. Miller
Dear Dr. Bauman–
I regret to inform you that I’m not having any luck with my hearing issue.
On Saturday, January 12, after having gone off the amlodopine for a few days, starting on the 9th, I began seeing a real spike in my BP: 180/102, and finally drove over to the ER at 11:45 PM, where they measured it at 235/114!!!
I stayed in ER for two hours, and around 2:00 AM they discharged me after the BP dropped down to around 170/81 and recommended that I restart the amlodopine.
Although I was totally asympto-matic I’m now back on the amlodo- pine and the BP is doing better.
At this point I’m not sure how we’ll continue. There is no change in my hearing–still a low, 60 cycle hum on occasion, and, of course, the pitch distortions/perceptions.
I’ll try to stay in touch. Thanks for your assistance. We’re digging out from about 8″ of snow here!!
Dr. Miller
Hi DR. Franklin, your comments moved me. I wish you are fine and hope you were able to treat your hearing. I was singing terribly at church and couldnt understand i was out of tune, seems that propranolol seems to have something to do with It. Anyways, God Bless
I am taking Bisoprolol Fumarate 2.5mg and Rivaroxaban 20mg for a heart condition (AF). could one or both of these be messing up my pitch perception ? It’s impossible to listen to piano music any more – other instruments aren’t so bad. Would it be worth talking to my GP in case there are alternatives ?
Hi Arthur:
I don’t have any specific information on either of these drugs causing pitch distortion, but if I had to choose, my money is on the Bisoprolol as it can cause you to hear phantom sounds so it may also mess up your perception of sound. Furthermore, it is in the same class as Propranolol which is reported to cause pitch perception. Drugs in the same class often have the same or similar ototoxic properties.
If you need a beta blocker, why not ask your doctor to prescribe one of the ones that hasn’t had many ototoxic reports. For example, Pindolol, Carteolol, Betaxolol, Acebutolol, Nadolol, Labetalol or Nebivolol in that order and see if your pitch perception goes back to normal.
Or you could stop taking the Bisoprolol for a week or two and see if your pitch perception normalizes. (Run that by your doctor of course.) If so, you’d know for sure whether the Bisoprolol is the culprit.
Cordially,
Neil
Thanks for the advice, Neil. I’ll consult my GP and do as you suggest. I’ll post the results – I’m sure I can’t be alone with this problem. Why should piano music be affected to the greatest extent, I wonder ?
Hi Arthur:
I don’t know why you experience more problems with the piano music. I’m no musician, but perhaps it has to do with the complexities of the sounds the piano produces?
Cordially,
Neil
Dear. Dr. Bauman, I
lost my pitch in In Nov. 1916. I did not send a fallow up. I just thought all was lost. I have not touched a key board in the last 3 yearsl My MD prescribed Metoprolol. stopped it 3 years ago I’m now 91
Hi Charles:
I sure hope you meant 2016 or you lost your pitch years before you were born. Was your pitch distortion due to your taking the Metoprolol? Interesting that your pitch did not return to normal when you stopped the Metoprolol. This is what happens to some people.
Cordially,
Neil
I took propranolol for the first time today, and lo and behold, all my phone’s notification sounds are about a half-to-whole step down, and the chime on my Google Homes sound lower as well.
At first I thought it was a system-wide software glitch on Google’s end, but, nope — all me. Confirmed when I realized the tone the fan makes when the HVAC is running is even different.
What a weird side effect. Really happy with the propranolol, though. Fortunate I’m not in a profession dependent on my pitch perception, I guess.
Dr. Bauman,
I am a 59 year old military musician and my ability to hear any kind of pitch left me a week ago. No music sounds right and I can no long play or sing. After reading your article, I suspect that a dramatic increase in Propranolol (which I take for essential tremor) might have caused it, as that was 2 weeks ago. Also, I had Covid, which might have contributed to the problem. My hearing is fine. I truly cannot keep living like this, it is like all the important things in my life have been taken away. Any thoughts?
Hi Lance:
Propranolol can certainly cause pitch distortion, so I’d suggest you get your doctor to prescribe a different drug instead of the Propranolol, and preferrably not a beta blocker as others in this class of drugs have the same pitch distortion property.
Cordially,
Neil
Hi! It’s so interesting that I found this; I’ve taken propranolol for a while, but only the last few times have I experienced a pitch shift. I only take as needed and don’t take as often as I have before. When I do now, I get that head rush feeling and every sound is 1/2 to 1 whole step lower. It goes away as the effects fade. Any idea why I’ve never had this problem before, and do now?
Hi Davis:
I can’t tell you the exact reason. I put it down to drugs being a fickle lot and don’t always do things “logically”. Why can one person take a drug for 10 years without a side effect and another person takes the same drug and the very first pill causes them permanent tinnitus for example.
Or why can one person take a drug and not have any side effects (like you) and then another time they have side effects? That’s just the way it is.
There must be reasons, but there are so many factors involved, you’d have to try and find what is different when the drug “acts up” vs. the rest of the time.
Cordially,
Neil
Hi Dr Neil,
Just my two cents,
It took me several weeks, but I realized it was my Propranolo 40mg BD that caused my pitch distortion.
I am a medical doctor, and also have perfect pitch. I take propranolol for cholinergic urticaria, PRN. I’ve noticed the days I take I hear music and pitch about a quarter-tone flat, and it does ruin the experience. I play piano and violin, and can’t imagine playing violin with this, as it’ll give the tendency to play a quarter tone sharper to my ear whereas the people hearing would find it a little too sharp.
It seems to be reversible, things settle a few days after stopping, but I do wonder if prolonged use will affect my pitch hearing permanently.
Thanks for the article,
Jason
Hi Jason:
Thanks for your story. It seems a good number of people find their pitch off after taking Propranolol. From what I have learned, this is a temporary condition while the drug is in your body. I don’t recall anyone saying they had this pitch shift permanently once they stopped taking the drug. But I suppose it could happen. If there is another drug that would do the job, switching drugs would prevent this pitch shifting from happening and perhaps prevent it from becoming permanent (if that happens, but has not yet been reported to my knowledge).
Cordially,
Neil
Are there any peer-reviewed articles about this? I heard a distorted sound today and am wondering if medication could be the reason
Hi Judi:
I’m not aware of any peer-reviewed articles on this. But peer-reviewed doesn’t make what I wrote any less true. And the best reports are from the people that have experienced this themselves–and their stories are below this article.
If you stop taking Propranolol and your pitch returns to normal, you know the Propranolol is the culprit. You might have to wait 2 or 3 weeks before your pitch perception returns to normal.
Cordially,
Neil