The Effects of Substance Misuse on Auditory and Vestibular Function: A Systematic Review.
Amanda Chiao, Michelle L Hughes, Priya Karimuddanahalli Premkumar and 1 others
PMID 37784231WHAT IT FOUND
Substance misuse, particularly opioids and alcohol, is linked to hearing and balance problems in case reports.
Opioid use often causes permanent, profound hearing loss. Alcohol misuse is associated with high-frequency hearing loss and central balance deficits. Evidence is weak and mostly anecdotal.
Key findings
01Prescription opioid misuse is associated with sudden or rapidly progressive, often permanent and profound sensorineural hearing loss, particularly when combined with acetaminophen.
02Chronic alcohol misuse is associated with permanent high-frequency sensorineural hearing loss and central vestibular dysfunction, with severity correlating with duration of use.
03Illicit drug use (cocaine, heroin, amphetamines) is associated with sudden bilateral hearing loss that is often temporary, though poly-substance use may lead to permanent loss.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The evidence base is very weak, with 60% of the 67 included studies being single case reports or case series without a control group. Many studies relied on self-reported symptoms rather than objective audiometric or vestibular testing. Most studies did not account for confounding factors such as noise exposure, head trauma, or other health comorbidities common in this population. The review did not perform a formal risk of bias assessment due to the nature of the included studies. Sex and gender differences were not adequately analyzed, with many studies including only males. Poly-substance use was common, making it difficult to attribute effects to a single substance.
Declared interests
All authors have no conflicts to disclose.
The easy way to misread this
Do not interpret these associations as proven causation or use them to guide specific medical management. The evidence is derived almost entirely from low-quality case reports and small cohorts with significant confounding factors. Many patients used multiple substances, making it impossible to isolate the effect of any single drug. Clinical decisions should be based on objective testing and comprehensive patient history, not solely on this review's hypotheses.