(816) Chronic Prescribed Opioid Use and Adverse Audiovestibular Outcomes: Evidence From a Large Real-World Cohort

Introduction: While opioid overdose has been linked to sensorineural hearing loss (SNHL), the effects of long-term prescribed opioid therapy remain unclear. Using a large, real-world cohort, we evaluated if chronic opioid therapy is associated with adverse hearing and vestibular outcomes compared to the non-ototoxic analgesic duloxetine, a guideline recommended alternative for musculoskeletal pain.

Methods: This retrospective study used the TriNetX Research Network to identify patients (2006–2024) with dorsalgia or osteoarthritis treated for ≥1 year with opioids or duloxetine, defined by an initial prescription within one year of diagnosis and subsequent prescriptions at 6–12 months and beyond 12 months. Patients with ototoxic medication exposure or diagnoses of depression, anxiety, or substance abuse were excluded. Cohorts were propensity score–matched 1:1 for age, sex, race, Charlson comorbidity markers, and psychiatric disorders. Outcomes at 3, 5, and 10 years included sensorineural hearing loss, sudden hearing loss, tinnitus, and vestibular dysfunction; constipation served as a positive control, and conductive hearing loss and atopic dermatitis as negative controls. Additional matched analyses compared opioid vs. no opioid use and duloxetine vs. no duloxetine use.

Results: Compared with duloxetine, opioid treated patients (n=4,064/group) had higher risks of vestibular dysfunction at 5 years (RR 1.85, 95% CI 1.20–2.72, p=0.004) and bilateral SNHL at 10 years (RR 1.73, 95% CI 1.28–2.35, p< 0.001). Constipation was more common in the opioid cohort at all time points (p < 0.001), while atopic dermatitis was not increased (p=0.235 at 10 years). Duloxetine showed no association with hearing outcomes (n=4,001). Opioid versus no-opioid analyses (n=102,164) suggested higher hearing outcomes rates but failed negative controls.

Conclusions: Chronic prescribed opioid use may be associated with higher rates of SNHL and vestibular dysfunction compared to the non-ototoxic analgesic duloxetine, supporting investigation of mechanisms of opioid ototoxicity to inform prescribing practices for pain management.