Sensorineural Hearing Loss in Opioid Substance Abuse: A Case Report

Document Type

Conference Proceeding

Publication Date

5-9-2025

Abstract

Opioid overdose is a major public health concern with complications including respiratory depression, hypoxic injury, and cardiac arrest. A less common and poorly understood complication is acute sensorineural hearing loss. Isolated case reports have documented rare cases of hearing impairment following opioid exposure, however the mechanism of hearing loss and proper treatment management remain unclear. Proposed etiologies include ototoxicity, ischemic injury, and hypoxic damage to the auditory pathways. Treatment typically includes corticosteroid therapy but certain studies suggest hearing loss as an irreversible complication, which highlights our limited understanding on improving hearing outcomes. This report aims to contribute to the limited literature by detailing an instance of acute bilateral hearing loss following opioid overdose.

A 20-year-old male with a history of ADHD, asthma, and marijuana use was found unresponsive at home. The patient presented with pinpoint pupils, hypoxia, and pulselessness, necessitating CPR from EMS. He demonstrated minimal improvement to mentation from initial Narcan dose. In the ED, he was tachycardic on 6L oxygen and exhibited acute bilateral hearing loss and left lower extremity paralysis with numbness. He denies a history of seizures, drug abuse, and self-harm. Initial evaluation revealed a positive urine drug screen for cocaine, opioids, and cannabinoids, with significant lab abnormalities: respiratory acidosis, hyperkalemia, acute kidney injury, and hypoglycemia with elevated but downtrending troponin and lactic acid levels. CT imaging revealed intramuscular edema of the left gluteal, iliopsoas, and external rotator muscles. The patient noted left lower extremity numbness described as hot and prickly from the hip to the foot, with moderate tenderness to deep palpation.

The patient was admitted to the ICU and started on a Narcan drip, resulting in improved mentation. Treatment included IV antibiotics for aspiration pneumonia, hyperkalemia management, supportive care with IV fluids, and pain management with opioids and oral acetaminophen. Due to persistent bilateral hearing loss, Solu-Medrol 40 mg every 6 hours was initiated for suspected opioid-induced ototoxicity, leading to notable improvement. On day three the steroid regimen was adjusted to 60 mg every 8 hours, on day four 80 mg every 12 hours, and then discontinued on day five as the patient's hearing normalized. Neurology and orthopedics were consulted for left lower extremity weakness and severe pain, determining that rhabdomyolysis was most likely instead of a vascular etiology. The patient remained hemodynamically stable, with gradual resolution of symptoms. After a four night hospital stay, the patient was discharged with resolved hearing loss and improved lower extremity pain and mobility.

Our case demonstrates acute bilateral sensorineural hearing loss as a rare complication of opioid overdose. The patient's hearing loss improved with corticosteroid therapy, suggesting a potential inflammatory or ototoxic mechanism. Increased awareness of this complication is crucial for prompt treatment with a patient-centered approach that increases the probability for reversal of hearing loss. Further research is needed to elucidate the pathophysiology and establish evidence-based treatment protocols for opioid-related auditory dysfunction.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025.
Abstract 1856

This document is currently not available here.

Share

COinS