Major Increase in Tinnitus After Taking Tylenol

[Flyingsheep]

Hello Dr Nagler,

First off thank you for giving your time and being here answering questions. I am very thankful for your generosity.

To give you some background, I'm 30 years old and I've had tinnitus for 1.5 years which started immediately after a night of drinking too much in Colorado (wasn't used to the altitude). It was mild and got worse over time, and I even had a bout of hyperacusis which ended up resolving. It's been doing a lot better since this past summer, and thankfully has quieted down to near silence over the past two weeks where I actually started to forget about it. I even got an audiogram recently (which I will attach here) from an audiologist to see if I am experiencing any detectable hearing loss, and she told me I have amazing hearing and was perplexed as to why I had tinnitus. I had a word recognition test too with background noise and got a perfect score.

However, about 4 nights ago I took 1000mg of Tylenol when a nasty headache appeared after drinking red wine and went to bed. About 24 hours later my tinnitus spontaneously jumped to an unmaskable severe level and has been unchanged for the past 4 days, even in the morning when I wake up (when normally it's really quiet in the morning). Never has it been this bad, and it went from hiss/static to a tone around 17 kHz that orbits between both ears. It's so intrusive and I've been feeling nauseous at night, having difficulty sleeping. I've read online that Tylenol is generally safe and not really considered ototoxic, especially when taking 1000mg one time. I rarely take Tylenol but when I did I never had an issue before.

So my question is, is it possible that Tylenol can be ototoxic, like in this case? It's the only thing I can point to since I haven't had any loud noise exposure, and I've read that damage takes around 24 hours to reflect with changes in tinnitus.

Also, can alcohol be ototoxic and cause tinnitus? Many people tell me it shouldn't, and even more say that my tinnitus is from something else. Also could I be experiencing ototoxic damage because I took Tylenol an hour or so after drinking a couple glasses of wine? I feel like I should just never touch alcohol again... I know tinnitus is vastly unknown and understand if you don't know the answers to these questions.

You're also totally welcome to chime in on anything I brought up that is a myth or I've been misinformed on. Thank you very much for taking the time to read my concerns!

 

[Dr. Nagler]

Hello Dr Nagler, First off thank you for giving your time and being here answering questions. I am very thankful for your generosity.

Glad to help. My apologies for not responding sooner. I've had some "stuff" going on, Goes with being into my 70s, I guess.

So my question is, is it possible that Tylenol can be ototoxic, like in this case?

My mother used to say that the only things in life that are certain are death and taxes. So with apologies to Mom, I am going to take the liberty of adding a third: The only things in life that are certain are death, taxes, and that taking 1000mg acetaminophen (Tylenol) one time for a headache will not cause auditory damage. So rest easy, my friend.

Can taking 1000mg of acetaminophen one time for a headache temporarily aggravate your tinnitus without causing auditory damage? Well, there are around a gazillion drugs that have been reported to do that, and I think acetaminophen is one of them. But the half-life of acetaminophen is around three hours, which means that for all intents the drug was completely out of your system before your tinnitus increased in loudness. So I do not think it at all likely that the acetaminophen played even a small role.

It's the only thing I can point to since I haven't had any loud noise exposure,

Maybe it was just your tinnitus doing its tinnitus thing? Tinnitus really doesn't need a reason to get louder. Kinda like my kids when they were toddlers.

and I've read that damage takes around 24 hours to reflect with changes in tinnitus.

You can have auditory damage without any change in tinnitus. You can have changes in tinnitus without auditory damage. And as far as that 24 hour rule goes, I have never heard of such a thing. I wonder where you read it. If there is a legitimate study, please let me know. Thanks.

Also, can alcohol be ototoxic and cause tinnitus?

Alcohol in moderation does not cause auditory damage. I do not know about what effect excessive daily drinking over many years might have on the auditory system. But there are a whole lot of reasons other than your ears not to drink excessively! Now some people do find that red wine (even in moderation) aggravates their tinnitus. Most don't, but some do. Red wine has never been a problem for me in that regard, but if it did aggravate my tinnitus, that wouldn't stop me from drinking a glass or two (or three) of red wine with dinner. I personally wouldn't give my tinnitus the satisfaction of depriving me of a nice claret! Not for a minute.

You're also totally welcome to chime in on anything I brought up that is a myth or I've been misinformed on. Thank you very much for taking the time to read my concerns!

You are most welcome.

Stephen M. Nagler, M.D.