Background: Auditory disorders associated with substance abuse are rare. Hearing loss secondary
to heroin and hydrocodone abuse has been described variously as not always responsive
to steroid management, as not always reversible, and in some cases, as nonresponsive
profound sensorineural hearing loss requiring cochlear implantation. We present a
case of a teenager with sudden-onset moderate to severe bilateral sensorineural hearing
loss after documented polysubstance “binging.” The hearing loss improved substantially
after high-dose steroid and vasoactive therapy.
Purpose: The purpose of this report is to describe the hearing disorder of a patient who had
awakened with a bilateral severe hearing loss following a night of recreational drug
abuse.
Research Design: Case report and review of the literature.
Data Collection and Analysis: The subject of this report is an 18-yr-old patient with a history of substance abuse.
Data collected were magnetic resonance /computed tomography brain imaging; metabolic,
infectious disease, and autoimmune evaluation; and extensive audiologic evaluation,
including pure-tone and speech audiometry, immittance measures, distortion-product
otoacoustic emissions, and auditory brainstem response testing. Serial audiograms
were collected for 10 mo following the onset of symptoms.
Results: Two days of polysubstance abuse (heroin, benzodiazepine, alcohol, and crack [smoked
cocaine]) resulted in moderately severe sensorineural hearing loss bilaterally. The
loss responded to a 1 mo course of high-dose prednisone and a 10 mo course of pentoxifylline.
Hearing sensitivity subsequently improved, leaving only residual high-frequency sensorineural
hearing loss.
Conclusions: This case report highlights the importance of “recreational” drug abuse in the evaluation
of sudden hearing loss. Potential etiologies include altered pharmacokinetics, vascular
spasm/ischemia, encephalopathy, acute intralabyrinthine hemorrhage, and genetic polymorphisms
of drug-metabolizing enzymes.
Key Words
Cocaine—overdose - heroin—overdose - polysubstance abuse - sensorineural hearing loss
- sudden hearing loss
