Authors: F A van Gaalen E A Compier A J Fogteloo
Publish Date: 2009/03/05
Volume: 266, Issue: 5, Pages: 773-774
Abstract
Over the years several cases of bilateral sudden sensorineural hearing loss SHL after a heroin overdose have been described including the recent case in this journal Although these cases all suggest that a large dose of opiates may cause acute hearing loss the fact that the heroin used in these cases was illegal makes it impossible to rule out an effect of a heroin contaminant We now report a patient who after taking an accidental overdose of prescribed methadone developed acute reversible bilateral hearing lossAfter taking 15 tablets of 5 mg of methadone a 37yearold man was admitted to our hospital with nausea deafness confusion and a low respiratory rate His condition responded well to a single dose of naloxone and a urine sample tested positive for methadone After regaining full consciousness the patient complained of profound hearing loss with a mild tinnitus He had no vestibular symptoms or aural fullnessNeurological examination was normal and examination of the tympanic membranes showed no abnormalities The patient had no history of hearing problems had never used opiates before and admitted that he had taken the methadone from his brother who was enrolled in a heroin withdrawal programAudiogram recorded a day after a methadone overdose The audiograms is set out with frequency in hertz Hz on the horizontal axis logarithmic scale and a linear hearing level scale in decibel dB on the vertical axis Right ear left and left ear right Symbols “O” and “X” are air conduction and ““ and “”” indicate bone conductionIn our case of sudden bilateral SHL after an overdose of prescribed methadone an effect of a contaminant is very unlikely As our case shows that a methadone overdose can precede bilateral SHL this supports the claim that in the previous cases of heroin induced hearing loss heroin itself was indeed the cause A possible explanation for the fact that this is only the first reported case of bilateral SHL after a methadone overdose is that methadone overdoses are much rarer than heroin overdoses 2In theory it is possible that in our case and the other cases the hearing loss was purely coincidental and not because of the overdose itself Nevertheless it should be kept in mind that SHL and in particular when it is bilateral is rare and that there was a clear time relation between the overdose and the onset of the hearing lossThis article is published under an open access license Please check the Copyright Information section for details of this license and what reuse is permitted If your intended use exceeds what is permitted by the license or if you are unable to locate the licence and reuse information please contact the Rights and Permissions team
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