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Sudden hearing loss associated with methylphenidate therapy.

Ugur Karapinar1, Omer Saglam, Engin Dursun

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Methylphenidate, used for attention deficit/hyperactivity disorder, may cause sudden, irreversible hearing loss. This serious adverse effect necessitates careful consideration before initiating treatment.

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Area of Science:

  • Otolaryngology
  • Pediatric Neurology
  • Pharmacology

Background:

  • Attention deficit/hyperactivity disorder (ADHD) is commonly treated with methylphenidate.
  • Sudden sensorineural hearing loss (SSNHL) is a critical otolaryngologic emergency.
  • The potential ototoxicity of psychostimulant medications requires investigation.

Observation:

  • An 8-year-old child with ADHD experienced acute left-sided hearing loss, tinnitus, vertigo, and aural fullness.
  • Symptoms commenced within 24 hours of the initial methylphenidate dose.
  • Clinical examination revealed profound left-ear hearing loss, absent stapedial reflexes, and absent otoacoustic emissions.

Findings:

  • No other causes for sudden hearing loss were identified through medical history, physical examination, or investigations.
  • Audiological assessments confirmed complete hearing loss in the affected ear.
  • A causal association between methylphenidate and the sudden hearing loss was hypothesized due to the temporal relationship and lack of alternative explanations.

Implications:

  • Methylphenidate may represent a risk factor for irreversible sudden sensorineural hearing loss.
  • Clinicians should counsel patients and guardians about potential auditory risks before prescribing methylphenidate.
  • Further research is warranted to elucidate the mechanism and prevalence of methylphenidate-induced ototoxicity.