Sensorineural hearing loss in a patient treated with sertraline: A case report

Dear Editor, As antidepressant use has significantly increased over decades, the matter of drug safety and adverse effects has been concerning. Hearing damage related to serotonergic modulation has been demonstrated in a few animal studies.[1] Serotonin can be found in structures of the central auditory pathway, from cochlear nuclei to the auditory cortex, constituting an important circuit in hearing processing.[2] Serotonin decreases cochlear blood flow, which could lead to cochlear microcirculation dysfunction.[3] Dysfunction of the serotonergic system is implicated in the perception of tinnitus.[4] Thus, it is quite evident that antidepressants may contribute to hearing loss in humans. In our case, a 40-year-old male married patient presented with 4 years history of obsessive-compulsive disorder. The patient was tried with fluoxetine up to 80 mg previously but shifted to sertraline due to partial response. The patient was started with 50 mg Sertraline and up titrated to 200 mg in two divided doses. The patient has been on 200 mg sertraline for 6 months and was maintaining well (the Yale Brown Obsessive-Compulsive Scale Score was 8). However, he complained of decreased hearing, tinnitus, and vertigo in both the ears at 200 mg of sertraline, 2 months after starting it, which was sudden in onset and gradually progressive. There was no history of any other ototoxic drugs use, substance abuse, or hearing impairment in the past. The patient was then referred to the Otorhinolaryngology department of a local hospital. On pure tone audiometry, 50 decibel threshold hearing loss was found at 250, 500, and 1000 hertz, respectively, in both the ears. It was classified as moderate impairment as per WHO’s grading of hearing impairment, due to which the patient was having distress and difficulty in doing his daily chores. The patient was then shifted to Clomipramine (25 mg) and up titrated to 225 mg in two divided doses. The patient was followed up at 4 weeks and at 8 weeks. The hearing loss improved, and tinnitus decreased in both the ears after discontinuation of sertraline. A study revealed that all classes of antidepressants consistently increased the sensorineural hearing loss risk.[5] The increased serotonin levels in the presence of SSRI may be contributing to the significant changes seen in auditory parameters.[6] Another case report revealed that fluvoxamine can cause sudden hearing loss and tinnitus in patients.[7] It was reported that those who were on multiple antidepressant drugs were consequently at risk of adverse effects.[8] Sertraline was found to be effective in decreasing tinnitus severity.[9] However, there is insufficient evidence to support this. Trials found possible benefits at higher doses, some trials did not meet the quality standards, and inadequate outcome measures were used, had high dropout rates, had methodological bias, and failed to differentiate between the effects of SSRIs on tinnitus and on symptoms of anxiety and depression.[10] Hence, clinicians should be cautious when prescribing antidepressants and avoid prescribing multiple antidepressants simultaneously for patients who are at risk of hearing problems. This case report has highlighted the possible association of hearing loss with SSRIs and will encourage future research to establish this causal relationship. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.