Increased Risk of Sudden Sensorineural Hearing Loss in Patients Receiving Sedative-Hypnotics: A Propensity Score Weighting Cohort Study

Hui-Wen Yang,1– 3 Yu-Chieh Huang,4 Kuan-Wei Chiang,5 Yuan-Liang Wen,1– 3 Sheng-Yin To,1– 3 Senyeong Kao,1,2 Li-Ting Kao1,3,6 1Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; 2School of Public Health, National Defense Medical Center, Taipei, Taiwan; 3School of Pharmacy, National Defense Medical Center, Taipei, Taiwan; 4Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan; 5Wu Zhenyu Clinic of Otolaryngology, Taoyuan, Taiwan; 6Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, TaiwanCorrespondence: Li-Ting Kao, School of Pharmacy, National Defense Medical Center, Taipei City, 11490, Taiwan, Tel +886-2-8792-3311 ext. 18893, Email [email protected]: Benzodiazepine receptor agonists (BZRAs), including benzodiazepines (BZDs) and Z drugs, are widely prescribed for anxiety and sleep. Therefore, issues of tolerance, dependence and adverse effects are of concern. Recent studies suggested a potential link between BZRAs and hearing problems. However, the actual relationship was still unclear. Accordingly, this study aims to investigate the actual association between BZRA use and risk of sudden sensorineural hearing loss (SSNHL) using population data.Patients and Methods: This study used the Taiwan Longitudinal Health Insurance Database. 137,277 BZRA users and 1,328,554 nonusers were identified for relevant analyses. We used cohort design with inverse-probability treatment weighting (IPTW) strategy to balance the baseline differences of demographics and comorbidities between two groups. The 5-year incidence of SSNHL was followed. Cox proportional-hazard regression analyses were used to estimate the hazard ratios (HRs).Results: BZRA users showed an increased 5-year SSNHL risk (adjusted HR: 1.244) after weighting. Subgroup and sensitivity analyses produced consistent results. Notably, SSNHL risk was higher among young BZRA users (adjusted HR: 1.397). BZRA users had the highest SSNHL risk in the first year (adjusted HR: 2.037) after IPTW.Conclusion: BZRA use elevated the risk of SSNHL, particularly in young adults and in the first year. This emphasises the importance for physicians and policymakers should be aware of the potential hearing difficulties among BZRA users and take necessary examinations.Keywords: benzodiazepine receptor agonists, drug safety, hearing, sudden sensorineural hearing loss, sedative-hypnotics