Acetaminophen, also called paracetamol or APAP, is a widely used pain and fever reliever that research treats as a separate class from aspirin and other NSAIDs. Its link to tinnitus rests mainly on one large cohort of women, in which use on most days of the week was associated with a modestly higher risk of persistent tinnitus.

Why it matters for tinnitus

Analgesics are among the most commonly used drugs in the US, as the authors of one hearing cohort point out, so even a small effect would touch many people. The evidence also differs from the aspirin story. High-dose aspirin can cause ringing that usually fades once the drug clears, as described in aspirin, NSAIDs and tinnitus. For acetaminophen, the signal comes from frequent use tracked over years, as a statistical association rather than an effect soon after a dose.

What the evidence says

The evidence is thin. A PubMed search for acetaminophen or paracetamol with tinnitus returns 14 records, and only one is a study designed to test the question. No randomised trial or systematic review on acetaminophen and tinnitus turned up in that search.

  • Tinnitus cohort. The Nurses' Health Study II followed 69,455 women aged 31 to 48 with no tinnitus at the start, from 1995 to 2017, through questionnaires every two years. Over 1,120,936 person-years, 10,452 reported new persistent tinnitus. Compared with use on less than one day a week, acetaminophen on 6 to 7 days a week carried a hazard ratio of 1.18 (95% CI 1.07 to 1.29), and risk tended to rise with frequency. Use and tinnitus were self-reported, reasons for use were unknown, and the authors call for studies in men and non-White women and for work on whether the link is causal.
  • Hearing-loss cohorts. The same research group found that men aged 40 to 74 who took acetaminophen two or more times a week had a hazard ratio of 1.22 for self-reported, professionally diagnosed hearing loss, and 1.99 in men under 50. In 62,261 women, acetaminophen on 2 to 3 days a week (relative risk 1.11) and 4 to 5 days a week (1.21) was linked to hearing loss, but use on 6 or more days was not significantly linked (1.08, 95% CI 0.95 to 1.22). In a third cohort of 55,850 women, more than six years of use, against less than one, carried a relative risk of 1.09. These studies measured hearing loss, not tinnitus.
  • Case series and laboratory work. A retrospective review from a US otology centre described 12 patients with rapidly progressive sensorineural hearing loss who had overused hydrocodone, which is often combined with acetaminophen; none improved after high-dose prednisone. In mouse cochlear cultures, hair-cell death was driven mainly by acetaminophen rather than the opioid, and a study in a mouse auditory cell line pointed to oxidative and endoplasmic reticulum stress. This concerns misuse and cells in a dish, not ordinary use.

What this means for you

In the tinnitus cohort, the comparison group was women using acetaminophen less than one day a week, and the reported increase was for use on 6 to 7 days a week. It is a relative figure from an observational study, which cannot show the drug caused the tinnitus. The conditions behind frequent use, such as headache or chronic pain, cannot be separated from the drug in that data. In the same cohort, frequent non-aspirin NSAID use was also linked to higher risk, so switching to one is no simple way round it.

Do not stop or change pain relief you need on the strength of this. If you take acetaminophen most days, or your tinnitus seems to track how often you take it, talk to a doctor or pharmacist. Hearing that drops suddenly, over hours to three days, needs same-day care, as explained in sudden sensorineural hearing loss.

How it connects