Low-dose Aspirin Does Not Progress Age-Related Hearing Loss in Older Adults

Low-dose aspirin (100 mg) daily does not affect the progression of age-related hearing loss among older adults, a new study found.¹

“During the present trial, a gradual deterioration in hearing acuity was observed in our study population, with the threshold values of pure-tone audiometry increasing by approximately 3 decibels over a 3-year period,” wrote investigators, led by David P. Q. Clark, MSc, from Monash University and Alfred Hospital in Australia. “This change aligns with previous studies reporting that after 60 years of age, hearing thresholds tend to worsen, with a mean decrease of 1 decibel per year.”

High levels of aspirin can progress age-related hearing loss. A 2014 review of 37 studies observed the relationship between high aspirin and hearing loss with individuals on > 1.96 g/d of aspirin having poorer hearing^.2 Studies vary on the milligram threshold for potential ototoxic consequences; in rare cases, people have experienced hearing loss after taking as low as 325 mg: a single dose, regular strength tablet. However, no studies examined whether low-dose aspirin (100 mg) also progressed age-related hearing loss.

In ASPREE-Hearing (Aspirin in Hearing, Retinal Vessels Imaging and Neurocognition in Older Generations), a secondary analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial, investigators sought to determine whether daily low-dose aspirin slows age-related hearing loss progression in healthy community-dwelling older adults.¹ The primary objective was to access hearing measures of air conduction audiometry and binaural speech perception in noise.

The study included 279 healthy participants aged ≥ 70 years, recruited between January 1, 2010, and December 31, 2014. More than half of the sample was male (55%), and the median age at baseline was 73.1 years. At baseline, participants had no signs of cardiovascular disease, dementia, significant physical disability, or any illness expected to limit their life expectancy to ≤ 5 years.

Moreover, investigators excluded participants with bilateral cochlear implants or bilateral deeply inserted per-tympanic or implanted hearing aids. Participants who use other hearing devices were included.

Participants were randomized 1:1 to receive either 100 mg daily of enteric-coated aspirin or placebo. Hearing loss was already reported at baseline for 71% in the aspirin group and 67% in the placebo group.

Hearing assessments took place in medical clinic rooms, community centers, or purpose-built mobile vans at baseline, 18 months, and 3 years after randomization. Participants wore sound-attenuating earmuffs and removed any hearing aids. An otoscopic examination occurred at every assessment.

Compared with placebo, aspirin did not affect the mean 4-frequency average threshold from baseline to year 3 (aspirin: baseline, 27.8 decibels; year 3, 30.7 decibels; difference, 3.3 decibels; placebo: baseline, 27.5 decibels; year 3, 30.9 decibels; difference, 3.0 decibels; P = .55) nor did it affect any other tested frequencies. Investigators noted an increase in air conduction thresholds indicating hearing deterioration.

“The results… demonstrated a more rapid decrease in hearing sensitivity observed at higher pure tones (4 and 8 kHz), where the effects of aging are most prominent,” investigators wrote.

Additionally, investigators observed no significant differences in the mean speech reception threshold between the aspirin and placebo group at the year 3 follow-up assessment (aspirin: baseline, –9.9 [3.8] decibels; year 3, –9.1 [3.8] dB; difference, 0.9 [2.9] decibels; placebo: baseline, –10.5 [7.1] decibels; year 3, –9.6 [4.1] decibels; difference, 0.9 [5.9] decibels; P = .86). The findings were comparable across sex, age groups, diabetic, and smoking status.

Investigators said the study was limited by the primary outcome relying on pure-tone audiometry, which is not objective since it requires volitional responses to auditory stimuli. Also, research has suggested a slight decrease in reliability for older adults.

Ultimately, investigators concluded by saying how future trials need to be conducted to determine whether other anti-inflammatory or antiplatelet agents provide a protective effect on hearing loss.

“The clinical implications of this study result from the widespread regular use of aspirin among older individuals and the observational data linking chronic use of analgesic use with hearing loss,” investigators wrote. “Despite the lack of an expected beneficial effect of low-dose aspirin, we did not identify a deleterious effect similar to that seen in the US Health Professionals observational study.”

References

1. ^{Clark DPQ, Zhou Z, Hussain SM, et al. Low-Dose Aspirin and Progression of Age-Related Hearing Loss: A Secondary Analysis of the ASPREE Randomized Clinical Trial. JAMA Netw Open. 2024;7(7):e2424373. doi:10.1001/jamanetworkopen.2024.24373}
2. ^{Kyle ME, Wang JC, Shin JJ. Ubiquitous aspirin: a systematic review of its impact on sensorineural hearing loss. Otolaryngol Head Neck Surg. 2015;152(1):23-41. doi:10.1177/0194599814553930}
3. ^{Ototoxicity and Hearing Loss. Hearing Resource Center. February 17, 2024. https://hearingresourcecenterllc.com/ototoxicity-and-hearing-loss/. Accessed August 1, 2024.}