Abstract Opioid toxicity is a known cause of respiratory depression, altered mental status. However, acute sensorineural hearing loss (SNHL) is a rare but increasingly recognized complication (1). We present case of profound bilateral SNHL following suspected opioid ingestion, highlighting the importance of early recognition and intervention. 23-year-old man with a history of depression, polysubstance abuse was brought in by emergency medical services (EMS) after being found unresponsive at a bus stop. An empty methadone bottle was discovered at the scene, prompting EMS to administer Narcan. On arrival at the emergency department, the patient exhibited fluctuating mental status with intermittent responsiveness. His vital signs were unremarkable except respiratory rate of 14/min, point-of-care glucose of 26 mg/dL, for which dextrose was administered without significant improvement in mentation. investigations revealed a mixed respiratory acidosis (pCO2 86 mmHg) with an anion gap metabolic acidosis, an elevated lactate of 12.8 mmol/L, creatinine level of 3.3 mg/dL. The patient also developed rhabdomyolysis, with creatine phosphokinase (CPK) peaking at 30,000 U/L, along with hyperkalemia, AST 1,000 U/L. CT head and temporal bone showed no acute pathology. After 48 hours, his mental status improved. ENT evaluation and audiometric testing confirmed severe bilateral sensorineural hearing loss at frequencies above 5,000 Hz after he complained loss of hearing. Although urine toxicology screening was negative for traditional compounds, it is important to note that standard immunoassay tests may not reliably detect all opioids. The patient was started on a one-month prednisone taper, resulting in mild hearing improvement, and was discharged with close follow-up with ENT. Discussion Sudden SNHL associated with opioid use has been described with the unclear mechanisms such as ischemic injury secondary to opioid-induced respiratory depression (2). hypotension-induced overstimulation of kappa opioid receptors, leading to reduced cochlear afferent activity, or contamination with ototoxic substances such as quinine. Steroids are the mainstay of treatment for acute SNHL, with prior cases showing improvement following early administration. Opioid overdose should be considered a differential diagnosis in cases of acute bilateral SNHL, particularly in young individuals with polysubstance use. Prompt audiologic evaluation and corticosteroid treatment may be beneficial, warranting further research. References: 1. Hughes ML, Rodriguez AI, Hatch J, Zoucha K. Hearing and Vestibular Loss with Misuse of Opioids and Illicit Drugs: A Review of the Literature. Audiol Neurootol Internet. 2. Kiyatkin EA. Hypoxic effects of heroin and fentanyl and their basic physiological mechanisms. Am J Physiol Lung Cell Mol Physiol This abstract is funded by: None
Pinjari et al. (Fri,) studied this question.