Risk of sudden sensorineural hearing loss in adults using phosphodiesterase type 5 inhibitors: Population-based cohort study

Wei Liu, Patrick J. Antonelli, Philipp Dahm, Tobias Gerhard, Joseph A.C. Delaney, Richard Segal, Stephen Crystal, Almut G. Winterstein

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Purpose: The objective of the study was to determine the risk of sudden sensorineural hearing loss (SNHL) associated with use of phosphodiesterase type 5 (PDE5) inhibitors. Methods: We conducted a retrospective cohort study in the MarketScan Commercial Claims and Encounters Database including adult men who initiated a PDE5 inhibitor (n = 377,722) and 1,957,233 nonusers between 1998 and 2007. Periods of drug exposure were assessed on a weekly basis based on pharmacy billing records, assuming use of 1 dose per week (current use). Incident sudden SNHL was defined based on inpatient or outpatient visits with International Classification of Diseases, Ninth Revision, Clinical Modification codes 389.1x, 389.2x, or 388.2 plus ≥2 procedure codes for audiometric hearing testing within ±30 days of sudden SNHL diagnosis. We used age- and propensity score-adjusted Cox proportional hazards model to evaluate the risk of sudden SNHL during periods of current or recent use compared with that of nonuse. We conducted sensitivity analyses by varying the assumed drug utilization frequency and sudden SNHL case definition. Results: We evaluated 1233 sudden SNHL cases, resulting in an incidence of 4.35, 5.58, and 2.38 per 10,000 person-years for current, recent, and nonuse of PDE5 inhibitors, respectively. Compared with nonuse, the adjusted hazard ratio was 1.25 (1.01-1.55) for current use with a risk difference of 1.97 (1.12-2.82) per 10,000 person-years. For recent use, the adjusted hazard ratio was 1.60 (1.33-1.94) and risk difference was 3.19 (2.24-4.14). Estimates were consistent across the sensitivity analyses. Conclusions: Use of PDE5 inhibitors is associated with a small but significantly increased risk of sudden SNHL.

Original languageEnglish (US)
Pages (from-to)587-595
Number of pages9
JournalPharmacoepidemiology and Drug Safety
Issue number6
StatePublished - Jun 2018

Bibliographical note

Funding Information:
Dr Antonelli has received financial support from the industry, but none represents any conflict with the present study: consulting fees from Otonomy and research support from Alcon Laboratories, Sound Pharmaceuticals, Auris Medical, Edison Pharmaceuticals, and Otonomy. No other disclosures were reported.

Funding Information:
Supported in part through AHRQ U19HS021112. The funder had no rule in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
Copyright © 2018 John Wiley & Sons, Ltd.


  • erectile dysfunction
  • ototoxicity
  • pharmacoepidemiology
  • phosphodiesterase 5 inhibitor
  • sudden sensorineural hearing loss


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