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Knight Ridder Newspapers
DETROIT - Rush Limbaugh's entry into a rehabilitation program for addiction to prescription painkillers underscores an important message to the millions of Americans who take the drugs: Chronic abuse may cause hearing loss.
The link between hearing loss and high doses of painkillers like Vicodin, Lorcet and OxyContin is not yet well-known in medicine.
Until now, the drugs have not been included in medical references to medicines associated with hearing loss.
But Limbaugh's public admission two weeks ago prompted warnings to people to report hearing loss quickly to their doctors if they are abusing the drugs. Quick action may prevent further hearing loss, experts say. Limbaugh's hearing loss has made national headlines for the past two years.
"The message is not out there with doctors, pharmacists or lay people," said Dr. Gail Ishiyama, a neurotologist at the University of California, Los Angeles School of Medicine. Her UCLA team published research in 2000 in the journal Neurology, linking deafness to abuse of Vicodin.
Typical doses of the drugs, taken under a doctor's supervision, are not a problem, she cautioned. It's abuse of the drugs that has been associated with hearing loss, she said.
One case study in the research involved a man who took escalating doses of Vicodin for eight to nine years for migraine headaches, until eventually he was downing 35 tablets a day. The other patient in the study, also a migraine sufferer, took 60 pills a day. Both ended up with hearing loss in both ears.
About 11 million Americans use prescription pain medicines for back, cancer and headache and other pain. For many, the drugs provide relief other treatments can't bring or sustain. But they can be addictive when overused. Limbaugh joins actress Melanie Griffith and Cindy McCain, wife of U.S. Sen. John McCain, R-Ariz., among celebrities who have come forward with stories of addiction to painkillers prescribed for severe back pain.
The drugs can be purchased easily on the Internet. Their abuse has triggered congressional hearings, stronger warning labels, public awareness and pharmacy-tracking programs by the drug manufacturers to combat illegal trafficking and doctor-shopping by patients.
Limbaugh reportedly was taking as many as 60 OxyContin pills daily, as well as other drugs, including Vicodin and Lorcet. This latest foray into rehab is at least his third in recent years.
Limbaugh's initial diagnosis of hearing loss came in 2001. Doctors at the House Ear Clinic in Los Angeles said he had autoimmune ear disease, a type of hearing loss associated with fluctuating hearing, dizziness, ear fullness and sudden loss of hearing. The same facility is among the few to study the link between hearing loss and prescription painkiller abuse. The clinic has identified at least 29 people who developed hearing loss after Vicodin abuse.
Spokesmen for Rush Limbaugh Syndicators, which produces Limbaugh's daily radio show, and House Ear Clinic spokeswoman Christa Spieth Nuber did not return calls about whether Limbaugh previously had acknowledged his drug abuse to his doctors.
That leaves open the question of whether Limbaugh might have halted further loss of his hearing if he had told his doctors what he acknowledged publicly last week.
He also might not have needed a cochlear implant - a surgically implanted device that restores some hearing, some doctors say.
"If he would have been honest, and that's a guess on our part, and if he had some hearing left and stopped abusing certain medications," his hearing loss "might have stopped right there and not required a cochlear implant," said Dr. Michael LaRouere, a hearing specialist with the Michigan Ear Institute, a Farmington Hills facility affiliated with Providence Hospital and Medical Centers of Southfield, Mich.
Added Dr. Paul Kileny, director of speech and audiology at the University of Michigan Medical School: "It's possible he did it to himself." Limbaugh might have undergone unnecessary treatment with high dose steroids and a chemotherapy drug, methotrexate, that might not be appropriate for hearing loss caused by painkillers, Kileny said.
Hearing loss linked to painkillers is such a new problem that there's no agreement about what treatment might help. Last week, the Journal of the American Medical Association reported that methotrexate was not helpful in maintaining hearing in people with autoimmune disease, compared with high-dose steroids.
Ishiyama and Dr. Bruce Gantz, chief of the University of Iowa College of Medicine's Department of Otolaryngology, urged patients who abuse prescription painkillers to be seen immediately by physicians and to get hearing tests if they develop any problem with their hearing. Warning signs include ringing in the ears, pressure and a sense of fullness.
"We don't have proof of this yet, but our feeling is that if you stop the drug, you might be able to halt the progression of hearing loss, at least to keep it at the level you are at," Ishiyama said.
DRUGS THAT MAY HURT HEARING
Some 200 drugs and chemicals may cause temporary or permanent hearing loss and balance problems, according to the American Speech-Language-Hearing Association.
Here's a list of the best-known ototoxic medicines, as they are called: aspirin; quinine products, including tonic water; blood pressure and heart medicines known as loop diuretics, such as Lasix; aminoglycoside antibiotics, such as streptomycin, and antineoplastic cancer drugs, such as cisplatin and carboplatin.
Symptoms range widely, but include ringing in the ears, trouble walking in the dark, a wide gait and unsteadiness.
For information: www.vestibular.org/ototox.html and www.asha.org .
(c) 2003, Detroit Free Press. Distributed by Knight Ridder/Tribune News Service.