Dr Sharon Curhan and colleagues from Brigham and Women's Hospital in Chicago investigated the effects of regular analgesic use in 26,917 men. Previous research had shown that analgesics might harm the cochlea.

After a 20-year follow-up, 3,488 cases of hearing loss were reported in the men in the study group, all of whom were white and aged 40-74 years.

Hearing loss was independently associated with regular use of the analgesics aspirin, paracetamol and NSAIDs.

Dr Curhan said that widespread analgesic use and the implications of hearing loss meant the study represented an important public health issue.

'If individuals find they have a need to take these medications regularly, they should consult their healthcare professional to discuss the risks and benefits and to explore the alternatives,' she said.

Overall in the trial, participants who took paracetamol twice or more each week were 38 per cent more likely to develop hearing loss. The risk increased by 32 per cent in regular users of NSAIDs and 13 per cent in regular aspirin users.

The risk was more pronounced in younger men. Men under age 50 taking paracetamol regularly had a 99 per cent increased risk of hearing loss. The risk was 33 per cent higher for regular aspirin use and 61 per cent for NSAIDs.

Duration of treatment also affected the risk of hearing loss for paracetamol and NSAIDs, but not for aspirin.

Men who took NSAIDs or paracetamol regularly for over four years were 33 per cent more likely to develop hearing loss than those who did not.

The risk also appeared to be additive when taking multiple analgesics, the authors noted. NSAIDs and paracetamol taken together showed the highest risk of any two combinations at 58 per cent increased risk.

• Am J Med 2010;123:231-7