Do You Know The 12 Beta Blockers That Do Not Cause Tinnitus?

Are you experiencing tinnitus on beta-blockers? You’re not alone. Ear ringing or tinnitus is a side effect of some beta-blockers. Having this constant ringing in the ears can be pretty annoying. So, let’s look at those beta blockers that do not cause tinnitus.

Beta-Blockers and Tinnitus

As we’ve already said, some beta-blockers do cause tinnitus. So, what is the solution to this problem? The easy answer is, go to your doctor. They know your condition well. Thus, they can prescribe you the correct beta-blocker, which won’t cause tinnitus.

Bisoprolol, nebivolol, and carvedilol rarely cause tinnitus. So, if you’re taking them, then they may be the culprit. Beta-blockers like atenolol, metoprolol, propranolol, acebutolol are relatively safer.

However, you should never make the change yourself. Many other factors come to play. So, it’s best to consult your physician for treatment options. That being said, let’s have a more in-depth look at beta-blockers and tinnitus.

Tinnitus

Tinnitus is a condition where you experience ringing sounds in your ears. It occurs when there is no external source of sound. This is a prevalent problem. It affects around 15-20% of the adult population. However, it does vary in severity among individuals.

The type of sound heard can be buzzing, chirping, whistling, hissing, ringing, etc. The intensity of sound can be more or less depending on the conditions. For example, you may not feel it very often in crowded places. But when you’re alone or in a quiet place, it might be more intense.

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We can broadly classify tinnitus as subjective or objective. Objective tinnitus has an anatomic origin. That is, the ringing sound has a physical origin. So, the problem is present in the cochlea (the hearing apparatus) or other areas.

However, subjective tinnitus is not so. There are no abnormalities in the auditory apparatus. Instead, it has a nervous basis. The abnormal function of the auditory nerves or the brain is responsible for this type of tinnitus.

beta blockers that do not cause tinnitus
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Cause of Tinnitus

There are various causes of tinnitus. It is not an illness in and of itself. Instead, it is a symptom that may signify an underlying disorder. Some causes are:

The most common cause is related to excessive noise exposure. Many people work in environments with lots of sounds. Excessive loud noises gradually damage the hearing apparatus. This damage accumulates over time. And it may manifest itself as tinnitus. Some of the most dangerous jobs include:

  • Construction workers
  • Miners
  • Carpenters
  • Airline staff
  • Railway worker
  • Truck drivers
  • Military
  • Workers in industries

Diseases affecting the hearing apparatus like:

  • Otitis media
  • Otosclerosis
  • Deafness
  • Conditions affecting the middle ear cavity

Causes relating to the nervous system are:

  • Tumors in various regions of the brain may influence the auditory cortex or pathway
  • Concussion and head injury
  • Multiple sclerosis and other brain disorders

There may even be physical causes in the case of objective tinnitus. This may be vascular in origin. Thus, any condition affecting the arteries may cause tinnitus. Abnormal contraction of muscles of the middle ear can cause tinnitus as well.

Some drugs also cause tinnitus. Let’s take a more in-depth look into this topic. And if you are looking for beta blockers that do not cause tinnitus, this article will be the best resource.  

Drug-Induced Tinnitus

Administration of some drugs can cause tinnitus as well. The precise mechanism isn’t precisely understood. However, scientists believe that it has to do with damage to the cochlea.

The cochlea is a snail-shell-like structure that helps you to hear. It consists of a spiral canal. In the canal are membranes with tiny hair embedded in them. The sound waves vibrate these membranes. And the hair cells transfer this vibration to nerve signals.

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So, damage to this structure can cause hearing defects. Numerous drugs can damage this system. They damage the hair cells and other parts of the sound generation system. Hence, abnormal auditory signals are sent to the brain. So, it perceives these ringing noises, which is tinnitus.

Scientists also believe that peripheral nerves may be involved. Some ototoxic (damaging to the ears) can directly harm the auditory nerves. Such damage to the nerve can give rise to abnormal sensations as well. Future research will help to shed more light on the matter.

Ototoxic Drugs

Many have complained of tinnitus by using various drugs. Common drugs that cause tinnitus include:

Aminoglycoside antibiotics

These classes of antibiotics include gentamicin, streptomycin, amikacin, kanamycin, etc.

Salicylates

They mainly include aspirin and other related drugs.

Diuretics

Particularly loop diuretics like furosemide, bumetanide, etc., can cause ototoxicity. Thiazide diuretics like chlorthalidone, bendroflumethiazide too may lead to ototoxicity.

Other drugs like NSAIDs (ibuprofen, diclofenac, indomethacin), beta-blockers, angiotensin II receptor blockers, benzodiazepines, tricyclic antidepressants (TCA) can cause tinnitus as well.

Whatever the mechanism of drug-induced tinnitus may be, it poses a big problem. Antibiotic-induced tinnitus may sometimes be incurable. However, tinnitus by other drugs is generally temporary. So, if you’re able to identify the issue soon, there’s a chance you can prevent it.  

Are Beta-blockers Causing Tinnitus?

So, where do beta-blockers stand in ototoxicity? Before we explain that, let’s take a look at this class of drugs.

Beta-blockers are a class of drugs that act on beta-adrenoceptors. These drugs antagonize or ‘block’ these receptors. Epinephrine and norepinephrine can usually stimulate these receptors.

These receptors are found in cardiac muscle, smooth muscles, lungs, kidneys, etc. They are part of the sympathetic nervous system or the ‘fight or flight’ response.

However, with the administration of these drugs, these receptors are inactivated. So, the effects of epinephrine and norepinephrine are stopped. This can have some beneficial effects.

Beta-blockers are thus used to treat a variety of conditions. Some of them are:

  • Angina
  • Arrhythmia
  • Atrial flutter/fibrillation
  • Heart failure
  • Heart attack or Myocardial infarction
  • High blood pressure
  • Sometimes even in glaucoma

Side effects

Like all other drugs, beta-blockers have some side effects as well. Inappropriate dosing more often leads to these effects. They are

  • Nausea
  • Vomiting
  • Bradycardia or heart slowing down
  • Fatigue
  • Dizziness
  • Difficulty in breathing due to bronchoconstriction
  • Dizziness or loss of consciousness due to hypotension
  • Low blood glucose levels
  • Altered lipid metabolism

Another uncommon side effect is tinnitus. Ototoxicity with beta-blockers is very rare. However, it can still happen. A study found that the beta-blocker carvedilol is positively associated with hearing loss. This can exacerbate or even cause tinnitus.

Tinnitus is also more common with nebivolol and bisoprolol. Propranolol too very rarely causes ototoxicity and hearing defects.

Beta Blockers That Do Not Cause Tinnitus

There are quite a few beta-blockers with almost no history of ototoxicity. However, you should consider other factors. Because, as we’ve said, beta-blockers very rarely cause tinnitus. Thus, there’s a high probability that your tinnitus is due to other causes.

However, if your tinnitus appeared just after beta-blockers, then it may be due to the drug. In that case, it is best to consult with your physician. You can even see an otologist. As they’re experts, they can accurately determine if your tinnitus is due to beta-blockers.

woman gets happy using beta blockers that do not cause tinnitus
Photo by Ava Motive from Pexels

If your tinnitus is due to beta-blockers, your physician can help get you alternatives. As we’ve said, many beta-blockers don’t cause tinnitus. They include atenolol, metoprolol, acebutolol, nadolol, etc. However, you should never make the change yourself.

Your physician may also prescribe you other drugs depending on your condition. You may be taking beta-blockers for hypertension. Other hypertension drugs which won’t cause tinnitus include medications from the class:

  • calcium channel blockers
  • angiotensin-converting enzyme inhibitors
  • alpha antagonists
  • diuretics

If you’re suffering from congestive cardiac failure, alternative drugs include:

  • Angiotensin-converting enzyme inhibitors
  • Diuretics
  • Aldosterone antagonists
  • Angiotensin-receptor neprilysin inhibitors
  • Digoxin

If you’re suffering from angina or myocardial infarction, then your physician may prescribe you:

  • Calcium channel blockers
  • Nitrates
  • Antiplatelet and anticoagulant type drugs

What to do if you have tinnitus?

As we’ve said earlier, you have to consult with your doctor if you have tinnitus. A change in medication can help you solve your problem. The ways of treating and preventing tinnitus are:

Taking care of your ears

Tinnitus is more often than not caused by excessive sound.

  • If your workplace leads to excessive exposures, then wear earplugs or other safety devices. Try to keep the noise exposure to a minimum.
  • Try not to operate lawn mowers or other power tools without adequate protection.
  • Try to limit using headphones as much as possible. Avoid blasting music at a high volume while using headphones. The volume should ideally be 60% of the maximum. Noise-canceling headphones are helpful in this case as well.
  • Try to avoid loud and noisy places as much as possible. They include bars, parties, sporting events, etc.
  • Allergies and Tinnitus have a close tie. So, you should stay away from any allergen that you are susceptible to. 

Drugs

Some drugs have proven helpful in treating tinnitus. They include some antidepressants or sedative-hypnotic anxiolytic medicines. You should never take these drugs on your own. Instead, only take them if your physician prescribes them. These have variable results.

If you need any beta blocker drugs, make sure you ask your doctor about beta blockers that do not cause tinnitus. 

Assistive devices and background music

Some devices help in keeping the noise of tinnitus to a minimum. They include hearing aids, masking devices, or similar devices. Constant background music is an effective tinnitus therapy. And some people have benefited from the use of these appliances.

E extra cautious if you are pregnant or doing heavy exercise. Excess blood flow in certain blood vessels can cause pulsatile tinnitus anxiety. Treating tinnitus and anxiety is a bit tricky. 

Therapy

Since subjective tinnitus has a nervous origin, various therapy can prove effective. One of these is tinnitus retraining therapy. Here, the patient receives continuous neutral sounds all the time. This cancels the effect of tinnitus on the brain over time.

Cognitive therapy is used for tinnitus as well. This therapy reduces uneasiness and discomfort caused by the constant ringing sensation.

FAQ

Do all beta-blockers cause tinnitus?

No, all beta-blockers don’t cause tinnitus. Some cause tinnitus very rarely.

Does bisoprolol cause ringing in the ears?

Bisoprolol can cause ringing in the ears very rarely.

What is the most effective treatment for tinnitus?

The most effective treatment for tinnitus includes avoiding excessive noise, assistive devices like hearing aids and masking devices, cognitive behavioral therapy, etc.

What is the safest beta blocker?

Beta-blockers like atenolol, metoprolol, etc., are safe to use with minimum side effects.

Conclusion

Ototoxicity with beta-blockers is quite rare. However, it isn’t unheard of. Some beta-blockers may cause tinnitus. But there are beta blockers that do not cause tinnitus, like atenolol, metoprolol, acebutolol, etc. With proper lifestyle changes and prescription changes from your physician, you can cure your tinnitus in no time!

SM Kamal Hasan

Dr. SM Kamal Hasan, MBBS(Medicine), Rangpur Medical College and Hospital Rangpur- Dinajpur Highway, Cantt, Near Central Jail, Rangpur 5400, Bangladesh

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