Sensorineural Hearing Loss and Phosphodiesterase-5 Inhibitors: A Systematic Review.

INTRODUCTION: Sudden sensorineural hearing loss (SSNHL) can significantly impact quality of life. Recent studies propose a link between the use of phosphodiesterase-5 inhibitors (PDE-5is) and SSNHL emergence. OBJECTIVE: To clarify the relationship between PDE-5i use and the risk of SSNHL development. DATA SYNTHESIS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, two independent reviewers searched the PubMed, Embase, and Web of Science databases for articles up to December 2023 on hearing loss in PDE-5i users. Out of 190 abstracts initially identified, 6 met the inclusion criteria, totaling 54 patients aged between 37 and 62 years. One study involved 4 female participants, while the rest focused on 50 male patients. Sildenafil, vardenafil, and tadalafil were the most commonly used PDE-5is. All patients experienced sensorineural hearing loss, ranging from moderate to profound, with 4 patients (7%) noting tinnitus and 3 patients (5%), vertigo, in addition to the hearing loss. One patient experienced bilateral hearing loss 15 days after initiating sildenafil consumption. Corticosteroid therapy was the exclusive treatment in all cases. The long-term outcomes following the cessation of the medication were available in 7 cases: 4 patients (57%) had no improvement, 2 patients (29%) fully recovered, and 1 patient (14%) had incomplete resolution of the hearing loss. CONCLUSION: The current systematic review underscores the importance of monitoring hearing in PDE5i patients and advising them about the potential risk. Further research with larger samples and control groups is needed to establish a definitive causal link.