{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T23:30:11Z","timestamp":1765409411171,"version":"3.46.0"},"reference-count":36,"publisher":"BMJ","issue":"6457","license":[{"start":{"date-parts":[[1984,12,1]],"date-time":"1984-12-01T00:00:00Z","timestamp":470707200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br Med J (Clin Res Ed)"],"published-print":{"date-parts":[[1984,12,1]]},"abstract":"<jats:p>Loss of hearing in a 43 year old man during treatment with metoprolol was dose related and disappeared within a few months after the drug had been stopped. The hearing impairment was of mixed type, with an air bone gap without any disorder of the middle ear observable by conventional clinical methods. Similar scattered reports from international sources on loss of hearing during treatment with beta blockers are also presented.<\/jats:p>","DOI":"10.1136\/bmj.289.6457.1490","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T11:00:59Z","timestamp":1238670059000},"page":"1490-1492","source":"Crossref","is-referenced-by-count":10,"title":["Beta blockers and loss of hearing."],"prefix":"10.1136","volume":"289","author":[{"given":"R","family":"F\u00e4ldt","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Liedholm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Aursnes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1984,12,1]]},"reference":[{"article-title":"A system of operative surgery, founded on the basis of anatomy","author":"Bell, C.","key":"ref_1","unstructured":"Bell C. A system of operative surgery, founded on the basis of anatomy. London: Longman, Hurst, Rees and Orme, 1809:135."},{"issue":"8","key":"ref_2","first-page":"481","article-title":"Experimental researches applied to physiology and pathology","volume":"1852","author":"Brown-Sequard, C.E.","unstructured":"Brown-Sequard CE. Experimental researches applied to physiology and pathology. Medical Examiner 1852;8:481-504.","journal-title":"Medical Examiner"},{"issue":"1","key":"ref_3","first-page":"161","article-title":"Sur quelques arthropathies qui paraissent dependre d'une lesion du cerveau ou de la moele epiniere","volume":"1868","author":"Charcot, J.M.","unstructured":"Charcot JM. Sur quelques arthropathies qui paraissent dependre d'une lesion du cerveau ou de la moele epiniere. Archives de Physiologie Normal et Pathologique. 1868;1:161-78.","journal-title":"Archives de Physiologie Normal et Pathologique"},{"key":"ref_4","first-page":"11","article-title":"Pressure sores and the spinal cord injured. Model Systems'","volume-title":"SCI Dzgest 1981; fall 3: 3: 9-18; winter 3: 3","author":"Young, J.S.; Burns, P.E.","unstructured":"Young JS, Burns PE. Pressure sores and the spinal cord injured. Model Systems' SCI Dzgest 1981;fall 3:3:9-18; winter 3:3:11-26."},{"issue":"27","key":"ref_5","first-page":"324","volume":"1876","author":"Fagge, C.H.","unstructured":"Fagge CH. Transactions of the Pathological Society of London 1876;27:324.","journal-title":"Transactions of the Pathological Society of London"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0002-9610(34)90429-3","article-title":"Management of urologic complications in injuries to the spine; report of 54 cases without single infection in urinary tract","volume":"26","author":"Connors, JR, Nash; J.E.","year":"1934","unstructured":"Connors JR, Nash JE. Management of urologic complications in injuries to the spine; report of 54 cases without single infection in urinary tract. Am 7 Surg 1934;26:159-67.","journal-title":"Am 7 Surg"},{"key":"ref_7","first-page":"1057","article-title":"New viewpoint toward spinal cord injuries","volume":"124","author":"Kennedy, R.H.","year":"1946","unstructured":"Kennedy RH. New viewpoint toward spinal cord injuries. Ann Surg 1946;124: 1057-65."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/S0140-6736(61)91033-9","article-title":"The prevention of pressure sores: significance of spontaneous bodily movements","volume":"ii:","author":"AN, Exton Smith; RW, Sherwin","year":"1961","unstructured":"Exton Smith AN, Sherwin RW. The prevention of pressure sores: significance of spontaneous bodily movements. Lancet 1961;ii:1124-6.","journal-title":"Lancet"},{"key":"ref_9","article-title":"Spinal cord injuries-comprehensive management and research","author":"Guttmann, L.","year":"1976","unstructured":"Guttmann L. Spinal cord injuries-comprehensive management and research. 2nd ed. Oxford: Blackwell Scientific, 1976.","edition":"2nd ed"},{"key":"ref_10","first-page":"10","article-title":"The pathophysiology and management of pressure sores","volume":"11","author":"Enis, J.E.; Sarmiento, A.","year":"1973","unstructured":"Enis JE, Sarmiento A. The pathophysiology and management of pressure sores. Orthopaedic Review 1973;11:10,25.","journal-title":"Orthopaedic Review"},{"key":"ref_11","first-page":"17","article-title":"Clinical research in patient support systems","volume":"1","author":"Bliss, M.R.","year":"1981","unstructured":"Bliss MR. Clinical research in patient support systems. Care Science and Practice 1981;1:17-36.","journal-title":"Care Science and Practice"},{"key":"ref_12","first-page":"235","article-title":"Prevalence and incidence of pressure sores in acute spinal cord injuries","volume":"19","year":"1981","unstructured":"Richardson RR, Meyer PR. Prevalence and incidence of pressure sores in acute spinal cord injuries. Paraplegia 1981;19:235-74.","journal-title":"Paraplegia"},{"key":"ref_13","first-page":"214","article-title":"The care and management of spinal cord itijuries","author":"Bedbrook, G.M.","year":"1981","unstructured":"Bedbrook GM. The care and management of spinal cord itijuries. New York: Springer-Verlag, 1981:214."},{"key":"ref_14","first-page":"143","article-title":"ulcers-principles and techniques of management","author":"MBPressure, Constantin","year":"1980","unstructured":"Constantin MB, ed. Pressure ulcers-principles and techniques of management. Boston: Little Brown and Co, 1980:143-4."},{"key":"ref_15","article-title":"Pressure sores in an orthopaedic population: an epidemiological survey","author":"Versluysen, M.C.","year":"1983","unstructured":"Versluysen MC. Pressure sores in an orthopaedic population: an epidemiological survey. Nursing Research Papers 1983;No 1. (St Bartholomew's Hospital, London.)","journal-title":"Nursing Research Papers; No 1"},{"key":"ref_16","first-page":"182","article-title":"The married life of paraplegics and tetraplegics","volume":"2","author":"Guttmann, L.","year":"1964","unstructured":"Guttmann L. The married life of paraplegics and tetraplegics. Paraplegia 1964; 2:182-8.","journal-title":"Paraplegia"},{"article-title":"Accepted 25","year":"1984","key":"ref_17","unstructured":"(Accepted 25 October 1984)"},{"key":"ref_18","unstructured":"Patient and methods A 29 year old man was admitted to hospital in 1969 for hypertension and glucosuria. Blood pressure was 160\/120 mm Hg despite treatment with chlorthalidone 50 mg daily during the previous two months. Intra-arterial blood pressure was normal, and glucosuria disappeared when the drug was stopped. In 1970 he was investigated further. X ray films of the heart were normal. Angiography showed minor, possibly hypertensive, changes of the intrarenal arteries. Funduscopic examination and tests for phaeochromocytoma and primary hyperaldosteronism yielded normal results. He was again discharged without treatment.","article-title":"Patient and methods A 29 year old man was admitted to hospital in 1969 for hypertension and glucosuria. Blood pressure was 160\/120 mm Hg despite treatment with chlorthalidone 50 mg daily during the previous two months. Intra-arterial blood pressure was normal, and glucosuria disappeared when the drug was stopped. In 1970 he was investigated further. X ray films of the heart were normal. Angiography showed minor, possibly hypertensive, changes of the intrarenal arteries. Funduscopic examination and tests for phaeochromocytoma and primary hyperaldosteronism yielded normal results. He was again discharged without treatment"},{"key":"ref_19","article-title":"In 1977 his blood pressure was permanently raised, and increasing doses of propranolol (up to 480 mg daily) were prescribed (figure). Propranolol was replaced by metoprolol in December 1977. Blood pressure was well under control but he himself increased the dosage of the drug to get rid of palpitations of the heart","volume-title":"he noticed loss of hearing and short attacks of dizziness; The drug was stopped in March","year":"1978","unstructured":"In 1977 his blood pressure was permanently raised, and increasing doses of propranolol (up to 480 mg daily) were prescribed (figure). Propranolol was replaced by metoprolol in December 1977. Blood pressure was well under control but he himself increased the dosage of the drug to get rid of palpitations of the heart. In 1978 he noticed loss of hearing and short attacks of dizziness. The drug was stopped in March 1982, after which he noticed a gradual improvement in hearing during the following months."},{"key":"ref_20","unstructured":"Pure tone audiometry was performed with clinical audiometers of the type Madsen OB 70 until 1981, thereafter of the type Madsen Micro-5. They were equipped with matched TDH-39 earphones with MC 41\/AR cushions calibrated according to ISO-R389-1964. Measurements of bone conduction were performed with Radioear B-70 bone telephone, calibrated according to standards adopted by the Swedish Technical Audiological Society. Speech audiometry was performed with word lists3 presented from a tape recorder (Revox A77) and passed through the speech channel of the audiometer. Acoustic impedance was measured with a Grason-Stadler 1723 middle ear analyser with a probe tone frequency of 220 Hz at 90 db sound pressure level.","article-title":"Pure tone audiometry was performed with clinical audiometers of the type Madsen OB 70 until 1981, thereafter of the type Madsen Micro-5. They were equipped with matched TDH-39 earphones with MC 41\/AR cushions calibrated according to ISO-R389-1964. Measurements of bone conduction were performed with Radioear B-70 bone telephone, calibrated according to standards adopted by the Swedish Technical Audiological Society. Speech audiometry was performed with word lists3 presented from a tape recorder (Revox A77) and passed through the speech channel of the audiometer. Acoustic impedance was measured with a Grason-Stadler 1723 middle ear analyser with a probe tone frequency of 220 Hz at 90 db sound pressure level"},{"key":"ref_21","article-title":"The first hearing test was performed in 1970 and showed normal hearing except for a slight sensorineural high tone loss of hearing. A second pure tone audiogram in October 1978 showed a bilateral, symmetrical, quite extensive loss of hearing of mainly conductive type. In November 1980 pure tone audiometry showed loss of hearing combined type bilaterally, somewhat more pronounced on the right side. Speech audiometry accorded with pure tone audiometry and tympanometry, and stapedius reflex thresholds were normal bilaterally (85-95 db)","volume-title":"showed dose related loss of hearing","author":"A pure tone audiogram in March 1983 confirmed normal hearing except for the sensorineural high tone loss of hearing already seen in","year":"1979","unstructured":"The first hearing test was performed in 1970 and showed normal hearing except for a slight sensorineural high tone loss of hearing. A second pure tone audiogram in October 1978 showed a bilateral, symmetrical, quite extensive loss of hearing of mainly conductive type. In November 1980 pure tone audiometry showed loss of hearing combined type bilaterally, somewhat more pronounced on the right side. Speech audiometry accorded with pure tone audiometry and tympanometry, and stapedius reflex thresholds were normal bilaterally (85-95 db). Pure tone audiometry in February 1979 (200 mg metoprolol), November 1980 (400 mg), and October 1982 (drug free) showed dose related loss of hearing. A pure tone audiogram in March 1983 confirmed normal hearing except for the sensorineural high tone loss of hearing already seen in 1970."},{"key":"ref_22","unstructured":"In a provocation test (28 November to 12 December 1983) he received metoprolol 100 mg twice daily. During provocation the thresholds were within the normal range but raised 5-10 db. The same results were found 10 days after provocation, but after another three weeks the thresholds were the same as before provocation. During provocation he experienced some dizziness but no loss of hearing. A positive Romberg's test with a tendency to fall forwards and an abnormal finger to nose test on the right side could be shown but not at a second examination four weeks after the provocation.","article-title":"In a provocation test (28 November to 12 December 1983) he received metoprolol 100 mg twice daily. During provocation the thresholds were within the normal range but raised 5-10 db. The same results were found 10 days after provocation, but after another three weeks the thresholds were the same as before provocation. During provocation he experienced some dizziness but no loss of hearing. A positive Romberg's test with a tendency to fall forwards and an abnormal finger to nose test on the right side could be shown but not at a second examination four weeks after the provocation"},{"key":"ref_23","article-title":"In our patient varying loss of hearing appeared during treatment with metoprolol and disappeared when the drug was stopped. With one exception the extent of loss of hearing was related to the dose of metoprolol. The exception was in October 1978, when the daily dose","volume-title":"One explanation of the quite extensive loss of hearing on this occasion might have been that he was taking a higher dose than had been prescribed; it might alternatively have been a delayed effect of the higher dose (600 mg daily) that had been taken about one month earlier. The rather slow return to normal of the thresholds after the provocation test supports the second theory. The raised thresholds during provocation were for each frequency close to the methodological error. As, however, the thresholds for almost all frequencies were raised, the slight loss of hearing may be assumed to have been real","year":"was 200 mg.","unstructured":"In our patient varying loss of hearing appeared during treatment with metoprolol and disappeared when the drug was stopped. With one exception the extent of loss of hearing was related to the dose of metoprolol. The exception was in October 1978, when the daily dose was 200 mg. One explanation of the quite extensive loss of hearing on this occasion might have been that he was taking a higher dose than had been prescribed; it might alternatively have been a delayed effect of the higher dose (600 mg daily) that had been taken about one month earlier. The rather slow return to normal of the thresholds after the provocation test supports the second theory. The raised thresholds during provocation were for each frequency close to the methodological error. As, however, the thresholds for almost all frequencies were raised, the slight loss of hearing may be assumed to have been real."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/S0140-6736(84)92859-9","article-title":"Drugs and the heart four years on","volume":"i:","author":"Opie, L.H.","year":"1984","unstructured":"197 1979 1980 1981 1982 193 198","journal-title":"Lanzcet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1017\/S0022215100084632","article-title":"Practolol and deafness","volume":"91","author":"Jones, R.F.M.; Hammond, V.T.; Wright, D.; Ballantyne, J.C.","year":"1977","unstructured":"Opie LH. Drugs and the heart four years on. Lanzcet 1984;i:496-500.","journal-title":"J Larynigol Otol"},{"key":"ref_26","article-title":"Speech audiometry, an experimental and clinical study with Swedish language material","volume":"114","author":"Liden, G.","year":"1954","unstructured":"Jones RFM, Hammond VT, Wright D, Ballantyne JC. Practolol and deafness. J Larynigol Otol 1977;91:963-72.","journal-title":"Acta Otolaryngol"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/S0378-4347(00)82062-9","article-title":"Determination of propranolol and six metabolites in human urine by high-pressure liquid chromatography","volume":"162","author":"Pritchard, J.F.; Schneck, D.W.; AH, Jr, Hayes","year":"1979","unstructured":"Liden G. Speech audiometry, an experimental and clinical study with Swedish language material. Acta Otolaryngol 1954; suppl 114.","journal-title":"J Chromatogr"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/S0021-9673(01)95315-4","article-title":"Atenolol determination by high-performance liquid chromatography and fluorescence detection","volume":"171","author":"Yee, Y.-G.; Rubin, P.; Blaschke, T.F.","year":"1979","unstructured":"Pritchard JF, Schneck DW, Hayes AH Jr. Determination of propranolol and six metabolites in human urine by high-pressure liquid chromatography. J Chromatogr 1979;162:47-58.","journal-title":"J Chromatogr"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1111\/j.2042-7158.1975.tb09473.x","article-title":"The gas chromatographic determination of atenolol in biological samples","volume":"27","author":"Scales, B.; Copsey, P.B.","year":"1975","unstructured":"Yee Y-G, Rubin P, Blaschke TF. Atenolol determination by high-performance liquid chromatography and fluorescence detection. J Chromatogr 1979;171: 357-62.","journal-title":"J Pharm Pharrnacol"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S0021-9673(00)89216-X","article-title":"Determination of debrisoquine and its 4-hydroxy metabolite in biological fluids by gas chromatography with flame-ionization and nitrogen-selective detection","volume":"133","author":"Lennard, M.S.; Silas, J.H.; Smith, A.J.; Tucker, G.T.","year":"1977","unstructured":"Scales B, Copsey PB. The gas chromatographic determination of atenolol in biological samples. J Pharm Pharrnacol 1975;27:430-3.","journal-title":"J Chromatogr"},{"key":"ref_31","first-page":"1256","article-title":"Arthropathy induced by beta blockade. Br MedJ3","volume":"287","author":"Savola, J.","year":"1983","unstructured":"Lennard MS, Silas JH, Smith AJ, Tucker GT. Determination of debrisoquine and its 4-hydroxy metabolite in biological fluids by gas chromatography with flame-ionization and nitrogen-selective detection. J Chromatogr 1977; 133:161-6."},{"key":"ref_32","first-page":"49","article-title":"Senile changes in the middle ear joints","volume":"83","author":"Etholm, B.; A, Jr, Belal","year":"1974","unstructured":"Savola J. Arthropathy induced by beta blockade. Br MedJ3 1983;287:1256-7."},{"key":"ref_33","article-title":"Beta-adrenoreceptor antagonists and diplopia","volume":"826","author":"Weber, J.C.P.","year":"1982","unstructured":"Etholm B, Belal A Jr. Senile changes in the middle ear joints. Ann Otol Rhinol Laryngol 1974;83:49-54.","journal-title":"Lancet"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/0022-510X(74)90107-5","article-title":"The stapedius reflex in the diagnosis of myasthenia gravis","volume":"21","author":"Blom, S.; Zakrisson, J.E.","year":"1974","unstructured":"Weber JCP. Beta-adrenoreceptor antagonists and diplopia. Lancet 1982;ii:826.","journal-title":"Y Neurol Sci"},{"key":"ref_35","first-page":"748","article-title":"Aspirin or nadolol-induced hearing loss. Drug Initell Clin","volume":"16","author":"Pirrotta, J.A.; Fraser, D.G.","year":"1982","unstructured":"Blom S, Zakrisson JE. The stapedius reflex in the diagnosis of myasthenia gravis. Y Neurol Sci 1974;21:71-6.","journal-title":"Pharmn"},{"article-title":"Accepted","year":"1984","key":"ref_36","unstructured":"Pirrotta JA, Fraser DG. Aspirin or nadolol-induced hearing loss. Drug Initell Clin Pharmn 1982;16:748."}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.289.6457.1490","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.289.6457.1490","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T23:18:06Z","timestamp":1765408686000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.289.6457.1490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1984,12,1]]},"references-count":36,"journal-issue":{"issue":"6457","published-online":{"date-parts":[[1984,12,1]]},"published-print":{"date-parts":[[1984,12,1]]}},"alternative-id":["10.1136\/bmj.289.6457.1490"],"URL":"https:\/\/doi.org\/10.1136\/bmj.289.6457.1490","relation":{},"ISSN":["0007-1447","1468-5833"],"issn-type":[{"type":"print","value":"0007-1447"},{"type":"electronic","value":"1468-5833"}],"subject":[],"published":{"date-parts":[[1984,12,1]]}}}