Does diclofenac cause ear ringing? Exploring the link between NSAIDs and tinnitus

October 9, 2025 •

4 min read

A longitudinal study of nearly 70,000 women found that frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with an almost 20% higher risk of tinnitus. This highlights the evidence-backed reality that, yes, diclofenac can cause ear ringing in some individuals, particularly with higher doses or prolonged use.

Quick Summary

Diclofenac, a common NSAID, can cause tinnitus (ear ringing), often reversibly with reduced dosage or discontinuation. The risk is typically linked to higher doses and frequent use, and alternative pain management options are available.

Key Points

Diclofenac and Tinnitus are Linked: Diclofenac, like other NSAIDs, has been identified as a potential cause of tinnitus, or ear ringing, especially with frequent or high-dose use.
Tinnitus is Often Reversible: For many, the ear ringing associated with diclofenac is temporary and resolves after discontinuing the medication or lowering the dose.
Dose-Dependent Risk: The risk of developing tinnitus from diclofenac is typically higher with increased dosage and duration of use.
Consult a Healthcare Provider: It is crucial to speak with a doctor if you experience tinnitus while taking diclofenac to rule out other causes and discuss safe alternatives.
Alternatives Exist: If diclofenac causes problematic tinnitus, other pain management options, including alternative NSAIDs or non-NSAID analgesics, can be explored with your doctor.
Management Strategies Help: If tinnitus persists, non-pharmaceutical methods like noise masking, stress reduction, and hearing aids can help manage symptoms.

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) prescribed to treat pain and reduce inflammation in conditions like arthritis, migraines, and joint pain. While it is an effective medication for many, it is not without potential side effects. Among the less common but notable adverse effects is tinnitus, the perception of ringing, buzzing, or other sounds in the ears.

What is Diclofenac?

Diclofenac belongs to a class of drugs that work by inhibiting the body's production of prostaglandins. These are hormone-like substances that play a significant role in causing pain, fever, and inflammation. By blocking their production, diclofenac helps to relieve these symptoms. It is available in various forms, including oral tablets, topical gels, and patches. The specific formulation and dosage can influence the likelihood of experiencing systemic side effects.

The Connection Between NSAIDs, Diclofenac, and Tinnitus

Research has established a clear association between the frequent use of NSAIDs and an increased risk of developing tinnitus. The Nurses' Health Study II, which tracked thousands of women over two decades, found that those who used NSAIDs frequently had a significantly higher chance of experiencing persistent tinnitus. Diclofenac is one of the NSAIDs linked to this side effect, as confirmed in patient information leaflets and clinical trial data.

The risk of developing tinnitus from diclofenac is often dose-dependent, meaning it is more likely to occur with higher daily doses or when taken over an extended period. For most individuals, this adverse effect is reversible, and the ringing or buzzing sensation subsides once the medication is stopped or the dosage is reduced. However, anyone experiencing this should consult a healthcare provider before making any changes to their medication regimen.

Proposed Mechanisms of Ototoxicity

While the exact mechanism is not fully understood, scientists have proposed several ways in which NSAIDs like diclofenac could cause or worsen tinnitus:

Reduced Cochlear Blood Flow: NSAIDs might restrict the blood flow to the cochlea, the hearing part of the inner ear. This reduction can damage the delicate hair cells responsible for converting sound waves into electrical signals for the brain, which can be perceived as tinnitus.
Alterations in Neurotransmission: Changes in the central auditory pathways in the brain, potentially resulting from diminished inhibition caused by the drug, can contribute to the perception of sound.
Chronic Inflammation and Ototoxicity: In some cases, particularly with topical ear applications where the eardrum is damaged, diclofenac can be directly ototoxic, or damaging to the inner ear.

Understanding Risk Factors and Management

Several factors can increase an individual's risk of experiencing diclofenac-related tinnitus. Long-term, frequent use and higher dosages are the most significant culprits. Pre-existing hearing conditions or other health issues may also contribute to the risk. The good news is that for the majority of patients, the tinnitus is a temporary condition that resolves after medication adjustment.

Comparison of Pain Relievers and Tinnitus Risk

When considering pain management options, it is helpful to compare the relative risks of tinnitus associated with different medications. It is important to note that all NSAIDs carry some degree of risk, and individual reactions can vary.


Medication (Generic Name)	Drug Class	Tinnitus Risk	Reversibility	Notes
Diclofenac	NSAID	Moderate (Higher with high dose/chronic use)	Often Reversible	Oral forms have higher systemic risk than topical.
Ibuprofen	NSAID	Moderate (Higher with high dose/chronic use)	Often Reversible	Very common OTC pain reliever.
Naproxen	NSAID	Moderate (Higher with high dose/chronic use)	Often Reversible	Lasts longer than ibuprofen.
Aspirin	NSAID/Salicylate	Well-documented risk, especially at high doses	Often Reversible	High doses used for specific conditions.
Acetaminophen	Non-NSAID Analgesic	Linked to tinnitus in some studies	Varies	Not an anti-inflammatory; generally safer for stomach.
COX-2 Inhibitors	Selective NSAID	Linked to tinnitus in some studies	Varies	Fewer GI side effects than traditional NSAIDs.

Steps to Take If Tinnitus Occurs

Consult Your Doctor: Do not stop taking a prescribed medication abruptly. Discuss your symptoms with your healthcare provider, who can rule out other causes and guide you on a safe course of action.
Dosage Adjustment: Your doctor may recommend a lower dose or a different pain reliever to see if the tinnitus improves.
Monitor Your Symptoms: Keep a journal of when you experience tinnitus and other potential symptoms. This can help your doctor better understand the cause and effect.

Non-Pharmaceutical Management for Tinnitus

For those who need to continue with diclofenac or another NSAID, or for whom the tinnitus is persistent, non-pharmaceutical strategies can help manage the condition:

Noise Masking: Using a white noise machine, a fan, or low-level background music can help mask the ringing sound.
Cognitive Behavioral Therapy (CBT): This can help change the emotional response to tinnitus, making it less intrusive.
Stress Reduction: Stress and anxiety can worsen tinnitus. Relaxation techniques, exercise, and adequate sleep can help manage symptoms.
Hearing Aids: For those with an underlying hearing loss, hearing aids can amplify external sounds, making the tinnitus less noticeable.

Conclusion

While diclofenac is a valuable medication for managing pain and inflammation, it's important to be aware of its potential side effects, including the risk of tinnitus. The condition is often reversible by adjusting the dosage or discontinuing the medication under a doctor's guidance. For most people, the benefits of diclofenac outweigh the potential risks, but awareness and proper medical supervision are essential for safe treatment. Patients who experience ear ringing should promptly inform their healthcare provider to explore alternatives or management strategies, ensuring their pain is treated effectively while minimizing unwanted side effects. For more information, please consult the MedlinePlus Drug Information on Diclofenac.

Frequently Asked Questions

No, tinnitus caused by diclofenac and other NSAIDs is typically reversible. The symptoms should subside after stopping the medication or lowering the dosage, under a doctor's supervision.

Tinnitus is the perception of noise or ringing in the ears when no external sound is present. It is a symptom of an underlying condition, not a disease itself.

Yes, those taking higher doses, using the medication long-term, or with pre-existing hearing conditions may be at greater risk. Individual susceptibility also plays a role.

The risk is lower with topical forms compared to oral diclofenac, as less of the drug enters the bloodstream. However, ototoxicity is a potential risk, especially in cases of chronic ear infection with a perforated eardrum.

While many NSAIDs can cause tinnitus, the specific risk can vary based on the drug, dose, and individual factors. High-dose aspirin, for example, is well known for causing reversible tinnitus.

You should not stop taking a prescribed medication abruptly. It is essential to consult your doctor, who can help determine if the diclofenac is the cause and recommend a safe course of action.

Depending on the condition, alternatives may include other NSAIDs with different risk profiles, non-NSAID analgesics like acetaminophen, or topical treatments. A doctor should be consulted for the best option.