When Rush Limbaugh announced two years ago that he had suddenly gone deaf, he was uncharacteristically circumspect about the possible cause. "There is a theory as to what's happening," Limbaugh told his listeners in October 2001, "but I'm going to keep that to myself. It's not genetic. There's something more going on than that."
Was the "something more" Limbaugh's abuse of painkillers?
The New York Daily News reported last week that Limbaugh is under investigation for buying "thousands of addictive pain killers from a black-market drug ring." Relying heavily on a story that first appeared in the National Enquirer, the Daily News reported that Limbaugh's former housekeeper claims to have supplied him with massive quantities of OxyContin, Lorcet and hydrocodone between 1998 and 2002.
Lorcet -- which, like Vicodin, is a mixture of hydrocodone and acetaminophen -- has been linked to sudden and profound hearing loss in patients who misuse or abuse the drug. First in 1999 and then more forcefully in the summer of 2001, physicians at the House Ear Clinic in Los Angeles warned doctors and consumers of a "possible correlation between permanent hearing loss" and hydrocodone-acetaminophen combinations such as Lorcet and Vicodin. The Los Angeles Times reported in September 2001 that doctors at House and other Southern California medical facilities had identified 48 patients who suffered hearing loss after taking exceptionally high doses of the drugs.
Coincidentally -- or not -- Limbaugh turned to the House Ear Institute after he began experiencing what doctors there called "rapidly progressive hearing loss" in May 2001. Limbaugh announced his hearing loss on Oct. 8, 2001, after listeners to his show began to notice that his voice had lost some of its usual basso profundo thunder. The news of Limbaugh's hearing loss was greeted with something approaching mourning on the right; the White House expressed George W. Bush's personal concern for Limbaugh and said that the president considered him a "national treasure."
Three days later, doctors at House told reporters that they were treating Limbaugh for "hearing loss resulting from autoimmune inner ear disease," or AIED. The doctors said that they based their diagnosis on Limbaugh's "medical history and hearing tests." However, they noted at the time that "Mr. Limbaugh does not display most of the symptoms associated with AIED."
House physicians issued a statement late last week in which they stuck with their diagnosis of AIED, despite the surfacing of allegations that Limbaugh had abused one of the drugs House previously identified as causing hearing loss. "The AIED diagnosis has not changed, and the House Ear Clinic continues to consult Mr. Limbaugh regarding his treatment for this disorder, and to follow up with him regarding his cochlear implant," they said.
In the statement, the House doctors said that hearing loss caused by an overdose of Vicodin-type drugs "usually occurs over a period of days," while hearing loss caused by AIED typically occurs "over a period of several weeks to months." Limbaugh's hearing loss reportedly took several months, from May through September 2001.
But Dr. Gail Ishiyama, a UCLA neurotologist studying the mechanism that triggers hearing loss in Vicodin users, said that there is no real way to tell the difference between AIED and Vicodin-induced hearing loss -- unless the patient confesses to drug abuse. "It can present very similarly," she told Salon Monday, "and unless the patient tells you that they're abusing the Vicodin or other pain medication, you wouldn't know the difference."
Ishiyama disagreed with House's contention that hearing loss in drug cases happens faster than that in AIED cases. "Both typically are on the order of months, a few months or so," she said. Ishiyama said that "the only difference" in how the two maladies present themselves is the patient's history; if a patient denies abusing drugs, doctors "couldn't really know" whether the patient suffered from AIED or drug-induced hearing loss.
"Patients don't admit to the drug use, and it actually sounds like that was the case in his particular case," Ishiyama said. "So many patients are reluctant to admit to their abuse even if they're asked." Ishiyama, who is conducting research under a grant from the National Institute of Deafness and Other Communication Disorders, said it is unfortunate that patients frequently withhold information about drug abuse from their doctors because evidence shows that drug-induced hearing loss may be halted if the drug use is stopped in time.
When asked about the AIED diagnosis late last week, House spokeswoman Christa Spieth Nuber initially told Salon that Limbaugh underwent blood tests during his diagnosis and treatment at House, and that the tests did not reveal any signs of drug abuse. Minutes later, however, Spieth Nuber called back to say that she had discussed Limbaugh's case with Dr. Jennifer Derebery, one of the physicians who had treated Limbaugh, and that Derebery told her that Limbaugh had not, in fact, been tested for "toxicity" related to drug use. She said her earlier statement to the contrary had been an error based on her own mistaken assumption about the way Limbaugh's case would have been handled.
Spieth Nuber said a toxicity test was not necessary in Limbaugh's case because the House doctors had already made their AIED diagnosis based on a full medical evaluation, Limbaugh's medical history -- as provided to them by his earlier doctors and by Limbaugh himself -- and the relatively slow nature of his hearing loss.
Ironically, when Limbaugh made his announcement in October 2001, he told listeners that they "would not believe the medication that is flowing through me in an attempt to reverse this." He said: "I'm popping pills [and] I'm shooting up stuff. I've never done stuff like this before." The medication ultimately proved ineffective, and Limbaugh received a cochlear implant in 2001, reportedly restoring much of his hearing and allowing him to continue working.
Premiere Radio Networks, which distributes Limbaugh's show, referred calls about his hearing loss to the House clinic. Meanwhile, Limbaugh has been circumspect about the allegations that he abused drugs -- and silent altogether about any possible link between drug abuse and his hearing loss. On his radio show Monday, Limbaugh mentioned the drug-related allegations against him but offered no specific information.
"I am waiting to find out just exactly what I am facing legally, and until I know that, I'm not going to say anything -- much less, I can't," Limbaugh told listeners Monday. "When such time comes, fear not, what there is to be known will be known and I will tell you. But until it is permissible and makes sense for me to tell you that, I can't and I won't."