Welcome to The Thin Line, The New York Post’s series about the darker side of GLP-1 drugs. Though GLP-1 agonists sold under brand names like Ozempic have helped millions of people lose weight, manage diabetes and improve other health conditions, they are not without risks. Check back for more stories about the lesser-known downsides of these wildly popular medications.
The day Sarah Ago buried her mother, grief should have been the hardest thing she had to contend with.
Instead, as the 46-year-old minister rose to deliver the eulogy on that frigid winter morning, something far stranger cut through the sorrow: her own voice.
Every word seemed to thunder inside her skull, each breath bouncing back in a deafening echo.
“It was like being in a tunnel, only able to hear my own magnified voice,” Ago told The Post. “You’re in your own head, hearing yourself like Darth Vader.”
While mourners sat in quiet remembrance, Ago was fighting a different battle — one that was loud, disorienting and unfolding within her own body.
“It took away from the moment, and it just made something that is already challenging that much more difficult,” she remembered.
Only later would she discover the cause: patulous Eustachian tube dysfunction, also known as pETD, an ear condition that can cause people to hear their own voice, breathing and internal bodily sounds at an overwhelming volume.
The trigger? Rapid weight loss spurred by a GLP-1 — and she’s not the only one.
Doctors say they’re now seeing a growing number of patients develop the rare ear disorder after shedding weight quickly on blockbuster diabetes and obesity drugs.
“This used to be something we wouldn’t even see once a year,” Dr. Jessica Lee, a board-certified otolaryngologist at Charleston ENT and Allergy in South Carolina. “Now it’s gone up to one every other month.”
Weight had long felt like an uphill battle for Ago, who moved from one weight loss program to the next throughout the years.
Eighteen months ago, she turned to tirzepatide, the active ingredient in GLP-1s like Mounjaro and Zepbound.
“It has worked beautifully for me,” said the mother of two, noting she’s lost 60 pounds so far. “To feel confident in my own body and not feel like I need to hide has been truly a huge relief.”
“Many patients are initially misdiagnosed with things like allergies or fluid in the ear. Some people, women especially, are just told it’s anxiety.”
Dr. Jessica Lee
But about six months in, something strange began to happen.
“I could hear things outside with my left ear, but in terms of my right, it was entirely consumed with the sound of my own breathing and my voice, which was like 400 times louder than the normal volume,” Ago said.
The episodes would come without warning and sometimes last for hours, leaving her nauseous and fatigued. A minister, she says the condition has made it much harder to stay present while preaching.
Ago went to urgent care, where doctors suspected she had a snorkeling-related ear infection and prescribed antibiotics. But when the medication ran out, the symptoms remained.
Six months later, she booked an appointment with Lee, an ear, nose and throat specialist and board-certified lifestyle medicine physician.
“I thought maybe this was just some fluke. I didn’t know it was a diagnosable condition,” Ago said. But what she was dealing with had a name: pETD.
Humans have two Eustachian tubes — one on each side of the head — that connect the middle ear to the back of the throat. Under normal conditions, these tubes stay closed and briefly open to equalize pressure between the inside of the ear and the outside world.
But in pETD, one or both tubes remain open.
“People will hear echoing of their own voice, or they will hear their breathing loudly, almost like they’re breathing in their own ear,” Lee explained.
Others experience muffled hearing, ringing in the ears, or a persistent sensation of fullness that doesn’t improve with yawning or swallowing.
In more severe cases, patients can hear internal bodily sounds most people never notice — from heartbeat and blood flow to neck creaking or even eye movement.
There can be many causes, but one of the most common is rapid weight loss.
“The Eustachian tube is surrounded by tissue. Some is cartilage, some is bone and some is fat. The first two are fixed, but in cases of rapid weight loss, the fat pad around the Eustachian tube can shrink,” said Dr. Hamid Djalilian, an ear specialist and tinnitus specialist at the UC Irvine School of Medicine.
“Because the fat pad provides structural support to keep the tube shut, when it shrinks, it causes problems,” he explained.
Doctors have seen this pattern before.
“We saw a rise when bariatric surgery became popular several decades ago, but things really tapered off until around two or three years ago when the GLP-1 rise occurred,” Lee said.
And its not just in the States. A study published last year by a German ENT clinic documented seven patients with pETD between June 2024 and June 2025. Each developed symptoms after four to ten months on GLP-1s, with weight loss ranging from 8.2% to 18.7% of their baseline body weight.
Still, specialists say awareness remains low.
“Many patients are initially misdiagnosed with things like allergies or fluid in the ear. Some people, women especially, are just told it’s anxiety.” Lee said. “It’s something that people don’t know about but should absolutely be aware of, because with these medications, the incidence is increasing.”
Online, some GLP-1 users are sharing experiences similar to Ago’s.
“I have lost 30 lbs. and started in mid-February with hearing my own voice and breathing in my right ear. It has been making me feel like I am losing my mind,” one TikTok user commented on a video about the side effect.
“I have this on Mounjaro for 6 months lost 60 lbs. and this is driving me crazy,” another wrote.
“I lost 35 pounds this year and have this issue now, I am MISERABLE … I was told ‘gain some weight back,’” a third added.
While pETD itself isn’t dangerous, its impact can be significant.
“Because these symptoms can occur with daily activities — speaking, breathing and swallowing — they can affect daily life. The pressure sensation can also cause discomfort,” said Dr. Ryan Salvador, an ENT surgeon at Sinus & Snoring Specialists.
“Taken together and if severe enough, pETD can cause social withdrawal, in addition to anxiety and depression.”
While some GLP-1 users are told to regain weight to ease symptoms, specialists say there are other options.
“If it’s not too severe, there are several conservative measures to try. These include things like staying well-hydrated, using certain nasal sprays and avoiding anything that decongests the nose,” said Djalilian, chief medical advisor at NeuroMed Tinnitus Care.
“As a mid-tier intervention, we can place a small piece of paper over the eardrum to dampen the transmission of sound,” he continued. “Finally, there are more invasive treatments like injectables, stents or even surgeries.”
In Ago’s case, two doctors recommended surgery. But she was hesitant. It would require stopping tirzepatide — and even then, the relief would likely be temporary, with repeat procedures potentially needed down the line.
Instead, Lee tried a less invasive approach: placing a small patch on her eardrum to weigh it down and help retrain her right Eustachian tube.
“This side effect has not been fun and has been challenging, but I think the benefits have outweighed the cost.”
Sarah Ago
The outpatient procedure was quick and done without anesthesia, but its effects weren’t permanent. So far, she’s had it done twice.
“There was some improvement, but over time, as I think my body has adapted to the new weight — which Dr. Lee said could happen — the instances of when I have this are less and less,” Ago said. “I still have it, but probably 90% of the time I don’t, so that’s a huge improvement.”
Today, at least 1 in 8 American adults have tried a GLP-1 to slim down, and doctors say cases like Ago’s could become more common as new pill versions attract more users.
“Weight loss or the GLP-1 medication aren’t bad. They can be life changing. But the point really is that the rapid tissue loss is what causes these anatomic and physiologic changes,” Lee said.
That’s why working with a doctor is essential, she added, since the treatment can be adjusted to help minimize side effects.
“There is pretty good evidence from previous studies that if you slow the rate of weight loss down, the body has more time to acclimate and you’re less likely to get these symptoms,” Lee said.
Even with the complications, Ago says she doesn’t regret starting a GLP-1.
“This side effect has not been fun and has been challenging, but I think the benefits have outweighed the cost,” she said.
For others navigating similar symptoms, she suggests getting evaluated by a specialist early and exploring all of your options.
“If you’re not interested in surgery, or if that thought concerns you, give it time, because it may be that your body will adjust and adapt,” Ago said. “I think sometimes if we can keep that in mind and know that’s a possibility, then it can help us endure in the meantime.”
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