Hi, Spiriva (tiotropium bromide) and Advair (fluticasone propionate and salmeterol) are medications used to manage asthma symptoms. They work in different ways, with Spiriva being a bronchodilator that opens up airways and Advair is a combination of a corticosteroid and a bronchodilator. While both medications are generally safe and effective, they can have side effects, including voice changes and hearing loss. However, it s important to note that these side effects are relatively rare and may not be directly caused by the medication. Voice changes, such as hoarseness or a deepening of the voice, are a known side effect of Advair, and less commonly, of Spiriva. These changes are usually temporary and go away when the medication is stopped or the dosage is adjusted. However, if the voice changes are severe or persistent, it s important to talk to your doctor to rule out any underlying issues. Hearing loss is a less common side effect of these medications, but it has been reported. The exact mechanism behind this side effect is not well understood, but it may be related to the medications effects on the nervous system or blood flow to the inner ear. If you have developed hearing loss, it s important to speak with your doctor right away. It s also important to note that other factors, such as age, noise exposure, and other medical conditions, can contribute to hearing loss. Your doctor may want to perform a hearing test or refer you to an audiologist to help determine the cause of your hearing loss. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Priyanka, General & Family Physician