Ototoxic Medications

Female scientist holding potentially ototoxic medication

(Adapted from the Canadian Hearing Society Blog  – February 7, 2018)

There is a rather large list of prescription medications that are currently or have previously been on the market that have the ability to cause hearing loss, either temporary or permanent. When medications result in hearing loss, ringing in the ears, or balance disorders, they are known as ototoxic. With over 200 ototoxic drugs being prescribed over the counter or in hospitals they can include over the counter painkillers,  certain antibiotic families and chemotherapy drugs. A dosage of certain drugs can cause irreparable damage to the inner hair cells. In some instances, the side effects  caused by these drugs can be reversed when usage is stopped. Other times, the damage is permanent.

Tinnitus or ringing in the ears is often the first sign that a medication is ototoxic. If hearing loss develops, it may be some time before you notice. These medications can also cause onset balance disorders or dizzy spells. Feeling dizzy or difficulty in hearing conversations may cause you to stop participating in your usual activities and affect your quality of life.

Ototoxic Medications

(Provided by the Canadian Hearing Society)

  • Aminoglycoside antibiotics such as streptomycin, dihydrostreptomycin, kanamycin, gentamicin, neomycin, tobramycin, netilmicin, and amikacin can cause permanent hearing loss. Notice how all of these antibiotics end in “mycin” or “cin”. They are used to treat severe infections such as ones in the abdomen and urinary tract. Depending on the drug, they can affect both your hearing and balance system.
  • Erythromycin is a class of macrolide antibiotics. It’s used to treat certain infections caused by bacteria, including ear infections, bronchitis and pneumonia to name a few.  This drug compared to almost all other ototoxic medications which affect hearing in the high frequencies first, making it more difficult for the patient to detect that they are having a hearing problem until more damage occurs. The good news is, if the patient stops taking erythromycin, the hearing often settles back down to normal limits.
  • Salicylate pain relievers, for example aspirin or Pepto-Bismol, when taken in large doses (such as 8-12 pills per day) or quantities can cause temporary hearing loss.
  • Nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen, Aleve, Motrin, Naproxen – again, when taken in large doses – can temporarily affect your hearing.
  • Quinine used to treat malaria or nocturnal leg cramps can cause temporary hearing loss. Once quinine is stopped, the hearing-related side effects generally disappear.
  • Loop diuretics such as fursosemede (Lasix) used to treat congestive heart or renal failure, cirrhosis or hypertension can cause temporary or permanent hearing loss.
  • Anti-neoplastics used in chemotherapy such as cisplatin and carboplatin are ototoxic.  Cisplatin is one of the most damaging medications in existence for your hearing and can live in the inner ear fluids for up to a year post-treatment. Anti-neoplastics are used to treat esophageal, cervical, ovarian, testicular, bladder, lung and brain cancers. Hearing loss resulting from cisplatin or carboplatin is permanent. High doses of radiation to the head, ear or brain can cause permanent or temporary hearing loss as well.

Factors to consider

There are numerous factors that affect ototoxicity. Dosage, course of treatment, genetics, age, dehydration,  kidney and liver functions are the main factors to consider. Your doctor and pharmacist should be working collaboratively to ensure there are not any inherent risks to permanent hearing loss. In some instances, exposure to loud noise while taking certain drugs will increase their damaging effects. Toxins found in heavy metals, solvents and gases can also affect your hearing (Figure 1). These toxins can be found in occupational settings such as manufacturing facilities, dry cleaning, or in household items such as adhesives, spot removers, insecticides and paint/varnishes.

Ototoxic Substances
Toxins Heavy Metals Solvents Gases
Lead Benzene Carbon Monoxide
Arsenic Butyl Alcohol
Manganese Hexane
Cobalt Styrene
Mercury Toluene
Xylene

Figure 1

When To See Your Doctor or Audiologist

Ototoxic medications are typically used to treat serious illness. Your doctor should consider the effects of the medication on your hearing and balance systems.

Before starting ototoxic medication, we recommend seeing an audiologist for a baseline hearing test or balance assessment. Your test results can be helpful to your physician. They can evaluate if any steps should be taken to stop or change the medication if it begins affecting your hearing. If the medication cannot be stopped or changed, it’s advisable to meet with your audiologist for periodic hearing tests or to make adjustments to your hearing aids as part of the monitoring process.

Concerned about how medication could be affecting your hearing? Our hearing health care professionals would be happy to provide you with a consultation and baseline hearing test. Use the following form to schedule an appointment today.