Ototoxic Hearing Loss – All You Need to Know



Ototoxic medications, although sometimes necessary for the treatment of severe infections, cancer, or heart disease, can be harmful to a person’s hearing. These medications can cause permanent ear damage, resulting in hearing loss, ringing in the ear, balance-related problems, and more. Knowing the causes and symptoms of ototoxic hearing loss can help diagnose and treat the condition.

What Is Ototoxic Hearing Loss?

Ototoxic hearing loss is damage to the inner ear caused by medications or other chemicals. While ototoxic medications can cause hearing loss, the severity of that loss may vary depending upon the dose, how long the person has been taking the medication, and whether they are taking more than one drug.

Besides ototoxic drugs, other factors that can contribute to ototoxic hearing loss include:

  • Family history of ototoxicity
  • Age (elderly and children are at increased risk
  • Impaired kidney function that causes drug accumulation and risk of toxicity
  • Cumulative lifetime dose of drugs that could have toxic effects
  • Existing hearing loss or ear damage
  • Previous exposure to neck and head radiation
  • Pregnancy

What Are the Signs of Ototoxicity?

The symptoms of ototoxicity can vary depending upon which part of the inner ear is affected:

  • The cochlea, which translates sound into electrical signals. Damage to the cochlea can result in diminished volume and clarity of sound.
  • The vestibular system, which helps maintain equilibrium. Damage here can result in problems with balance
  • The auditory nerve, which carries signals to the brain. Damage to this nerve can result in weak, distorted perception of sound.

Ototoxicity symptoms may include:

  • Tinnitus (ringing in the ears)
  • Dizziness
  • Loss of coordination
  • Hearing loss in one or both ears
  • Oscillating vision
  • Hyperacusis (increased sensitivity to sound at various frequencies)
  • Nausea or vomiting

What Does Ototoxicity Feel Like?

If you have ototoxicity, you may experience:

  • Abnormal sounds in your ear or head that become louder as the condition progresses, often resulting in difficulty sleeping.
  • Fullness in your ear or head, similar to the feeling one might experience during a cold.
  • Severe dizziness.

What Are Some Medications That Can Result in Ototoxic Hearing Loss?

The following medications have ototoxic properties which can affect your hearing:

1. Non-steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs like naproxen and ibuprofen can reduce blood flow to the cochlea, resulting (rarely) in hearing loss.

2. Chemotherapy Drugs

Chemotherapy drugs such as bleomycin, cisplatin, and carboplatin have been linked to tinnitus and hearing loss.

3. Aspirin

Taking large doses of aspirin, in the range of eight to ten pills per day (1500 mg or more), can cause temporary hearing loss. This effect is reversible with reduced dosage.

4. Loop Diuretics

Loop diuretics or “water pills” such as bumetanide and furosemide are prescribed to treat hypertension and edema. They act to decrease the amount of fluid in the body. They also can cause changes in fluid balance and electrolytes in the inner ear. This can lead to tissue swelling and issues with nerve signal transmission.

While hearing loss from loop diuretics is generally temporary, the effect can be permanent if the medication is used along with other ototoxic drugs.

5. Antibiotics

Patients taking aminoglycosides (a commonly used class of antibiotics) have an increased risk of experiencing permanent hearing loss.

Non-aminoglycoside antibiotics, such as vancomycin and erythromycin, have also been shown to cause ototoxic hearing impairment.

6. How Is Ototoxic Hearing Loss Treated?

Currently, there are no approved drugs for the prevention or treatment of ototoxic hearing loss. In some cases, symptoms improve when the patient stops taking the offending drug. In other cases, the risk of hearing damage must be balanced against the benefits of a particular medication. When a medication known to carry significant risk to hearing is prescribed, physicians often will discuss the possible need for hearing aids or cochlear implants as a result.

If you suspect you have ototoxic hearing loss or are experiencing its symptoms, schedule an appointment with Dr. Chris Hoffmann to get your hearing tested.


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Chris Lin Hoffmann

Dr. Chris Hoffmann is an audiologist who has been involved in hearing sciences for over 20 years. Her passion for helping people with their hearing led her to establish Hoffmann Audiology hearing clinic. Dr. Hoffmann has more than 14 years of clinical knowledge in hearing testing, hearing aid fittings, and aural rehabilitation.