Ototoxic medications are a common cause of hearing loss and tinnitus—particularly among older adults. Learn about ototoxicity, which medications are ototoxic and what you can do to protect your hearing.
Otolaryngologist and research professor Dr. Leonard Rybak, Ph.D, M.D., explains, “Ototoxicity is the process by which the inner ear is damaged by a drug. It can affect either the balance system or the auditory system, or sometimes both.”
Ototoxicity literally means “ear poisoning” (“oto” = ear, “toxicity” = poisoning). Any substance that might negatively affect the inner ear, specifically its sensory cells, is considered ototoxic. Because inner ear organs control both hearing and balance, damage from ototoxic drugs and medicines can result in hearing loss, tinnitus and balance problems.
Many medications are known to have ototoxic effects. According to the American Speech-Language-Hearing Association, more than 200 known ototoxic medications are in use today.
Being classified as ototoxic does not mean a medication will have the same effect on everyone- some people might not be affected at all. Symptoms can vary considerably depending on a person’s age and health history, the type of ototoxic drug being ingested and the extent of exposure. Symptoms of ototoxicity include:
“Certain medications are very prone to damaging the inner ear and causing hearing loss,” Dr. Rybak says. “Those include mainly cisplatin and aminoglycosides.” However, these respective anticancer and antibiotic medicines aren't the only drugs that can affect your hearing.
Common ototoxic drugs that may cause temporary or permanent hearing damage:
Common ototoxic drugs that may cause temporary damage include:
Ototoxic drugs that can cause permanent hearing damage include:
In some cases, removing the ototoxic medication from your regimen can reverse ototoxic hearing loss. However, the damage may be permanent. If you’re taking any of these medications on the advice of a physician, do not stop taking them. Speak with your doctor about any concerns you may have to determine what’s best for your situation.
There’s no specific test for ototoxicity. To make a diagnosis, doctors look at an individual’s health history, symptoms and hearing test (audiogram) results. They may also perform an ear inspection to rule out other potential hearing loss causes, such as an ear infection, ear wax buildup or a perforated eardrum.
Before starting a patient on an ototoxic drug, doctors are advised to conduct a baseline hearing test to help them monitor changes in the patient’s hearing during the treatment process. “If a patient didn’t have a previous hearing test prior to exposure to the drug, they wouldn’t know if they had hearing loss before or if it’s something related to the drug,” Dr. Rybak explains. “Before starting a patient on an ototoxic drug, doctors should do a baseline hearing test and do follow-up tests later to see if any changes have taken place.”
If stopping the ototoxic medication doesn't reverse the damage, other measures must be taken. Treatment for ototoxic hearing loss focuses on controlling the symptoms. Hearing aids (cochlear implants, in more severe cases) can significantly improve hearing for people with permanent hearing loss and tinnitus.
Researchers are working to develop ways to protect people from the effects of ototoxic medicines. Currently, there is no approved clinical method for guaranteed safety. However, there are several simple steps you can take to protect your hearing: