All About Ototoxic Hearing Loss

All About Ototoxic Hearing Loss

In hearing health, hearing loss by Laurie Duffy, M.S.

Laurie Duffy, M.S.

Many medications are designed to help us with specific ailments and continue to become more advanced. However even the most helpful and essential medications can have unexpected side effects. It is important to be aware of these side effects before you begin any new medication so you can weigh the benefits of the medication with the risk. Certain medications are considered ototoxic, meaning that they have the potential to damage hearing permanently. 

Symptoms of Ototoxic Hearing Loss

In most cases, the first sign of ototoxicity presents itself as ringing in the ears, also known as tinnitus. As ototoxic medications continue to be taken, hearing loss can slowly develop over time, making it difficult to understand speech and the loss of certain tones or pitches such as the wind in the trees or the chirping of birds. Another serious symptom of ototoxic medication is balance and vertigo issues as the inner ear becomes increasingly damaged. Often balance issues can be temporary while your body and brain recalibrate from the damage to the inner ear. 

What is happening inside my ear to cause these effects?

Our ears are complex and fragile, collecting sound and sending it to the inner ear where tiny hairs called cilia send the sounds to the brain to be interpreted and processed. We use our inner ears to not only hear but to also stay in balance. The canals of the ear are filled with fluid and lined with tiny cilia. When you move your head, the fluid in the canals also moves which in turn moves the cilia. The cilia not only communicate audio information to your brain but also the sounds location, proximity and approximate speed. Cilia also send position information as signals to your brain. Ototoxic medications cause damage to these sensory cells of the inner ear used in hearing and balance. 

Understanding Which Medications Are Ototoxic

There are many different medications that can damage your fragile inner ear. Not all of these drugs have the same function. For instance some medications used to treat cancer can damage the inner ear, while some heart medicines also are ototoxic. Some of these medications can be life saving, so weighing the benefits of treatment vs. risks to hearing is essential. The degree of ototoxicity varies, and is related to how long you take the medicine, infusion rates and other drug interactions. In some instances, exposure to a high and damaging level of noise while taking some ototoxic drugs can increase the damage to your ears. There are other categories of drugs known to be ototoxic including anesthetics, cardiac medications, glucocorticosteroids (cortisone, steroids) and mood-altering drugs. If you are particularly concerned with ototoxicity in medication here is a list of the most common types:

  • Chemotherapy and other cancer treatments – this includes bleomycin, cisplatin, and cyclophosphamide
  • Some diuretics – including furosemide or bumetanide
  • Some antibiotics — including aminoglycosides (gentamicin, streptomycin, or neomycin)
  • Nonsteroidal anti-inflammatory drugs (NSAIDS) – Most common being ibuprofen
  • Aspirin and other painkillers –ototoxicity is only a concern in large doses

How Can You Protect Your Ears?

It is important to understand the risk with the medications that you take regularly. If you do not need the medication then it may be safer for your ears to avoid the medication as regularly. In the majority of cases, ototoxic hearing loss is not permanent and is not even very common. However this does not rule out the risk completely. It’s important to understand that any damage to your inner ear is often permanent. If you take many medications, prescribed and over the counter it is important that your primary care physician keeps track of these to make sure the risk to your ears is not too severe. 

Addressing Hearing Loss

Hearing aids amplify the sounds that you struggle with and amplify them so you can hear much more clearly. If your ears are damaged due to ototoxic medication or any other cause it’s a great idea to set up an appointment to have your hearing tested and fitted with hearing aids that can help you recover from most types of hearing loss.