When considering medication side effects, most people anticipate issues like nausea or dizziness. However, a more permanent and less recognised risk exists: drug-induced hearing damage.
Known as ototoxicity, this condition affects the inner ear's delicate structures, potentially causing lasting harm to hearing and balance. With approximately 200 medications identified as having ototoxic properties, awareness is crucial for patients across the United Kingdom.
Understanding Ototoxicity and Its Mechanisms
Ototoxicity refers to chemical-induced damage to either the cochlea, affecting hearing, or the vestibular system, controlling balance. Common symptoms include persistent tinnitus (ringing in the ears), hearing loss (particularly with high-frequency sounds), dizziness, balance difficulties, or a sensation of ear fullness.
These effects range from temporary to permanent, depending on the specific drug, dosage, treatment duration, and individual susceptibility. The inner ear's extreme sensitivity makes it particularly vulnerable.
Most experts believe ototoxic medications cause damage by harming the tiny, irreplaceable hair cells within the cochlea or disrupting the delicate fluid balance essential for proper inner ear function. Once these hair cells are destroyed, they cannot regenerate, making resulting hearing loss typically irreversible.
Five Medication Categories Requiring Caution
1. Antibiotics
Aminoglycoside antibiotics, including gentamicin, tobramycin, and streptomycin, represent some of the most well-documented ototoxic medications. Typically administered intravenously for serious infections like sepsis, meningitis, or tuberculosis, these drugs can cause irreversible hearing loss, especially at high doses or during extended treatment courses.
Notably, these antibiotics can linger in the inner ear for weeks or months after treatment concludes, meaning damage might progress even after stopping medication. Genetic factors can increase individual vulnerability.
Other antibiotics of concern include macrolides (erythromycin, azithromycin) and vancomycin, particularly for older adults or those with kidney issues.
2. Heart and Blood Pressure Medications
Loop diuretics like furosemide and bumetanide, commonly prescribed for heart failure and hypertension, can cause temporary hearing impairment by disrupting the inner ear's fluid and electrolyte balance. Approximately 3% of users might experience these effects, especially with high intravenous doses.
Some blood pressure medications, including ACE inhibitors like ramipril and calcium-channel blockers such as amlodipine, have also been associated with tinnitus, though further research is needed to fully understand these connections.
3. Chemotherapy Drugs
Platinum-based chemotherapy agents, particularly cisplatin and carboplatin, rank among the most potent ototoxic medications. Cisplatin, used against testicular, ovarian, breast, and head/neck cancers, carries a significant risk of permanent hearing damage.
Alarmingly, up to 60% of cisplatin patients develop some degree of hearing loss, with risk increasing when radiation targets the head or neck area. Researchers continue exploring dosage adjustments to mitigate hearing damage without compromising cancer treatment effectiveness.
4. Common Pain Relievers
High doses of everyday painkillers present unexpected hearing risks. A substantial study found women under 60 regularly taking moderate-dose aspirin (325mg or more, six-seven times weekly) faced a 16% higher tinnitus risk.
Frequent use of NSAIDs (ibuprofen, naproxen) and paracetamol correlated with an approximately 20% increased tinnitus risk, particularly among regular female users. Another study linked long-term painkiller use to heightened hearing loss risk, especially in men under 60.
Fortunately, these auditory side effects typically resolve after discontinuing medication, though they generally occur only after prolonged, high-dose usage.
5. Antimalarial Medications
Drugs like chloroquine and quinine, used for malaria treatment and leg cramp relief, can cause reversible hearing loss and tinnitus. One study indicated 25-33% of people with hearing loss had previously taken these medications.
Hydroxychloroquine, treating lupus and rheumatoid arthritis, shares similar chemical structure and risks. While some patients recover after stopping treatment, others sustain permanent damage, particularly following long-term or high-dose usage.
Risk Factors and Protective Measures
Certain individuals face heightened vulnerability, including those with pre-existing hearing impairment, kidney disease, genetic susceptibility, or those taking multiple ototoxic drugs simultaneously. Children and older adults may also demonstrate increased sensitivity.
For serious conditions like cancer, sepsis, or tuberculosis, the therapeutic benefits of these medications typically outweigh potential hearing risks. Nevertheless, patients should maintain awareness and open communication with healthcare providers.
Always consult your doctor or pharmacist about potential hearing-related side effects when prescribed new medications. Promptly report any symptoms like ear ringing, dizziness, or muffled hearing to your healthcare provider. Early detection remains crucial for managing potential ototoxic effects and preserving your auditory health.
