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Some medications can be toxic to the ear. These are called ototoxic medications. The effects of these medications vary significantly. Some have a minor risk of hearing loss and some are almost assured to cause significant hearing loss and/or balance problems. The severity of damage to the ear is also dependent on dosage and how long they are taken. It may also be increased by poor kidney or liver function, as the druge may not be cleared out of your body as quickly.
Ototoxic medications can cause damage to the part of the ear involved in hearing or to the part that keeps us balanced. Some medications may affect both. You can ask your physician or pharmacist if you think you might be taking any of the medications listed below. There may also be a warning in the instructions. If you are given a medication that has a high risk of damage to the ear, your doctor may recommend you have your hearing monitored by an audiologist.
Ototoxic drugs are often used when there is no other available medication to treat serious conditions. You should never stop using a prescription drug without consulting your physician and always follow directions for medication exactly as prescribed.
Aminoglycosides
Aminoglycosides are a class of antibiotics. They are often given through IV and are frequently used to treat serious infections. When given in large doses (greater than 240 mg), aminoglycosides may damage hearing and/or balance function in the ear. Drugs such as neomycin, kanamycin and amikacin are particularly damaging to hearing. Streptomycin is especially damaging to balance function, although affects hearing as well.
Chemotherapy
Cancer fighting drugs (professionally called antineoplastic agents) can be toxic to the ear, but particularly when they include platinum. The primary drugs using platinum are cisplatin and carboplatin. Hearing loss and tinnitus are almost unavoidable with these drugs, but they are often used when no other alternative therapy exists. Patients receiving cisplatin or carboplatin are usually referred to an audiologist for monitoring of hearing. Tinnitus is also common with these drugs.
Diuretics
A certain type of diuretic, called a loop diuretic can cause permanent hearing loss. The most common drug causing hearing loss is furosemide (may be prescribed by the brand name Lasix). The effects of Furosemide may be reversible. However, Furosemide is most damaging to the ear and irreversible when it is given to patients with kidney failure who have previously taken aminoglycoside antibiotics.
Quinine
Quinine is used to treat malaria and is therefore not common in the U.S. Quinine typically must be taken in high doses to affect the ear and will cause loss of hearing and tinnitus. Some homeopathic remedies contain small amounts of quinine and are not likely to affect hearing.
Ototoxic medications are often used when nothing else will help. Therefore, stopping use of the drug may not be an option. Instead, you can talk to your prescribing physician and pharmacist about the likely effects of any drugs you are taking and visit an audiologist if there is risk of damage to the ear (sometimes the dose is small enough that no real risk exists).
An audiologist will review your medical history and determine whether an ototoxicity monitoring protocol is indicated for you. If so, the audiologist will do a comprehensive hearing exam and recommend periodic follow-up exams to monitor any changes in hearing. If changes are found, the audiologist may communicate this to your physician in case they are able to make any changes to medication to preserve hearing. In some cases, this is impossible without compromising a life-saving treatment. Your audiologist can also make sure that your hearing needs are addressed so that hearing loss doesn't interfere with daily activities in your workplace, family life, and social life.
Some ototoxic medications may continue to affect hearing up to 18 months after you stop taking them, so be sure to follow the recommendations of your audiologist and physician for follow-up visits to monitor changes to hearing.
