Understanding How Certain Medications Can Damage Your Hearing

Many people may consider the common side effects of medications as nausea, fatigue, or dizziness. However, a lesser-known risk exists that can lead to irreversible hearing damage: ototoxicity. Several prescription and over-the-counter drugs can harm the inner ear, specifically affecting hearing and balance systems. This damage occurs when drugs target the cochlea—the hearing organ—and the vestibular system responsible for balance. Symptoms include ringing in the ears (tinnitus), loss of high-frequency hearing, dizziness, balance issues, or a feeling of fullness in the ears. The severity can vary from temporary discomfort to permanent loss, influenced by the drug's nature, dosage, treatment duration, and individual susceptibility.

The inner ear’s delicate structure makes it highly vulnerable. Expert consensus suggests that ototoxic drugs often damage tiny hair cells within the cochlea or disturb fluid equilibrium, leading to irreversible hearing loss once these cells are damaged, as they do not regenerate. Approximately 200 medications are known to be ototoxic, with some of the most common being:

1. Antibiotics

Certain antibiotics like aminoglycosides (gentamicin, tobramycin, streptomycin) are used to combat severe infections such as sepsis or tuberculosis. Although their benefits are crucial, they are well-documented for causing permanent hearing damage, particularly with prolonged high-dose use or genetic predisposition. These drugs can linger in the inner ear for weeks or months, causing ongoing damage. Other antibiotics like macrolides (erythromycin, azithromycin) and vancomycin have also been linked to hearing issues, especially in vulnerable groups.

2. Heart Medications

Loop diuretics such as furosemide and bumetanide, commonly prescribed for heart failure or high blood pressure, may cause temporary hearing loss when administered in high doses or intravenously. Additionally, blood pressure medications including ACE inhibitors (e.g., ramipril) and calcium-channel blockers (e.g., amlodipine) are associated with tinnitus, although more research is needed to clarify their impact on hearing.

3. Chemotherapy Drugs

Chemotherapy agents containing platinum compounds like cisplatin and carboplatin are known for their high ototoxic potential. Used to treat various cancers, these drugs can cause permanent hearing loss, with up to 60% of patients experiencing some degree of audiometric decline. Research efforts focus on dosing adjustments to reduce this risk without compromising treatment efficacy.

4. Painkillers

Regular, high-dose use of common pain relievers such as aspirin, NSAIDs (including ibuprofen and naproxen), and paracetamol has been linked to tinnitus and hearing deterioration. Studies indicate that prolonged, moderate to high use increases the risk, especially in women under 60, and these effects generally resolve after stopping medication.

5. Antimalarial Drugs

Medications like chloroquine and quinine, used for malaria and leg cramps, can cause reversible tinnitus and hearing loss. Some individuals may recover after discontinuation, but high-dose or long-term use can lead to permanent damage. Those with pre-existing hearing conditions, kidney issues, or genetic tendencies face increased risks. It's essential to weigh the benefits of these drugs against potential hearing risks and consult healthcare providers regarding symptoms like ringing or muffled hearing.

While these medications are vital for treating serious health conditions, awareness of their ototoxic potential is crucial. If you are prescribed such drugs, monitor for symptoms like ringing, dizziness, or muffled hearing, and report any adverse effects to your healthcare provider promptly. Protecting your hearing health involves understanding the risks associated with specific medications and advocating for regular hearing assessments when using ototoxic drugs.