Hearing loss is extremely common and affects approximately 30 million Americans. Losing hearing permanently can have a profound impact on a person’s ability to communicate and, consequently, on their personal, professional, and social life. 

There are various types of hearing loss that occur due to different reasons. A common type is age-related hearing loss. However, a lesser known cause is drug-induced hearing loss. 

Please continue reading to learn about some ototoxic drugs, i.e., medications that may cause temporary or permanent hearing loss.

Can medications cause ear problems?

More than 100 classes of drugs have the potential to cause mild to severe ear problems. Drugs that cause hearing loss are called ototoxic. Besides hearing loss, taking certain medications can result in other ear problems like tinnitus (ringing in the ears), vertigo (dizziness), and disequilibrium (balance problems). 

Ototoxic drugs include both prescription and over-the-counter medicines. These drugs can  damage the structures in the inner ear, such as the cochlea and tiny hair cells, which are vital for normal hearing. 

Which over-the-counter drugs can cause hearing loss?

Studies have shown that long-term use of over-the-counter painkillers may lead to hearing loss. This includes commonly used pain relievers like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol). High doses of aspirin and too much aspirin can also harm your hearing. However, the usual dose of aspirin is not linked to a higher risk of hearing loss. It is believed these medications reduce blood flow to the sensitive inner ear.

You should always consult a healthcare provider for chronic pain. Do not take an over-the-counter medication for pain for a long time without talking to your doctor first, especially if you are currently taking other medications.

Which prescription drugs can cause permanent hearing loss?

Opioids

The illegal opioid drug heroin and prescription opioid pain relievers such as oxycodone, methadone, and tramadol can lead to hearing loss. These drugs cause decreased blood flow and damage to the nerves in the inner ear. This can affect nerve signals and lead to hearing loss.

Aminoglycoside Antibiotics

Aminoglycosides are commonly used to treat bacterial infections. They can generate free radicals and cause permanent damage to the sensory cells in the ear. In some cases, this can lead to permanent hearing loss. Examples of aminoglycoside antibiotics include streptomycin, gentamicin, tobramycin, amikacin, and neomycin. Neomycin was previously a very prevalent antibiotic used to manage children’s ear infections. It is less commonly prescribed now.

Loop Diuretics

Diuretics (water pills) are prescription medications used to treat high blood pressure, congestive heart failure, kidney failure, and ascites caused by liver cirrhosis. Some of the most frequently prescribed diuretics, such as furosemide (Lasix), bumetanide (Bumex), and ethacrynic acid (Edecrin), can cause ototoxicity. Other loop diuretics have also been shown to cause ototoxicity, such as torsemide, ozolinone, azosemide, piretanide, and indacrinone.

Chemotherapy Drugs

Chemo drugs like cisplatin and carboplatin are used to kill cancer cells. They are known to be ototoxic. These drugs are used to treat lung, testicular, gynecologic, and other types of cancers. Chemo-induced hearing loss usually occurs symmetrically in both ears and is typically irreversible or permanent.

Drugs Used to Treat Malaria

Drugs like quinine, chloroquine, and hydroxychloroquine are commonly prescribed to malaria patients. Quinine is also sometimes used to treat restless leg syndrome. Malaria patients treated with these medications can develop hearing loss and tinnitus (ringing in the ears). The hearing loss is sensorineural. It is usually a temporary hearing loss. 

Which drug causes hearing loss, especially with high-frequency ranges?

Aminoglycoside antibiotics and the chemotherapy drug cisplatin are known to cause permanent hearing loss, typically affecting the highest frequency ranges first and progressively causing hearing loss in the lower frequency ranges.

It is worth noting that high-frequency sounds are vital for understanding speech. This hearing loss frequency can therefore have a profound effect on communication abilities. 

What to do if a doctor prescribes drugs that can cause hearing loss?

If your doctor prescribes medications that cause hearing loss, remember that this is a “potential” side effect. It does not always mean that you will lose your hearing. Every person reacts to medications differently. Some people may experience permanent hearing damage, others may have problems like temporary tinnitus or hearing loss, and others may have no problems at all. 

However, it is good to keep in mind that over-the-counter painkillers and other drugs that are available without a doctor’s prescription can affect hearing health. Always read drug labels carefully and do not take more than the recommended dosage. Talk to your doctor or phrmacist if you don’t completely understand the potential side effects.

Talk to your doctor if you are worried that a prescription medication may cause hearing loss. They may be able to prescribe alternatives. On the other hand, if you are battling serious infections or fighting cancer, taking aminoglycoside antibiotics, cancer treatments, or other ototoxic drugs may be necessary. In these cases, your doctor will guide you to weigh the risks vs. benefits of the therapy.

The important thing is to receive personalized advice and work with your doctor to choose the best treatment options for you.

Your doctor may recommend you consult an audiologist for a hearing test before or shortly after starting treatment with potentially ototoxic medications. This assessment can serve as a baseline should you develop hearing problems in the future. 

Lastly, it is very important that you promptly report any symptoms such as tinnitus, hearing loss, dizziness, or balance problems to your doctor. Stopping an ototoxic drug in the early stages may prevent permanent damage. Your doctor can also prescribe tinnitus medications if required. 

Remember that the time of onset of drug-induced hearing loss is often unpredictable. People have developed hearing loss after taking a single dose of an ototoxic drug. On the other hand, hearing loss can occur several weeks or even months after completing treatment with ototoxic medications.

References:

1. https://news.harvard.edu/gazette/story/2016/12/longer-use-of-pain-relievers-associated-with-hearing-loss-in-women/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831770/
3. https://pubmed.ncbi.nlm.nih.gov/17266591/#
4. https://www.rutgers.edu/news/opioid-use-can-trigger-deafness#
5. https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0041-1740986.pdf
6. https://emedicine.medscape.com/article/857679-images