Ototoxic Drugs and Hearing Loss

© September 2000 by Neil Bauman, Ph.D.

Question: Is it true that some prescription drugs can damage our hearing?—K. C.

Answer: Yes, unfortunately it is true. In the course of talking with and helping multiplied hundreds of people with hearing losses, I am appalled at the enormous number of people who have lost much (or all) of their hearing from taking drugs prescribed by their doctors. Many of these unfortunate people were never told that taking such drugs could (and would) damage their ears.

There is abysmal ignorance on the part of both health care professionals and the general population concerning the many prescription drugs that can indeed damage our ears. One lady told me that when challenged, her doctor couldn't name even one such drug! In fact, ototoxic drugs are so far removed from the stream of human consciousness that the word is not even listed in most dictionaries!

We call drugs that damage our ears ototoxic (OH-toe-TOKS-ick although some people pronounce it AWE-toe-TOKS-ick) drugs. Ototoxic just means ear (oto) poisoning (toxic). These drugs typically either damage the hair cells in the cochlea, the hair cells in the balance (vestibular) system of our inner ears or our auditory nerves. Side effects of ototoxic drugs may include such things as temporary or permanent hearing loss (generally, but not always, at the higher frequencies); deafness; ringing or other noises in our ears (tinnitus); dizziness; vertigo (where the room seems to spin around); and hypersensitivity to sounds (hyperacusis).

I personally feel that the ototoxic properties of drugs are greatly under-reported. For example, what is listed as a rare ototoxic reaction, may in fact, be much more common. This is because many people do not recognize the ototoxic side effects of the drugs they are taking. For example, a bit of hearing loss may easily go unnoticed, especially if it is in the higher frequencies. People may not connect dizzy spells or ringing in their ears to the medications they are taking. Hence such side effects go unreported. We can be certain that the problem is considerably worse than has been reported.

Did you know that, according to one study, 51% of the approved drugs being released today have serious side effects (including ototoxic ones) that had not been detected at the time of the drug release to the public?

It is so easy to assume that because ototoxic side effects have not been reported for a given drug that it is safe for our ears. A good quote to remember is, "absence of evidence does not equal evidence of absence." In other words, just because an ototoxic side effect has not yet been reported for a specific drug does not mean that that drug will never cause ear damage.

Be careful about taking drugs. The existence of side effects is often downplayed. You need to know all the side effects of the drugs you are taking, and then decide with your doctor whether you are prepared to accept the risk of those side effects when compared to what benefits the drug is supposed to bring you. Did you know that an estimated one and a half million people in just the USA end up in the hospital each year as a result of the adverse side effects of prescription drugs? Another 100,000 people die each year from such adverse side effects! You do not want to be a part of these statistics!

There are many drugs that are ototoxic to some degree. For example, taking 6 to 8 aspirin a day can cause ringing in your ears (tinnitus) and temporary hearing loss. Some drugs will quickly and permanently damage your ears. You may be left with little or no hearing. This happened to Bonnie after she took an antibiotic to fight a life-threatening infection. Now she cannot hear any high frequency sounds. Other drugs can have both temporary and permanent effects. While taking chemotherapy, Ruby temporarily lost most of her hearing. After her treatments were over, most of her hearing returned, but she was left with permanent and annoying tinnitus.

Did you know that some drugs cause hearing/balance problems in 25 percent of the people taking them? Antibiotics are particularly notorious for this. One study of hard of hearing children in China revealed that 123 of the 154 children studied had lost their hearing from taking antibiotics. Of these 123 children, 60 of them had hearing problems due to the Aminoglycoside antibiotic Gentamicin. Nor does this just happen overseas. In one of my hearing loss coping skills classes I was shocked to find that about one-quarter of the people in that class had their hearing damaged from taking ototoxic drugs.

Unfortunately, the damage to your ears doesn't always show up while you are still taking the prescribed drug. It may not show up until weeks or even months later. By then it's too late for your doctor to do much about it. Also, be aware that drug damage is cumulative. When you take various drugs from time to time over many years, each different drug may have an almost undetectable deleterious effect on your ears, but eventually you may end up with a noticeable hearing loss.

Always ask your doctor or pharmacist about the possible side effects of any medications (or combinations of medications) you are taking. Have your doctor look these drugs up in their "drug bible" and show you. In the USA, doctors use the PDR (Physicians Desk Reference). In Canada they use the CPS (Compendium of Pharmaceuticals and Specialties).

Make up your own mind whether you want to risk the side effects of any drug before you begin to take it. Remember, it's your hearing that is at risk. You are the one who will have to live with the results—not your doctor or pharmacist. Sometimes, like in the two examples I gave above, the side effects of the drugs were less severe than the result of not taking them, namely, certain death. If your options are deaf or death, the choice is easy. However, if it's not a matter of life and death, do your research, and then make an informed decision. Don't let your doctor railroad you.

Your body may react differently than your doctor expects. Some drugs may build up to toxic levels in your blood if your body does not metabolize them as expected. Elizabeth found this out to her sorrow. Her doctor told her that a certain antibiotic he prescribed would only damage her hearing if taken at a high dose for a prolonged time. What happened to her? The very first (relatively low) dose permanently damaged her hearing. Now she has to wear two hearing aids just to be able to hear most of what people say.

It is most important that your doctor determine how well your kidneys are working before he prescribes various medications. This is because your body excretes many drugs through your kidneys. If they are not working properly, ototoxic drugs can quickly rise to dangerous levels in your bloodstream and cause permanent hearing loss.

Just because a drug is listed as being ototoxic doesn't necessarily mean you will damage your ears if you take it—but be warned—it may. Each person's body is slightly different and reacts differently. For example, Marcia has been taking Voltaren (Diclofenac) for 15 years and does not have any noticeable hearing damage although the drug she is taking is listed as having caused hearing loss, balance problems and tinnitus. She is one of the fortunate ones.

On the other hand, Flo took Prozac (Fluoxetine) for 5 years and had never been told it had ototoxic properties. Recently, when she stopped taking it, within 3 weeks she noticed a significant improvement in her hearing.

So which drugs are ototoxic? There are far too many to list in this short article. In fact there are at least 663 drugs that can damage your ears one way or another. Some classes of drugs that are ototoxic include the non-steroidal anti-inflammatory drugs (NSAIDs); many antibiotic drugs, especially the anti-bacterial drugs like the aminoglycosides; antihistamines such as the H1-blockers; several anti-cancer drugs; cardiovascular drugs including ACE inhibitors, beta-blockers, calcium blockers, etc.; diuretics, especially the loop diuretics; anticonvulsant drugs; antidepressant drugs, especially the tricyclic antidepressants; and a many others.

Instead of blindly taking drugs prescribed by your doctor, first become knowledgeable about such drugs. Learn about their ototoxic side effects. Carefully weigh their benefits versus their side effects then make your informed decision. Your ears will thank you for the rest of your life!

Learn more about the 663 drugs that can damage your ears and how you can protect your ears from their ravages.

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