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Ototoxicity: which drugs can cause hearing loss or tinnitus

Q: Main ototoxic drugs that cause hearing loss

Antitumor drugs. Chemotherapy drugs containing platinum (cisplatin and carboplatin) are ototoxic: symptoms can appear during treatment, but also months after its end. The hearing loss they cause generally occurs in both ears (bilateral sensorineural hearing loss) and unfortunately can degenerate to lead to complete hearing loss. This risk increases proportionally to the occurrence of the following conditions: high doses of medication taken, minor age, exposure to loud noises and genetic predisposition. Antibiotics. There are mainly three classes of ototoxic antibiotics: aminoglycosides, macrolides and glycopeptides. Each category of drug belonging to these classes has various negative effects on hearing: for example, streptomycin leads to temporary dizziness but also a severe loss of vestibular sensitivity, neomycin can cause deafness, gentamicin can cause loss of balance. As with anticancer agents, the risk of ototoxicity increases in association with other variables, such as the dose taken, the frequency of use and the presence of pre-existing hearing problems.

Last update on Oct 17th, 2021

It is well known that drugs can sometimes have side effects, but perhaps not everyone knows that some types of drugs can cause hearing damage. Impaired hearing can include symptoms such as tinnitus, hearing loss, dizziness and vertigo. In this article we will find out what ototoxic drugs are, what symptoms they cause and how to prevent them.

What does ototoxicity mean?

Ootoxicity is the toxic property of some drugs, such that their intake can cause problems affecting the hearing system. These hearing damage can occur both during drug treatment and at a later time and can be both temporary and permanent. There are categories more exposed to the risk of suffering hearing problems due to ototoxic drugs, such as:

the elderly,
people who already have hearing loss,
people with a hereditary predisposition.

In all these cases, a medical evaluation of the risk / benefit ratio of taking this type of drug is advisable, in order to determine the possibility of using an alternative therapy, where possible.

Which drugs are ototoxic?

There are more than 200 drugs that can cause hearing problems, both prescription-only and over-the-counter drugs. Most of these are used for the treatment of diseases that occur with advancing age, such as heart disease and cancer; however, there are also very common ototoxic drugs, such as some types of antibiotics, some diuretics and aspirin itself. Let's go into detail and distinguish between drugs that cause hearing loss, temporary or permanent, and drugs that cause or worsen the sensation of hearing a ringing in the ears.

Main ototoxic drugs that cause hearing loss

Antitumor drugs. Chemotherapy drugs containing platinum (cisplatin and carboplatin) are ototoxic: symptoms can appear during treatment, but also months after its end. The hearing loss they cause generally occurs in both ears (bilateral sensorineural hearing loss) and unfortunately can degenerate to lead to complete hearing loss. This risk increases proportionally to the occurrence of the following conditions: high doses of medication taken, minor age, exposure to loud noises and genetic predisposition.
Antibiotics. There are mainly three classes of ototoxic antibiotics: aminoglycosides, macrolides and glycopeptides. Each category of drug belonging to these classes has various negative effects on hearing: for example, streptomycin leads to temporary dizziness but also a severe loss of vestibular sensitivity, neomycin can cause deafness, gentamicin can cause loss of balance. As with anticancer agents, the risk of ototoxicity increases in association with other variables, such as the dose taken, the frequency of use and the presence of pre-existing hearing problems.

Main ototoxic drugs that cause tinnitus

The drugs just described have both hearing loss and tinnitus as side effects, but there are some in particular that have less severe effects and cause symptoms that are often temporary and related to the perception of hearing a sound in the ears, better defined as tinnitus. These drugs are:

Salicylates. A term that alone does not say anything to the less experienced, but it is a class of drugs to which aspirin also belongs. Taking these drugs can induce hearing loss associated with tinnitus, which generally resolves after a maximum of 72 hours and only in rare cases causes permanent effects.
Loop diuretics. They are a particular category of diuretics used for the treatment of hypertension and edema and can cause reversible hearing loss, the effects of which, however, can be more serious if they are combined with other ototoxic drugs.

What to do before taking an ototoxic drug

People with hearing loss should take precautions before taking an ototoxic drug. First of all, it is necessary to inform the doctor who prescribes the drug of any pre-existing hearing problems, so that he can evaluate the possibility of choosing an alternative therapy. If this solution is not feasible, the doctor will evaluate the right dose of the drug to be administered and will monitor the patient throughout the duration of the treatment. It may also be useful to carry out a hearing test before starting therapy, so as to objectively assess hearing capacity and be able to monitor it while taking the drug.

Other ototoxic substances

Not only drugs, but also other unsuspected substances that we take every day can have a percentage of ototoxicity, if taken excessively. The main ototoxic substances are:

Caffeine, contained in coffee, tea and some carbonated drinks can not only cause temporary hearing loss, but can also worsen an existing hearing loss.
Alcohol, because it can damage the hair cells that conduct sound to the brain, causing permanent hearing damage.
Smoking, due to the negative effects that nicotine causes on the cardiovascular system, the functioning of which is essential for good hearing.