by Jill Copley, Au.D., Doctor of Audiology
NOTE: I will be discussing how different medications may affect or cause hearing loss, tinnitus (ringing in the ears), and vertigo/dizziness. This is called ototoxicity, meaning something is toxic to your ear. If you notice these symptoms when taking these medications, TALK TO YOUR PHYSICIAN FIRST before stopping any prescribed medication.
When you see an audiologist, you may wonder, “Why does she need to see my medication list? She’s not my physician.” It’s a valid question. Many medications, some common and some not, can cause hearing loss, tinnitus, and balance problems or make those symptoms worse. It is important for us to know what medications and supplements you are taking to point out anything suspicious that might be causing these issues, so we can refer you back to your physician to discuss.
Depending on the source and how side effects are defined in studies, there are at least 200-600 drugs (prescription and over the counter) that can cause auditory-related symptoms. I will focus on hearing loss, tinnitus, and balance issues.
Aspirin: Aspirin and other anti-inflammatory medications, such as Aleve (Naproxen), Motrin and Advil (Ibuprofen), can cause ringing in the ears. Normal, recommended doses, such as 81 mg of aspirin per day, do not typically cause this side effect. However, these medications taken at large doses, such as taking aspirin eight times a day, could potentially cause tinnitus. Usually, the symptoms resolve when discontinuing or lowering the dose of the drug.
Aminoglycoside Antibiotics: I call these the “life and death” antibiotics. They are used alone, or in tandem, to fight serious bacterial infections. They are typically used in hospitals and are given by injection or IV (intra-venously). They often cause permanent damage to the auditory system. Examples include:
• Streptomycin is used in the treatment of tuberculosis, usually with other ototoxic medications, and is given by injection. It affects the 8th nerve, which sends hearing and vestibular (balance system) signals to the brain. Streptomycin can cause permanent tinnitus, vertigo and hearing loss.
• Gentamycin is given by IV or injection and is used to treat diseases such as meningitis, sepsis, and bone infections. It may cause tinnitus and hearing loss, but also attacks the vestibular system, causing significant balance issues and vertigo.
Loop Diuretics: The most common loop diuretic is Lasix (furosemide). Lasix is prescribed for edema and works to remove water/fluid from your system. It is often used for heart conditions to prevent fluid from accumulating around the heart. The cochlea (inner ear) has a delicate balance of membranes and fluids, and if those change, hearing loss and tinnitus can occur. Loop diuretics can potentially change those balances and cause hearing loss and tinnitus. Stopping or reducing the medication may reverse those side effects. Using Lasix as prescribed is usually not an issue. However, when using loop diuretics with aminoglycoside antibiotics, the risk of hearing loss and its severity greatly increases.
Macrolide Antibiotics: Common macrolide antibiotics, such as Zithromax and erythromycin, can potentially cause hearing loss, especially when taken at higher doses. It is typically reversible upon stopping the drug. If you do notice auditory symptoms when taking these drugs, contact your physician, as there are several classes of antibiotics that can be used for the same illness.
Platinum-based Chemotherapy Drugs: Common cancer drugs that fall in this category are Cisplatin and Carboplatin. They are used to treat many kinds of cancer such as ovarian, cervical, lung, and breast, as well as brain and adrenal tumors, and lymphoma. These chemotherapy drugs are different than a lot of medication in that they do not attack the disease itself – they kill good cells, as well as the cancer cells. Platinum-based chemotherapy can affect many parts of the body. Because the cochlea is extremely sensitive, it is highly susceptible to damage by these drugs. Hearing loss, tinnitus, and balance issues are common and usually permanent. Knowing this, hearing is often monitored while taking these medications.
Talking to your Physician: While many common medications do not cause auditory issues when taken alone, side effects may occur when taking multiple medications at a time (polypharmacy).
• It is important that your primary physician knows of every medication you are taking, even if not prescribed by her/him. Pharmaceutical computer systems can alert your physician if there is a serious known side effect if taking certain medications together.
• If you experience any symptoms such as hearing loss, tinnitus, or dizziness while taking medications, you should let your physician know immediately.
• For many conditions, there are alternative medications that can be used that may not have adverse side effects.
• Some supplements may cause tinnitus and dizziness, and they may adversely affect prescription medications you are taking, so it is important to list those, as well.
There are many other facets to medications and the auditory system, and I could not speak to them all in this article. Stay tuned, though. Total Hearing Care plans to sponsor a meeting next year with a pharmacist who can go into more detail on this topic and answer your questions.
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