Ototoxicity and a list of ototoxic drugs

Ototoxicity refers to temporary or permanent inner ear damage caused by substances like drugs or chemicals. It is often mentioned when discussing prescribed medications, but over-the-counter drugs can also cause hearing problems.

Some of the most well-known ototoxic drugs include certain chemotherapy drugs and infection-fighting antibiotics. Because these drugs can be life-saving, it is important to discuss the risks and benefits with your healthcare team.

If you have concerns about your hearing, you can visit our directory to find an audiologist near you. He or she can test your hearing and identify possible damage to your ear.

List of common ototoxic drugs

If you must take an ototoxic drug, follow the directions on the package or as prescribed by your doctor. Alert your doctor to any changes in hearing or balance.

Common ototoxic drugs include

• Non-steroidal anti-inflammatory drugs (e.g. aspirin, ibuprofen, naproxen)
• Opioid-based pain medications
• Some antibiotics (e.g. gentamicin, amikacin, streptomycin)
• Certain high blood pressure drugs

The most damaging ototoxic drugs include, but are not limited to

• Chemotherapy drugs containing platinum (e.g. cisplatin, carboplatin, oxaliplatin)
• Loop diuretics (e.g. furosemide, bumetanide, ethacrynic acid, torsemide) for heart or kidney problems

Alcohol and nicotine can also cause hearing problems.

Why do some drugs affect hearing and balance?

Your inner ear contains several tiny organs that are responsible for hearing and balance. They include the cochlea, semicircular canals, and the utricle and saccule. These sensory organs contain cells that are very sensitive to any changes in your environment or your body. While most medications do not cause a problem, some can damage these cells, especially if the dose is high or you take a drug for a long time.

As a result, you may experience hearing loss, dizziness and/or ringing in your ears, known as tinnitus. These symptoms usually go away once you stop taking the substance or medication. However, prolonged use can cause permanent hearing loss.

Drug-related hearing loss typically begins by damaging your ability to hear high-pitched sounds like women's and children's voices. Words like "sat" and "that" may be hard to tell apart.

Who's most at risk?

Anyone can be affected by ototoxic drugs, but the people most at risk include older adults and children. This is especially the case for those who take cisplatin as a cancer treatment.

Also, some health conditions may increase your risk, such as anemia.

This is an area of emerging research. At least one study has shown that some people may have a genetic mutation that protects them from hearing damage due to cisplatin, for example. However, more studies are needed to understand genetic factors that play a role in ototoxicity.

How to protect yourself

First, be aware of the side effects of all medications you take. In some cases, you may be able to switch to medications that have fewer side effects.

Also, read labels of any over-the-counter medications you take regularly. If you suspect you are using something that is ototoxic, speak to your doctor about your concerns. 

Track your medication use and let your doctor know if you experience a decline in your hearing or hear unusual sounds. Your doctor may prescribe a lower dosage or recommend you stop using the medication.

The damage to your hearing and balance may be temporary or permanent. If needed, a hearing care professional can offer appropriate treatment for your situation.

Additional sources

^{- American Cancer Society. "Ototoxicity and cancer therapy."}

^{- European Journal of Cancer. "Predicting cisplatin ototoxicity in children: the influence of age and the cumulative dose."}