The relationship between medication intake and auditory health is a critical area of study in the medical community. With an increasing number of individuals relying on various medications for chronic and acute conditions, the importance of understanding which pharmaceutical agents can potentially harm hearing cannot be overstated.

Ototoxicity refers to the property of being toxic to the ear (oto-), specifically the cochlea or auditory nerve and sometimes the vestibular system, leading to hearing loss or imbalance. Ototoxic effects can be temporary or permanent, affecting one or both ears. The mechanism behind such auditory damage often involves the drugs causing cellular damage to the hair cells in the cochlea, which are essential for hearing.

Which medications are most common with hearing loss as a side effect?

Aminoglycoside Antibiotics

• Gentamicin: Often used in severe bacterial infections, gentamicin can affect hearing when administered in high doses or to patients with renal impairment. Regular audiometric monitoring is advised.

• Streptomycin: Primarily used for tuberculosis, streptomycin poses a significant risk for vestibular and auditory damage, particularly with prolonged therapy.

• Tobramycin: Similar to gentamicin, tobramycin is used for complex bacterial infections but requires careful monitoring for ototoxicity, especially in patients with pre-existing hearing conditions or in combination therapy with other ototoxic drugs.

• Amikacin: While effective against resistant bacterial strains, amikacin carries a risk for ototoxicity, necessitating hearing tests before and during treatment.

Platinum-Based Chemotherapy Agents

• Cisplatin: A cornerstone in the treatment of various cancers, cisplatin-induced hearing loss is dose-dependent and more frequent in children. The high frequencies are usually affected first.

• Carboplatin: Although considered less ototoxic than cisplatin, carboplatin can still contribute to hearing loss, particularly in high cumulative doses or in pediatric populations.

Loop Diuretics

• Furosemide (Lasix): While essential for managing fluid overload, furosemide can cause reversible hearing loss, especially when administered in high doses or via rapid intravenous infusion.

• Bumetanide: Similar to furosemide, bumetanide's potential for causing transient hearing loss underscores the need for careful monitoring when used, especially in the elderly or those with renal failure.

Salicylates

• Aspirin (Acetylsalicylic Acid): High doses of aspirin, often used in certain chronic pain or rheumatologic conditions, can lead to reversible hearing loss or tinnitus, which typically resolves after discontinuation.

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

• Ibuprofen: Long-term or high-dose use of ibuprofen may lead to hearing issues, although this is relatively rare and often reversible upon cessation.

• Naproxen: Similar to ibuprofen, naproxen has been associated with hearing complaints, particularly with prolonged use at high doses.

Macrolide Antibiotics

• Erythromycin: At high intravenous doses, erythromycin can be ototoxic, with effects ranging from mild to severe and potentially reversible hearing loss.

• Azithromycin: While less commonly associated with ototoxicity than erythromycin, cases of hearing impairment have been reported, emphasizing the need for caution.

Antimalarial Drugs

• Quinine: Used to treat malaria, quinine can cause tinnitus, impaired hearing, and in rare cases, irreversible damage, especially with overdose or in sensitive individuals.

• Chloroquine and Hydroxychloroquine: Besides their role in malaria treatment, these drugs are used in autoimmune conditions but can lead to auditory damage or vestibular problems in a dose-dependent manner.

Antiviral Drugs

• Acyclovir and Ganciclovir: Used for viral infections, these drugs have been associated with transient hearing loss, particularly when administered intravenously and at high doses.

Antidepressants and Psychotropic Medications

• Tricyclic Antidepressants: Medications like amitriptyline and nortriptyline can cause tinnitus and other auditory disturbances, usually reversible upon discontinuation.

• Selective Serotonin Reuptake Inhibitors (SSRIs): Although less common, drugs like fluoxetine and sertraline have been linked to auditory side effects in sensitive individuals.

Diuretics for Meniere's Disease

• Acetazolamide: Used in the treatment of Meniere's disease, acetazolamide can sometimes exacerbate hearing loss or cause tinnitus, necessitating careful patient monitoring.

Emergency Measures for Hearing Problems

Upon noticing signs of hearing impairment, such as tinnitus (ringing in the ears) or difficulty hearing, individuals should:

1. Stop the medication: Consult a healthcare provider before discontinuing any medication suspected of causing hearing loss.
2. Seek medical evaluation: An audiologist or an otolaryngologist can assess hearing loss extent and potential reversibility.
3. Treatment options: Depending on the cause, steroids or other interventions may help reduce inner ear inflammation and restore some hearing.

Preventing Ototoxic Effects

Preventive measures against ototoxicity include:

• Regular hearing assessments: Especially for patients on long-term therapy with known ototoxic medications.
• Dosage management: Adjusting dosages to the lowest effective amount can help minimize risk.
• Alternative medications: Whenever possible, opt for less ototoxic drug alternatives.

By understanding the ototoxic potential of these medications, healthcare professionals can better manage patient treatments, minimizing the risk of hearing loss. It is crucial for patients undergoing therapy with any of these drugs to report any changes in their hearing to their healthcare provider promptly. Regular hearing assessments and vigilant monitoring of drug dosages can significantly mitigate the risks associated with ototoxic medications, preserving hearing health while managing underlying health conditions.