By Michelle Crouch, Sept 2022, AARP
More than 600 drugs have been linked to hearing loss and tinnitus, including over-the-counter pain relievers. It’s normal to experience hearing loss and balance issues as you get older. But before you chalk up those problems to age, experts say you should consider whether a medication could be damaging your ears.
More than 600 medicines have been linked to hearing loss, ringing in the ear (tinnitus) or balance problems. The list of so-called “ototoxic” drugs includes both over-the-counter and prescription options. Among them: medications that treat heart problems, pain, infections and more.
In some cases, the hearing problems caused by a medication is reversible and will go away when you stop taking it, says Lawrence Lustig, an otolaryngologist at New York-Presbyterian/Columbia University Irving Medical Center.
But some drugs can cause permanent damage.
Before starting a medicine classified as ototoxic, Lustig recommends getting a baseline hearing test and balance assessment, and then going for regular testing during treatment. That can help you and your doctor identify any hearing-related side effects early, since medicines often impact high frequency hearing first, so you might not notice the change without a hearing test.
Here are some common medications linked to hearing loss and what you need to know about this potentially life-altering side effect.
Older patients are especially vulnerable because their kidneys often aren’t as efficient at flushing out medications, putting them at higher risk of toxicity if a drug builds up in their system, Lustig says. Adults age 65-plus are also more likely to be taking more than one drug at a time and sometimes the combined effect of two medications can be worse than a drug on its own.
3 Ways to Protect Yourself
Ask about side effects. Ask your health care provider if hearing loss or tinnitus is a side effect of any of your prescriptions or over-the-counter medications.
Recognize early signs of trouble. Ringing or buzzing in your ears — or worsening tinnitus if you already have it — is often the first sign that a medication could be harming your hearing.
Opt for nondrug alternatives. Instead of reaching for a pain reliever for your bad back or bum knee, consider trying physical therapy, yoga or acupuncture.
1. Over-the-counter pain relievers
Because painkillers such as aspirin, acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil and Motrin are widely available without a prescription, many patients take them regularly and assume that they are harmless. In fact, about 1 in 3 Americans takes a store-bought pain medication every day, according to a 2022 survey. However, research indicates that over-the-counter pain relievers can contribute to both hearing loss and tinnitus, especially if they’re used for two or more days per week, says Sharon Curhan, an epidemiologist at Brigham and Women’s Hospital and Harvard Medical School and author of several studies on the connection. In a 2012 study that followed more than 62,000 women, Curhan discovered that frequent use of acetaminophen or NSAIDs, even in typical doses, was linked to an up to 24 percent higher risk of developing hearing loss. In men, a similar study demonstrated that regular use — two or more times per week — of acetaminophen, NSAIDs and aspirin are all associated with a higher risk of hearing loss. Another large study, the Epidemiology of Hearing Loss Study, found that among adults who already had hearing loss, NSAID use was associated with a 45 percent higher risk of progression of their hearing loss. Researchers speculate that the medications may reduce blood flow to the cochlea, an organ in the inner ear that helps with hearing. “The overarching message from these findings is that even though these analgesics are widely available without a prescription, these are still medications and there are potential side effects,” Curhan says. “For anyone who is considering taking these types of medications regularly, it is advisable to consult with a health-care professional to discuss the risks and benefits and to explore whether there are alternatives to using medication.” Fortunately, frequent use of low-dose aspirin (100 mg or less) has not been linked to hearing-related side effects. Many older adults take a low dose of the drug daily to prevent cardiovascular disease.
2. Aminoglycoside antibiotics
Some of the most damaging medications to hearing are a class of antibiotics called aminoglycosides, Lustig says. Available in pill form, as well as intravenously, they are believed to damage the sensory cells inside your ear needed for balance and hearing. One aminoglycoside, called gentamicin, is often administered intravenously in the hospital to fight severe bacterial infections, such as a bone or an organ infection. Other drugs in the class also include “micin” or “mycin” at the end, such as streptomycin, neomycin, kanamycin and tobramycin. Studies show more than 50 percent of patients who require multiple rounds of intravenous aminoglycosides may experience hearing loss. Even at recommended dosages, taking them “can result in rapid, profound, and irreversible hearing loss,” according to one review study. That study’s authors found that a single dose can result in permanent hearing loss in patients with a certain genetic mutation. Despite the risks, these antibiotics are sometimes needed to treat what can be a life-threatening infection, says Wendi D. Jones, a pharmacist with AspenRX Health in Washington, North Carolina. If your doctor prescribes an aminoglycoside, your health care provider should do concurrent blood testing to ensure the drug levels in your blood don’t get too high, Jones says. They should also monitor you for hearing-related side effects.
3. Loop diuretics
Loop diuretics are powerful medications that are used to treat high blood pressure and fluid retention due to heart failure, liver disease or kidney disease. The most commonly used loop diuretics are Lasix (furosemide), Bumex (bumetanide) and Demadex (torsemide). Experts believe these medications interfere with the ionic composition of the fluids in the ear, contributing to hearing loss. Although loop diuretics can cause permanent damage if you get a large dose by injection in the hospital, in most cases, they cause only temporary hearing loss that clears up once you stop using the drug. “Using the lowest dose that will effectively treat the condition helps prevent ototoxicity,” Curhan notes. If you already have hearing or balance problems, you might want to ask your doctor if a different type of diuretic would be a better choice for you.
4. Some chemotherapy drugs
Platinum-based chemotherapy drugs such as cisplatin and carboplatin are used to treat many types of cancer, including lung, reproductive, head and neck cancers. However, they can cause permanent hearing loss, tinnitus and balance problems. Because the drugs can be lifesaving, health care providers have to balance the pros and cons when deciding about treatment. “If a patient has to have it for a life-threatening condition, you give it to them,” Lustig says. Scientists are working to develop medications and treatment protocols to help protect hearing while a patient is being treated with the drugs.
5. Long-term hormone therapy
Hormone therapy can be helpful for treating menopausal symptoms such as hot flashes, but a large study led by Curhan and published in the Menopause in 2017 found a strong correlation between oral hormone therapy and hearing loss. The study, which followed almost 81,000 postmenopausal women for more than 20 years, found that the longer a woman took hormone therapy (estrogen therapy or estrogen plus progestogen therapy), the greater her risk of hearing loss. Compared to those who never took hormones, the risk of hearing loss was 15 percent higher among women who used oral hormone therapy for five to nearly 10 years and 21 percent higher among women who used the therapy for 10 years or longer, the study showed. Based on those results, Curhan recommends that women concerned about hearing limit their use of hormone therapy to five years or less.
6. Quinine, chloroquine and hydroxychloroquine
Quinine, a therapy to prevent and treat malaria, has long been known to cause temporary hearing loss, especially if given in large doses. Quinine is also sometimes prescribed off label to treat nocturnal leg cramps. Two similar drugs, chloroquine and hydroxychloroquine, are also used to treat malaria and are sometimes prescribed for autoimmune diseases such as Lupus. Both chloroquine and hydroxychloroquine were investigated as possible treatments for COVID-19 infection. Although all three drugs have been linked to temporary hearing loss and tinnitus, fortunately most patients find the hearing problems go away once they stop the medication.
Signs a Drug May be Harming Your Hearing
Just because a medication has been tied to hearing problems doesn’t necessarily mean you need to worry.
The severity and extent of the damage, if any, depends on many factors, including the dosage, how long you have been taking it, how often you take it, your kidney function, what other drugs you take, your age, if you’re dehydrated and even your genetic susceptibility, Lustig and Curhan say.
Contact a health care provider if you experience any of these signs that a medication could be harming your hearing:
A ringing, roaring or buzzing sound in one or both ears or in your head (tinnitus)
Worsening of existing tinnitus or you notice a new sound
A feeling of fullness or pressure in your ears (that isn’t due to an infection)
New onset of hearing loss or worsening of existing hearing loss
Vertigo or a spinning sensation, which sometimes can be accompanied by nausea
If you’re concerned, it’s important to consult to your health care provider before you make any changes to your medications, Curhan says. “Together, you can evaluate the risks and benefits and explore possible alternatives,” she says.