Marissa Ryan, M.D.
The inner ear houses our hearing and balance function. Some medications are toxic to the inner ear sensory cells and cause reversible or permanent hearing loss, balance loss (dizziness) or ringing in the ears (tinnitus). This is called‘ototoxicity.’ Some medications affect both the hearing and balance system. The hearing and balance loss are not always permanent and partial or complete recovery can occur if the medication is stopped.Sometimes delayed damage can occur several weeks after treatment is stopped. Kidney impairment, loud noise exposure, combinations with other medications and infections during treatment can make the damage worse. These drugs are often used to treat life-threatening medical conditions, so it is not always possible to stop the medicines, and patients and their physicians must make informed decisions about the effects of the drugs and any treatment alternatives.
There are over 200 different ototoxic medications, but these are some of the most commonly prescribed:
Aminoglycosides: gentamicin, streptomycin, neomycin
Cancer chemotherapy: cisplatin, carboplatin, cyclophosphamide, bleomycin, Difluoromethylornithine (DFMO)
Loop diuretics: furosemide (Lasix), bumetanide (Bumex), torsemide
Analgesics: hydrocodone (Vicodin, Norco, Zydone), Salicylates (aspirin)
Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), indomethacin (Indocin)
Fortunately, ototoxic medications do not affect all people, but some individuals are more susceptible to damage. This can run in families. It is hard to predict who is susceptible, so everyone should try to avoid them if possible. If your child must take one of these medications, then there are protocols to monitor hearing and balance before, during and after treatment. Blood levels of some medications should be monitored also. These are helpful questions to ask before startingototoxic medications:
By being aware of which medications are ototoxic, decreasing their use and monitoring treatment closely, the frequency and degree of inner ear damage can be minimized.
Reference: Rybak, LP. “Vestibular and Auditory Ototoxicity.” Cummings Otolaryngology –Head & Neck Surgery. Fifth Edition. 2010. Mosby Elsevier, NY.