Ototoxic meds: What you should know

Posted Tuesday July 29, 2014 by Beginnings

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

  • These are used to treat life threatening infections
  • Permanent damage

Cancer chemotherapy: cisplatin, carboplatin, cyclophosphamide, bleomycin, Difluoromethylornithine (DFMO)

  • Treat cancer
  • Permanent

Loop diuretics: furosemide (Lasix), bumetanide (Bumex), torsemide

  • Treat heart failure, fluid retention and kidney problems
  • Reversible damage

Analgesics: hydrocodone (Vicodin, Norco, Zydone), Salicylates (aspirin)

  • Treat acute or chronic pain, salicylates also thin blood and treat heart problems
  • Reversible

Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), indomethacin (Indocin)

  • Treat pain and inflammation
  • Reversible

Anti-parasitics: quinine

  • Treat and prevent malaria
  • Reversible

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:

  •  Is there an alternative medication or treatment?
  • Do any of the other medications that s/he takes make the risk of ototoxicity worse?
  • How long will s/he need to take the medication?
  • Can the prescriber and pharmacist double check the appropriate dosing?
  • What should I do if I think my child is having hearing or balance problems? (ringing in the ears, repetitive eye movements, stumbling and turning up the TV can all be signs)
  • How will ototoxicity be monitored? What will we do if ototoxicity is identified?

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.