About this factsheet

This factsheet is part of RNID's healthcare range. It is written for people who would like to find out more about ototoxic drugs. These are drugs that can occasionally cause hearing loss.

Read this factsheet to find out:

 
We will give information about the following drugs:

Disclaimer: You should not change the dose of any medication you are taking, or stop taking it as a result of reading this factsheet, unless the doctor who prescribed the medication agrees it is safe to do so. If you have any questions about any medication you are taking, or are about to take, speak to your doctor.

What are ototoxic drugs?

Ototoxic drugs may cause damage to the inner ear, resulting in hearing loss, balance problems and tinnitus.

Ototoxic drugs are not prescribed very often. They are not usually given as a medicine which you need to take regularly. Many of the drugs described here are only ototoxic if taken in a large or excess dose. However, some are used in situations where they may save your life.

What are the side-effects of ototoxic drugs?

Hearing loss

Ototoxic drugs damage the hair cells in the cochlea - the hearing organ in the inner ear - and/or the auditory nerve, which carries sound information processed by the cochlea to the brain. This type of hearing loss is known as sensorineural hearing loss. Sensorineural hearing loss is usually permanent. Other drugs can cause temporary hearing loss.

For an explanation of how the ear works, see our leaflet "Ears and ear problems".

Balance problems

Sometimes, ototoxic drugs can damage the balance system in the inner ear. This leads to dizziness and/or balance problems. For more information, see our factsheet "Balance problems".

Tinnitus

Tinnitus can be a side effect of ototoxic drugs. It is often the first sign that your hearing may be damaged. For more information, see our leaflet Tune Out Tinnitus.

Tinnitus is the word for noises that some people hear 'in the ears' or 'in the head', such as buzzing, ringing, whistling, hissing and other sounds. For more information about the relationship between drugs and tinnitus, contact the RNID Tinnitus Helpline or see our leaflet "Tune out tinnitus" and our factsheet "Drugs and tinnitus".

Should I change my medication?

If you think that a drug you are taking is causing hearing loss or making your existing hearing loss worse, you should discuss this with your doctor before you decide to reduce the dose or stop taking the medication altogether.
 
If you are convinced that a particular drug is causing your hearing loss, your doctor may be able to prescribe another drug that does not affect your hearing in the same way. There is usually more than one drug available to treat most conditions. If this is not possible in your case, you will have to decide whether the benefits of taking the drug outweigh the possibility of permanently damaging your hearing.
 
You should only come off a drug if you have talked about it with your doctor. You should go back to them if you have withdrawal symptoms. You may be able to take the drug at a lower dose for a while, and then reduce the dose gradually.

What is being done to make ototoxic drugs safer?

RNID is funding research into how ototoxic drugs can cause hearing loss and how to prevent them doing so. For more information about RNID's medical research, see our booklet Hearing the Future (opens new browser window).

Antimalarial drugs

What are antimalarial drugs?

Malaria is a parasitic disease spread by the bites of infected mosquitoes. Antimalarial drugs can be taken before, during and after a visit to an area where malaria is common, or as treatment for malaria if you get it. Antimalarial drugs are produced from the drug quinine. An example of an antimalarial drug is chloroquine, which is one of the most widely used antimalarial drugs in the world.

What are the side effects of antimalarial drugs?

Common side effects of antimalarial drugs include:

Contact the RNID Tinnitus Helpline for more information about the relationship between antimalarial drugs and tinnitus.

Can antimalarial drugs cause hearing loss?

There is no evidence to suggest that drugs produced from quinine cause permanent hearing loss.
 
The risks of any side effect from antimalarial drugs may be greater if you actually get malaria and are given high doses to treat the disease. Risks of side effects are lower when you take lower doses to stop you from getting malaria in the first place.
 
If you are about to travel to an area where malaria is common and you are concerned about the possible side effects of antimalarial drugs, you should discuss this with your doctor. You should balance the risks of the side effects listed here against the chance of getting malaria.
 
A tiny amount of quinine is added to tonic water, but this is not enough to cause hearing loss.

Aspirin

Aspirin is a drug taken to:

What are the side effects of aspirin?

When taken in its correct dose, aspirin is very unlikely to cause side effects. If taken in a large dose or an overdose, aspirin sometimes causes the following side effects:

These side effects are usually temporary and should disappear if you stop taking aspirin. For more information about tinnitus and aspirin, contact the RNID Tinnitus Helpline, or read our factsheet "Drugs and tinnitus".

Can aspirin cause hearing loss?

There is little evidence that aspirin causes permanent hearing loss. If your doctor has prescribed aspirin for you, you can always discuss changing the dose before you go ahead.

Antibiotics

What are antibiotics?

Antibiotics are a group of drugs which treat bacterial infections, ranging from quite mild infections to serious, life-threatening diseases.

Which antibiotics cause hearing loss?

The group of antibiotics that are most likely to cause hearing loss are aminoglycosides. These include gentamycin, streptomycin and neomycin. These antibiotics are often used to treat serious or life-threatening bacterial infections, such as tuberculosis (TB). They are sometimes prescribed when a bacterial infection does not improve with treatment using antibiotics which are not in the aminoglycosides group.

What are the risks of using drugs from the aminoglycosides group?
The risk of hearing loss from aminoglycosides can increase depending on:

Some research suggests that some people are very sensitive to
anti-bacterial eardrops. These can permanently damage your hearing if you have a perforated eardrum and the drug enters your middle and inner ear. Drops are more likely to cause damage if they are taken for a long time or in a large dose.
 
Aminoglycosides can also cause tinnitus, as well as hearing loss. If your problems are caught in time and the drug is stopped, the tinnitus will usually go away. In some cases, the hearing loss can be severe, although this is rare.
 
If you are prescribed aminoglycosides, you should be aware of the risk of permanent damage to your hearing. The effects are usually monitored when you are in hospital, by regular blood tests to estimate how much of the drug is in your bloodstream.
 
Aminoglycosides are generally prescribed to treat serious, life-threatening diseases, where saving your life is felt to be more important than the possible risk of damaging your hearing.

Cytotoxic drugs

Cytotoxic drugs are a group of drugs that destroy cells or prevent their regrowth. These drugs are mainly used to treat cancer. Cancer treatment with cytotoxic drugs is called chemotherapy. Cytotoxic drugs attack healthy cells as well as cancerous ones, so they can cause a variety of side effects.
 
Can cytotoxic drugs cause hearing loss?

A group of cytotoxic drugs can cause hearing loss. These include:

It is thought that Carboplatin is less ototoxic than Cisplatin, although all of these drugs can cause permanent damage to hearing.
 
Cytotoxic drugs are often used in combination with other drugs, which can affect the severity of hearing loss caused, depending upon which drugs are used together. If you are prescribed cytotoxic drugs, the effects will be carefully monitored. Tell your doctor immediately if you are taking these drugs and you:

These signs can be the first indication of hearing loss as a result of taking ototoxic drugs

Diuretics

Diuretics are a large class of drugs that increase the amount of urine produced by the kidneys. Diuretics are used to treat conditions in which fluid builds up in the tissues. These include heart and kidney failure and some liver diseases. Diuretics may also be used to treat high blood pressure.

Which diuretics can cause hearing loss?

Of the commonly used diuretics, only loop diuretics are known to cause hearing loss. They are called loop diuretics because they work in the region of the kidney known as the loop of Henle. Loop diuretics are commonly used to treat a build-up of fluid - for example if you have a heart attack. Examples of loop diuretics are furosemide (also known as frusemide), torasemide and bumetanide.
 
Loop diuretics are usually taken by mouth, but you may be given them by injection. Loop diuretics are usually only ototoxic when they are given in large doses by injection in life-threatening situations. If you already have hearing loss and balance problems, you should tell your doctor, as it would be better for you to receive treatment with diuretics that do not have ototoxic side effects.

Where can I get further information?

If you want to find out more about some of the subjects covered in this factsheet, you may find these RNID factsheets and leaflets useful:

RNID Information Line

The RNID Information Line offers a wide range of information on many aspects of deafness and hearing loss. You can contact us for printed copies of this factsheet and the full range of RNID information factsheets and leaflets.

RNID Information Line, 19-23 Featherstone Street, London EC1Y 8SL
Telephone: 0808 808 0123
Textphone: 0808 808 9000
Fax: 020 7296 8199
Email: informationline@rnid.org.uk

More about Tinnitus

If you want to find out more about tinnitus, we have a range of publications available. Have a look at our tinnitus factsheets and our leaflet "Tune out tinnitus". We also sell a book "Understanding tinnitus - managing the noises in your ears or in your head" and a range of relaxation CDs and cassettes.

If you feel you need more help with tinnitus directly from other people who also have it, you could contact a local tinnitus support group. There are about 100 of these in the UK. They are set up and run by people with tinnitus. The type of support and help they are able to offer varies between groups. Contact the RNID Tinnitus Helpline for details of your nearest group.