Ototoxicity is a big word which most are unfamiliar with. More simply stated, it is medicine-induced hearing loss which, although common, is rarely discussed and seldom explained.
Ototoxicity: When Medication Affects Hearing and Balance
Ototoxicity is a medical term many people have never heard. It refers to hearing or balance problems caused by certain medications or chemicals.
The word combines oto, meaning ear, with toxic, meaning poisonous or harmful. Medications used at home and medicines required during lifesaving treatment can sometimes have ototoxic effects.
Many classes of drugs used to treat pain, infections, cancer, cardiovascular conditions and kidney disease may affect the cochlea or the vestibular system inside the inner ear.
View the Ototoxic Medication Information at Full Size
Which Medications May Affect Hearing?
Medication categories that may have ototoxic effects include certain:
- Pain relievers, including aspirin at some doses.
- Nonsteroidal anti inflammatory drugs such as ibuprofen.
- Antibiotics.
- Loop diuretics.
- Chemotherapy medications.
- Medications used to treat serious infections or chronic diseases.
The risks vary considerably. A medication that is appropriate and necessary for one patient may not be appropriate for another. Never stop or alter a prescribed medication without first speaking with the healthcare professional who prescribed it.
Possible Signs of Ototoxicity
Ototoxic medication may damage delicate sensory hair cells and nerve structures inside the inner ear. Depending on the medication and the person, the effects may be temporary or permanent.
- New or worsening hearing loss.
- Ringing, buzzing or other sounds in the ears.
- Increased sensitivity to ordinary sounds.
- Dizziness or vertigo.
- Unsteadiness or balance difficulties.
- Difficulty understanding speech, especially in background noise.
Medication type, dosage, treatment schedule, duration of use and individual health factors can all influence the risk of ototoxic effects.
Hearing changes may develop gradually and may not be immediately noticed by the person receiving treatment. New symptoms should be reported promptly.
Who Should Be Part of the Conversation?
Questions about medication related hearing or balance effects may involve several members of your healthcare team:
- Your primary care physician.
- An ear, nose and throat physician.
- A physician assistant or nurse practitioner.
- Your pharmacist.
- Your oncologist.
- Your audiologist or hearing care professional.
Clear communication among these professionals can help identify risks, monitor changes and support informed treatment decisions.
What Is an Ototoxicity Monitoring Protocol?
An ototoxicity monitoring protocol provides a structured plan for evaluating hearing before, during and after treatment with a potentially ototoxic medication.
Early detection and proactive management are central goals of ototoxicity monitoring. Hearing changes may be overlooked by someone who is coping with a serious or life threatening disease.
When a change is identified early, the medical team may be able to consider treatment adjustments when doing so is medically appropriate. If the medication cannot be changed, early identification can still support counseling, communication planning and hearing rehabilitation.
Chemotherapy and Hearing Health
Cisplatin is an effective chemotherapy medication used to treat several types of cancer. It is also known to have a significant risk of ototoxic effects.
Patients receiving cisplatin or another potentially ototoxic treatment may benefit from an early referral to a hearing care professional. The goal is to document hearing before treatment and identify changes as soon as possible.
The medical benefits of cancer treatment may greatly outweigh the risk to hearing. Monitoring gives patients and healthcare professionals more information for making decisions and planning supportive care.
Recommended Hearing Monitoring
An Ototoxicity Monitoring Plan May Include:
- A baseline hearing test before a new medication is started or as close to the beginning of treatment as possible.
- Periodic hearing tests during treatment based on the medication and medical plan.
- Prompt testing when hearing, tinnitus, sound sensitivity, dizziness or balance symptoms develop.
- Testing after treatment to identify lasting changes.
- Communication among the hearing care professional, prescribing physician and other members of the medical team.
A baseline evaluation is especially valuable because it provides a point of comparison. Without that information, it can be more difficult to determine whether a hearing change occurred during treatment.
Ototoxic effects may first appear in the higher frequencies. These changes may progress before a person recognizes difficulty understanding everyday conversation.
Hearing difficulties may also make it harder to understand medical instructions. Prompt identification and appropriate communication support can therefore be particularly important during treatment.
Good Humor, Healthy Hearing
While we take your hearing care seriously, a little laughter goes a long way.
Talk With Your Healthcare Professionals
If you are beginning a new medication or medical treatment, ask whether it may affect your hearing or balance. Your physician and pharmacist can explain the known risks and why the medication has been recommended.
A professional hearing evaluation can document your current hearing and provide useful information for your medical team. Periodic testing may help identify changes early and guide appropriate support.
Are you taking a medication that may affect hearing or balance?
Ask your physician about the treatment and contact Focus Hearing to discuss appropriate hearing monitoring.
Contact Focus HearingResearch sources:
Durrant JD, Palmer CV, Lunner T. Analysis of counted behaviors in a single subject design: modeling of hearing aid intervention in hearing impaired patients with Alzheimer’s disease. International Journal of Audiology. 2005;44(1):31 to 38.
Konrad Martin D, Poling GL, Garinis AC and colleagues. Applying United States national guidelines for ototoxicity monitoring in adult patients: patient populations, service gaps, barriers and solutions. International Journal of Audiology. 2018;57:S3 to S18.
This information is provided for general educational purposes. Do not stop, reduce or change a medication without speaking with the prescribing healthcare professional.
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Stilwell, Kansas 66085
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