Ototoxicity: Is your medication damaging your hearing?

We all know that loud noises can permanently damage our hearing - but that off-the-shelf drugs like aspirin can cause hearing damage is news to me. Here, Karen Collins sheds light on this overlooked risk:

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Written by Karen Collins

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I’ve never heard anyone speak of what may be even more commonly damaging their ears: medications.

Surprisingly, hearing damage isn’t something we often talk or write about in the world of audio. If anything, we associate hearing damage with loud sounds, and we all know to take precautions against any sounds that may cause damage to our delicate and precious organs. We have SPL meters on our phones and gracefully excuse ourselves from situations that top 90dB, knowing that we may be risking some damage if we stay. We use ear muffs when we’re out recording loud sounds. But I’ve never heard anyone speak of what may be even more commonly damaging their ears: medications.

This includes common drugs like aspirin, acetaminophen (paracetamol), and ibuprofen, but also other painkillers, anti-depressants, antibiotics, and other medications.

Medications that damage hearing are called ototoxic (“oto” meaning “ear” and toxic meaning poisonous!). Our ears are very delicate and sensitive organs, and any medication may have some impact on your hearing. You have most likely taken some ototoxic medications without even knowing it. And for the most part, you probably got away with it. But taking any medication for a long period of time, or in large quantities, can cause permanent, irreversible hearing loss. This includes common drugs like aspirin, acetaminophen (paracetamol), and ibuprofen, but also other painkillers, anti-depressants, antibiotics, and other medications. We rarely read the fine print in taking medications (particularly those we buy off-the-shelf like aspirin), assuming that these are safe if they’re sold in stores everywhere. If we do read the fine print, we assume that the effects are rare. But millions of people are affected by ototoxic medications every single year. Some drugs have an almost 100% guarantee of causing hearing loss! Are you willing to take that risk and potentially do permanent damage to your hearing? I’m not a medical doctor, but I put together this brief guide to raise awareness—talk to your own doctor if you take any medication regularly.
 

How do I know if I’m taking an ototoxic drug?

There are 743 known ototoxic drugs. There is a list of a few here.

Just because a drug is not on that list does not mean it is not ototoxic. Acetaminophen is not on the list, but two studies, in 2010 and 2012, found that acetaminophen is even more toxic than Aspirin and NSAIDs. It is even worse when taken in combination with painkillers (as in the case of Vicodin. I’m always surprised when rock stars get addicted to a drug that will likely cause permanent hearing damage).

There are some studies that suggest that other medications may help to offset the effects (such as melatonin with certain ototoxic anti-cancer drugs)

The first sign of ototoxicity is usually tinnitus (ringing or buzzing in the ears). Other symptoms include light-headedness, vertigo, and hearing loss. If you experience symptoms, talk to your doctor about your medications and if you can, lower the dosage or find an alternative. There are some studies that suggest that other medications may help to offset the effects (such as melatonin with certain ototoxic anti-cancer drugs) . Often the symptoms will go away once the drug has cleared your system. However, sometimes, the damage will be permanent and there is no cure and no treatment to reverse the damage.

Be aware of ototoxic medications. If you are on any medication known to be ototoxic, talk to your doctor about finding an alternative. Avoid taking any painkillers if you can tough it out, since pretty much all analgesics and anti-inflammatories are known to be ototoxic. If you are on medication and you get tinnitus, weigh the pros and cons of the medication and talk to your doctor. Let your doctor know that you work in sound and you don’t want to take any ototoxic medications unless absolutely necessary. Do your own research and educate yourself on the risks and benefits of any medication.
 
A drug I take is not on the list of ototoxic medications, but I still have tinnitus.

Talk to your doctor and ask if the drug may be ototoxic. Remember, just because it’s not on the list does not make it safe, and your doctor may not be aware of the risks. Do a Google Scholar search through medical journals and see if others have reported hearing loss or tinnitus with your medication. It could be it’s just not reported, yet, but it may be ototoxic.

Left untreated, and with continued use, ototoxic medications can lead to permanent hearing damage. Be aware. Be careful taking any drug, and let your friends in the audio world know about ototoxicity. Take your health into your own hands and become knowledgeable about your ears.

A big thanks to Karen Collins for the insights on this overlooked risk!

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