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What You Should Know About Ototoxic Medications
by Stephen Epstein, M.D.
Reprinted with Permission from the
SHHH Journal, September/October 1995
(c) Self Help for Hard of Hearing People, Inc.
Ototoxic medications are those drugs that have the potential to cause
damage to the inner ear structures which may result in temporary or permanent
loss of hearing or an aggravation of an existing sensorineural hearing
loss. If you have an existing sensorineural hearing loss, regardless of
the cause, when using ototoxic medications, you are more vulnerable to
aggravation of that hearing loss.
As a result of using ototoxic medications, the degree of hearing loss
that occurs and the amount of recovery that follows depends upon the amount
and duration of the use of that particular medication. If you are consuming
more than one ototoxic medication, you are even more vulnerable to developing
a sensorineural hearing loss or aggravation of your existing sensorineural
hearing loss. Some ototoxic medications such as aspirin and aspirin-containing
drugs -- regardless of the amount and duration of usage -- when discontinued,
result in complete recovery of hearing and cessation of associated symptoms
such as tinnitus.
Guidelines to Follow
In regard to the use of ototoxic medications, whether they are over-the-counter
or prescription, there are several important facts you should know and
several important rules you should follow:
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Always inform your doctor that you have a sensorineural hear loss or
nerve-type hearing loss.
-
Always ask your doctor, when he is prescribing new medications for
you, to inform you of any potential side effects, especially if the medication
is ototoxic.
-
Always read the labels or ask your pharmacist about the potential ototoxic
effects of over-the-counter medications.
-
Always be aware of the early warning signs of
ototoxicity.
Signs of Ototoxicity, Listed in Order of Frequency
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The development of tinnitus (noises in the ears) in one or both ears.
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The intensification of existing tinnitus or the appearance of another
sound that didn't exist before.
-
Fullness or pressure in your ears -- other than being secondary to
an upper respiratory infection.
-
The awareness of a hearing loss in an unaffected ear or the progression
or fluctuation of an existing loss.
-
The development of vertigo or spinning sensation usually aggravated
by motion and may or may not be accompanied by nausea.
Should any of these symptoms develop while taking any medication --
stop the medication immediately and call your doctor.
Ototoxic Medications
Finally, you should be aware of the common ototoxic medications, how
they are prescribed, and for what conditions they are given.
The following is a simplified list of ototoxic medications and represents
the most common drugs. (There are many other medications that have bee
listed as potentially ototoxic; however the incidence is insignificant.
Consult your physician to be sure.) Keep this list for ready reference.
1. Salicylates - Aspirin and aspirin-containing products
2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) - Advil, Aleve,
Anaprox, Clinoril, Feldene, Indocin, Lodine, Motrin, Nalfon, Naprosyn,
Nuprin, Poradol,
Voltarin
3. Antibiotics - Aminoglycosides, Erythromycin, Vancomycin
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Aminoglycosides - Streptomycin, Kanamycin, Neomycin,
Gentamycin, Tobramysin, Amikacin, Netilmicin
These medications are ototoxic when used intravenously
in serious life threatening situations. The blood levels of these medications
are usually monitored to prevent ototoxicity.
Topical preparations and ear drops
containing these antibiotics, Neomycin and Gentamycin, have not
been demonstrated to be ototoxic in humans.
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Erythromycin - EES, Eryc, E-mycin, Ilosone, Pediazole, and
new derivatives of Erythromycin -- Biaxin, Zithromax
Erythromycin is usually ototoxic when given intravenously
in dosages of 2-4 grams per 24 hours -- especially if there is underlying
kidney insufficiency.
The usual oral dosage of Erythromycin averaging one gram per 24 hours
is not ototoxic.
There are no significant reports of ototoxicity with the new Erythromycin
derivatives since they are given orally and in lower dosages.
This antibiotic is used in a similar manner as the
aminoglycosides;
when given intravenously in serious life-threatening
infections, it is potentially ototoxic. It is usually used in conjunction
with the aminoglycosides which enhances the possibility of ototoxicity.
4. Loop Diuretics - Lasix, Edecrin, Bumex
These medications are usually ototoxic when given intravenously
for acute kidney failure or acute hypertension.
Rare cases of ototoxicity have been reported when these medications
are taken orally in high doses in people with
chronic kidney disease.
5. Chemotherapeutic Agents - Cisplatin, Nitrogen Mustard, Vincristine
These medications are ototoxic when given for treatment of cancer. Their
ototoxic effects can be minimized by maintaining blood levels of the medications
and performing serial audiograms. The ototoxic effects of these medications
are enhanced in patients who are already taking other ototoxic medications
such as the aminoglycoside antibiotics and the loop diuretics.
6. Quinine - Aralen, Atabrine (for treatment of malaria),
Legatrin, Q-Vel Muscle Relaxant (for treatment of night cramps)
The ototoxic effects of quinine are very similar to aspirin and the
toxic effects are usually reversible once medication is discontinued.
Just as you are responsible for your overall health, you are responsible
for the preservation of your hearing or the preservation of your existing
hearing reserve. Being aware of ototoxic medications and their potential
warnings is a good safeguard to protect your hearing -- and a sound
investment!
Stephen Epstein, M.D., F.A.C.S., is an otologist and a fellow of
the American Academy of Otolaryngology - Head and Neck Surgery, Inc., and
the American College of Surgeons. He is the director of The Ear Center
in Wheaton, Maryland.
Special tip for filling out medical forms
One SHHH member reports that when filling out medical questionnaires,
she lists ototoxic medications under "known allergies". This
invariably results in questions from medical staff, making them more aware
of her hearing loss.
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