Which Medications Can Affect Hearing?

What Is Ototoxicity and Why It Matters

Hearing loss in later life is common, but certain medicines can accelerate or worsen it. Ototoxicity refers to drug-induced injury of the inner ear (cochlea or auditory nerve), leading to hearing loss or tinnitus . Many older adults take multiple chronic medications, and some of these agents can damage hair cells in the ear or alter inner-ear function. Studies show that over 90% of older people use at least one drug with ototoxic potential , and those taking several such medications are more likely to have worse hearing than with aging alone . The hearing loss from ototoxic drugs is usually sensorineural (inner-ear) and affects high frequencies bilaterally, similar to age-related hearing loss . It is often progressive and can be irreversible for some drugs, so awareness is essential.

Aminoglycoside Antibiotics (Gentamicin, Streptomycin, etc.)

Aminoglycosides are a class of powerful antibiotics (e.g. gentamicin, streptomycin, amikacin, tobramycin) used to treat severe infections. They are well-known ototoxins. Hearing damage from aminoglycosides is often permanent and affects high frequencies, typically after days of treatment or over multiple courses . These drugs enter the inner ear via the bloodstream, accumulate in cochlear fluids, and generate reactive oxygen species (ROS) that trigger hair-cell death . The primary mechanism is apoptotic loss of outer hair cells (the sensory cells for sound) . Patients may notice tinnitus (ringing) or difficulty hearing high-pitched sounds. Renal impairment or dehydration can increase risk (drug levels stay higher). Importantly, aminoglycosides should not be mixed with other ototoxic agents. For example, giving a loop diuretic (see below) or vancomycin simultaneously greatly raises the chance of severe hearing loss . If treatment with an aminoglycoside is needed, doctors may monitor blood levels and hearing, use the lowest effective dose, and consider alternatives if possible. Patients should never stop or change antibiotics on their own; always consult a doctor or pharmacist before making any change.

Platinum Chemotherapy Drugs (Cisplatin and Carboplatin)

Cisplatin and related platinum-based chemotherapy drugs are highly ototoxic. They are used for cancers such as testicular, ovarian, or lung cancer. Cisplatin typically causes irreversible, bilateral sensorineural hearing loss, often starting at high frequencies . Hearing loss can occur after the first dose but is more common or severe after repeated cycles . Mechanistically, cisplatin also generates ROS in the cochlea and activates cell death pathways in hair cells . A recent meta-analysis found that about half of patients receiving cisplatin alone developed measurable hearing loss, and combining cisplatin with carboplatin raised the risk even higher . The damage can be permanent and sometimes profound; some patients may need hearing aids or other accommodations. If you are receiving cisplatin, your oncology team will often monitor hearing during treatment. Research is ongoing into protective agents, but currently prevention focuses on careful dosing. Patients should discuss any hearing symptoms with their cancer doctor rather than discontinuing lifesaving therapy.

Loop Diuretics (Furosemide, Bumetanide, Ethacrynic Acid)

Loop diuretics are “water pills” prescribed for conditions like heart failure or hypertension. Furosemide and ethacrynic acid are common examples. These drugs can cause hearing changes, usually reversible. High intravenous doses (especially in renal failure) can lead to sudden hearing loss or tinnitus . The mechanism is different from antibiotics: loop diuretics disrupt fluid and ion balance in the stria vascularis (a part of the inner ear that helps generate the ear’s electrical potential). This causes swelling (edema) in the cochlea and a rapid drop in the endolymphatic potential, impairing the hair cells’ function . Hearing often recovers after the drug is stopped or dose reduced. However, if a loop diuretic is used together with an aminoglycoside antibiotic or in severe kidney impairment, permanent hearing loss can occur . Therefore, these drugs are labeled as ototoxic especially in high doses or vulnerable patients. If you take a loop diuretic and notice sudden hearing changes, inform your doctor promptly.

Salicylates and NSAIDs (Aspirin, Ibuprofen, Naproxen, etc.)

Common painkillers and anti-inflammatory drugs can also affect hearing, particularly at high or chronic doses. The best-known example is aspirin (acetylsalicylic acid). High doses of salicylates (several grams per day, far above normal pain-relief doses) reliably produce tinnitus and hearing loss . This hearing effect is usually reversible within days after stopping the salicylate. Other non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, diclofenac, or indometacin can similarly cause temporary tinnitus or a slight rise in hearing thresholds . The mechanism is thought to involve impaired function of the outer hair cells (the “amplifiers” of sound in the cochlea) and some effects on auditory nerve activity . Large epidemiological studies have found that regular, long-term users of aspirin or NSAIDs have a mildly higher risk of developing hearing loss than non-users . For most people taking occasional or recommended doses of these painkillers, the risk is small. But for chronic users (e.g. arthritis patients), even a small risk can add up, especially when other risk factors (age, noise exposure) are present. Paracetamol (acetaminophen) has also been linked to hearing loss in some studies, though its mechanism is less clear.