When we think about the side effects of medicines, we might think of nausea, fatigue or dizziness. But there's another, lesser-known risk that can have lasting - and sometimes permanent - consequences: hearing loss. A wide range of prescription and over-the-counter drugs are known to be ototoxic, meaning they can damage the inner ear and affect hearing or balance.
Author
- Dipa Kamdar
Senior Lecturer in Pharmacy Practice, Kingston University
Ototoxicity refers to drug or chemical-related damage to the cochlea , which affects hearing, and the vestibular system , which controls balance. Symptoms can include tinnitus (ringing in the ears), hearing loss (often starting with high-frequency sounds), dizziness or balance problems or a sensation of fullness in the ears.
These effects can be temporary or permanent, depending on the drug involved, the dose and duration and a person's susceptibility.
The inner ear is highly sensitive, and most experts believe ototoxic drugs cause damage by harming the tiny hair cells in the cochlea or disrupting the fluid balance in the inner ear. Once these hair cells are damaged, they don't regenerate - making hearing loss irreversible in many cases.
Around 200 medicines are known to have ototoxic effects. Here are some of the most commonly used drugs to watch out for:
1. Antibiotics
Aminoglycoside antibiotics like gentamicin, tobramycin and streptomycin are typically prescribed for serious infections such as sepsis, meningitis, or tuberculosis - conditions where prompt, aggressive treatment can be lifesaving. In these cases, the benefits often outweigh the potential risk of hearing loss.
These drugs, usually given intravenously, are among the most well-documented ototoxic medications. They can cause irreversible hearing loss, particularly when used in high doses or over extended periods. Some people may also be genetically more vulnerable to these effects.
These drugs linger in the inner ear for weeks or even months, meaning damage can continue after treatment has ended.
Other antibiotics to be aware of include macrolides (such as erythromycin and azithromycin) and vancomycin , which have also been linked to hearing problems, particularly in older adults or people with kidney issues.
2. Heart medicines
Loop diuretics like furosemide and bumetanide are commonly used to manage heart failure or high blood pressure. When given in high doses or intravenously, they can cause temporary hearing loss by disrupting the fluid and electrolyte balance in the inner ear. Around 3% of users may experience ototoxicity.
Some blood pressure medications have also been linked to tinnitus.
These include ACE inhibitors - drugs like ramipril that help relax blood vessels by blocking a hormone called angiotensin, making it easier for the heart to pump blood - and calcium-channel blockers like amlodipine , which reduce blood pressure by preventing calcium from entering the cells of the heart and blood vessel walls. While these associations have been observed, more research is needed to fully understand the extent of their effect on hearing.
3. Chemotherapy
Certain chemotherapy drugs, especially those containing platinum - like cisplatin and carboplatin - are known to be highly ototoxic. Cisplatin, often used to treat testicular, ovarian, breast, head and neck cancers, carries a significant risk of permanent hearing loss. That risk increases when radiation is also directed near the head or neck.
Up to 60% of patients treated with cisplatin experience some degree of hearing loss. Researchers are exploring ways to reduce risk by adjusting dosage or frequency without compromising the drug's effectiveness.
4. Painkillers
High doses of common pain relievers, including aspirin, NSAIDs - non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, commonly used to relieve pain, inflammation and fever - and even paracetamol, have been linked to tinnitus and hearing loss.
A large study found that women under 60 who regularly took moderate-dose aspirin (325 mg or more, six to seven times per week) had a 16% higher risk of developing tinnitus. This link was not seen with low-dose aspirin (100 mg or less). Frequent use of NSAIDs as well as paracetamol was also associated with a nearly 20% increased risk of tinnitus, particularly in women who used these medications often.
Another study linked long-term use of these painkillers to a higher risk of hearing loss, especially in men under 60. In most cases, tinnitus and hearing changes resolve once the medication is stopped - but these side effects typically occur after prolonged, high-dose use.
5. Antimalarial drugs
Drugs like chloroquine and quinine - used to treat malaria and leg cramps - can cause reversible hearing loss and tinnitus. One study found that 25-33% of people with hearing loss had previously taken one of these drugs.
Hydroxychloroquine , used to treat lupus and rheumatoid arthritis, has a similar chemical structure and poses a similar risk. While some people recover after stopping the drug, others may experience permanent damage, particularly after long-term or high-dose use.
People with pre-existing hearing loss, kidney disease, or genetic susceptibility face higher risks - as do those taking multiple ototoxic drugs at once. Children and older adults may also be more vulnerable.
If you're prescribed one of these medications for a serious condition like cancer, sepsis or tuberculosis, the benefits usually outweigh the risks. But it's still wise to be informed. Ask your doctor or pharmacist if your medicine carries a risk to hearing or balance. If you experience ringing in your ears, dizziness, or muffled hearing, report it promptly.
Dipa Kamdar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
