Understanding Ototoxicity and Its Warning Signs

Medications are crucial in maintaining our health. They enable doctors to treat infections, control chronic illnesses, support cardiac and renal functions, and combat serious diseases like cancer.

As with all medical therapies, some medications may cause side effects. One less discussed side effect is changes in hearing or balance.

Ototoxic medications can harm parts of the inner ear, leading to hearing loss, tinnitus, dizziness, or balance issues. These effects vary among individuals, and many people take these drugs without problems. However, being aware of symptoms can help you notice any changes early and consult your healthcare team.

Most importantly, do not stop taking a prescribed medication based solely on online information. The benefits of treatment often outweigh the risks to hearing. Always discuss any concerns with your healthcare provider managing your care.

What Does Ototoxic Mean?

“Ototoxic” refers to something that can be harmful to the ear. In medicine, it is generally used to describe drugs that may affect the structures responsible for hearing or balance.

Deep inside the ear is the cochlea, a small, fluid-filled structure containing delicate sensory cells. These cells help convert sound into electrical signals that travel to the brain. Nearby structures help the body understand movement and maintain balance.

Certain medications may disrupt these systems by affecting sensory cells, nerves, fluid balance, or blood flow within the inner ear. Depending on the medication and the individual, the effect may be temporary or permanent.

Possible effects include:

• Reduced hearing
• Ringing or other sounds in the ears
• Difficulty understanding speech
• Dizziness or vertigo
• Unsteadiness
• Balance problems

The type and severity of symptoms can vary considerably from one person to another.

Hearing Changes May Not Be Obvious at First

Medication-related hearing loss does not always begin with a dramatic loss of sound. In many cases, the earliest changes affect higher frequencies.

High-frequency sounds contribute to speech clarity, and when these sounds become harder to hear, a person may still hear someone talking but struggle to understand exactly what was said.

Early changes may sound or feel like:

• People are mumbling more often
• Women’s or children’s voices are harder to follow
• Conversations become difficult in restaurants
• Words sound less sharp or distinct
• Certain consonants are easily confused
• Television dialogue is harder to understand
• The volume needs to be raised more often

Because these changes can be subtle, people sometimes blame the room, the speaker, or background noise. Hearing testing can determine whether there has been a measurable change.

Tinnitus Can Be an Early Warning Sign

Tinnitus, the perception of sound when no outside sound is present. It is often described as ringing, but it can also sound like buzzing, humming, hissing, clicking, or roaring.

Some people notice tinnitus before they recognize a change in hearing. It may be constant or intermittent and can occur in one or both ears.

Tinnitus has many possible causes, including noise exposure, hearing loss, earwax, health conditions, and medication side effects. Experiencing tinnitus does not automatically mean a medication has damaged your hearing. New or worsening tinnitus should, however, be discussed with your healthcare provider.

Beltone Sound also offers tinnitus evaluations and support options for people whose symptoms interfere with sleep, concentration, communication, or daily life.

Balance Symptoms Can Also Occur

The inner ear does more than help you hear. It also sends information to the brain about movement, head position, and balance.

When medication affects the balance portion of the inner ear, symptoms may include:

• Dizziness
• A spinning sensation
• Feeling lightheaded
• Unsteadiness while walking
• Difficulty walking in the dark
• Feeling as though the surroundings are moving
• Needing support on stairs
• A greater fear of falling

These symptoms can have many causes and should not be self-diagnosed. Promptly tell your medical provider about any new or worsening dizziness, especially when it begins after a medication or dosage change.

Medication Categories Associated With Ototoxicity

Hundreds of prescription and over-the-counter medications have been associated with possible hearing or balance effects. That does not mean they carry the same level of risk or that everyone taking them will have a problem.

Risk often depends on the medication, dose, treatment length, method of administration, kidney function, overall health, and whether other ototoxic medications are being taken at the same time.

Certain Antibiotics

Aminoglycoside antibiotics may be used to treat severe or complicated bacterial infections. These medications can be medically necessary, but they are also among the drug categories most often associated with ototoxicity.

Risk may be influenced by the dosage, length of treatment, kidney health, and previous exposure to similar medications.

Chemotherapy Drugs

Some cancer treatments, particularly platinum-based chemotherapy medications such as cisplatin, can affect hearing.

Changes may occur during treatment or become more noticeable afterward. Depending on the treatment plan, an oncology team may recommend hearing tests before chemotherapy begins and at selected points throughout care.

Hearing monitoring should never interfere with necessary cancer treatment. Its purpose is to document changes and provide the medical team with useful information.

Loop Diuretics

Loop diuretics help the body remove excess fluid and may be prescribed for heart, kidney, or blood pressure conditions.

Hearing effects are more likely under certain circumstances, such as higher doses, intravenous administration, reduced kidney function, or the use of other ototoxic medications. Some hearing changes related to loop diuretics may be temporary.

High-Dose Aspirin and Salicylates

The low-dose aspirin commonly recommended for cardiovascular care is different from taking aspirin at much higher doses.

High doses of aspirin or related salicylates may cause tinnitus or temporary hearing changes in some people. Never adjust medically recommended aspirin use without speaking with the provider who prescribed it.

Additional Medications

Certain antimalarial drugs, immunosuppressive medications, anti-inflammatory medications, and other treatments have also been linked to possible hearing or balance effects.

Medication lists can be difficult to interpret without medical context. A medication appearing on an ototoxicity list does not automatically make it unsafe or inappropriate for you.

Why Some People Face Greater Risk

Two people can take the same medication and have very different experiences. Individual health, treatment details, and previous hearing history all matter.

The possibility of medication-related hearing changes may be higher among people who:

• Already have hearing loss
• Have experienced tinnitus
• Have kidney disease or reduced kidney function
• Receive higher medication doses
• Require treatment for an extended period
• Take multiple medications with ototoxic potential
• Are receiving chemotherapy
• Are older adults
• Have a history of substantial noise exposure
• Have previously experienced medication-related hearing changes

Having a risk factor does not mean hearing loss is inevitable. It may simply mean that closer monitoring is appropriate.

The Value of a Baseline Hearing Test

A baseline hearing test documents how well you hear before treatment begins or before a noticeable problem develops.

Without a baseline, it can be difficult to determine whether your hearing has changed. People may remember that sounds seem different, but memory cannot show which frequencies have changed or how significant the difference may be.

A baseline evaluation creates an objective point of comparison. If testing is repeated later, your hearing care provider can look for even small shifts in hearing ability.

Baseline testing may be especially beneficial before:

• Beginning certain chemotherapy treatments
• Starting long-term antibiotic therapy
• Taking a medication known to have ototoxic potential
• Undergoing treatment when hearing risk factors are already present
• Combining more than one potentially ototoxic medication

Even when treatment has already started, a hearing test may still provide useful information.

What Happens During Hearing Monitoring?

Hearing monitoring is not the same for every patient. The schedule should be based on the medication, treatment plan, personal risk, and recommendations of the medical team.

Monitoring may include an initial evaluation followed by additional tests during or after treatment. These appointments allow the hearing care provider to compare results over time.

When a change is detected, the results can be shared with the prescribing provider. The medical team can then determine whether any treatment decisions are appropriate.

A hearing care professional does not instruct patients to stop or change medication. Their role is to evaluate hearing, document changes, explain the findings, and provide hearing support when needed.

Steps You Can Take to Support Your Hearing

Not every case of ototoxicity can be prevented, but you can take practical steps to become a more informed participant in your care.

Keep an Updated Medication List

Maintain a list of all prescription medications, over-the-counter products, vitamins, and supplements you take. Share it with each member of your healthcare team.

Ask About Possible Side Effects

When beginning a new medication, ask whether hearing, tinnitus, dizziness, or balance changes are known side effects. This does not mean you should avoid the treatment. It simply helps you know which symptoms should be reported.

Pay Attention to Changes

Do not wait for hearing loss to become severe. Report new tinnitus, muffled hearing, difficulty understanding speech, dizziness, or balance problems promptly.

Limit Unnecessary Noise Exposure

Medication-related risk and noise exposure are separate issues, but both can place stress on the hearing system. Use appropriate hearing protection around loud machinery, concerts, power tools, firearms, or other hazardous sound.

Follow the Treatment Plan

Take medications exactly as prescribed. Do not skip doses, change the amount, or discontinue treatment without medical guidance.

Complete Recommended Hearing Tests

When baseline or follow-up testing is recommended, keep those appointments. Small changes are easier to document when results can be compared over time.

What Should You Do if Symptoms Begin?

Contact your prescribing healthcare provider if you develop a noticeable change in hearing, new tinnitus, dizziness, or balance difficulties after starting medication.

Be prepared to explain:

• When the symptoms started
• Whether they are constant or occasional
• Whether one or both ears are affected
• Whether the medication or dosage recently changed
• Whether you are also experiencing dizziness or imbalance
• How the symptoms affect daily activities

Your provider may review your medication, medical history, dosage, kidney function, and other possible causes. A hearing evaluation may also be recommended.

Sudden hearing loss should be treated differently from a gradual change. A rapid loss of hearing in one or both ears requires prompt medical evaluation and should not be delayed while waiting for a routine hearing appointment.

Awareness Is the Goal—Not Fear

The purpose of learning about ototoxic medications is not to make people afraid of necessary treatment.

Antibiotics, chemotherapy drugs, diuretics, and other medications can provide essential and sometimes lifesaving benefits. For many patients, the value of treatment is much greater than the possibility of a hearing-related side effect.

Awareness allows you to recognize potential symptoms, ask informed questions, and communicate more clearly with your healthcare team. When appropriate, baseline testing and ongoing monitoring can provide a clearer picture of your hearing throughout treatment.

Let Beltone Sound Help You Monitor Your Hearing

If you are beginning a treatment with possible hearing-related side effects, have noticed a recent change, or simply want to establish a baseline, the hearing care professionals at Beltone Sound are here to help.

A comprehensive hearing evaluation can document your current hearing, identify existing concerns, and provide a reliable point of comparison for the future. If hearing loss or tinnitus is already affecting your daily life, our team can also discuss personalized solutions designed to help you communicate more confidently and stay connected to the people around you.

Contact your nearest Beltone Sound hearing care center to schedule a hearing evaluation.

References and Additional Resources

• American Speech-Language-Hearing Association. “Ototoxic Medications.”
• American Academy of Audiology. “Ototoxicity.”
• National Institute on Deafness and Other Communication Disorders. Hearing and Ear Health Resources.
• Cleveland Clinic. “Ototoxicity: Symptoms, Causes and Treatment.”
• Lanvers-Kaminsky C, et al. “Drug-Induced Ototoxicity: Mechanisms, Pharmacogenetics, and Protective Strategies.” Clinical Pharmacology & Therapeutics.
• Schacht J, Talaska AE, Rybak LP. “Cisplatin and Aminoglycoside Ototoxicity.” Hearing Research.

This article is provided for general education and is not a substitute for medical advice. Do not stop or change a prescribed medication without consulting the healthcare provider managing your treatment.