Medications That Cause Hearing Problems

Hearing impairment and other hearing problems become increasingly common as people get older. The vast majority of these problems are due to gradual damage to the inner ear that is associated with normal aging and exposure to loud noises over prolonged periods of time. But for some patients, the cause of hearing impairment may be found in the medicine cabinet.

Numerous medications, including several in common use, are ototoxic, meaning they can damage the parts of the ear and nerves critical to hearing. By knowing which drugs are ototoxic, patients can be alert for signs of new or worsening hearing problems and seek medical evaluation before those problems become severe or irreversible.

Hearing loss

Statistics compiled by the National Institute on Deafness and Other Communication Disorders reveal that hearing impairment is exceedingly common in the U.S.[1] About 38 million adults aged 18 and older report some hearing difficulty. Disabling hearing loss affects nearly one-tenth of adults aged 55 to 64. This increases to approximately one-quarter of people aged 65 to 74 and one-half of those aged 75 or older.

Hearing loss can be divided into three types: sensorineural, conductive and mixed.[2] Sensorineural hearing loss results from damage to the inner ear — which contains cells that convert sound vibrations into nerve impulses — or to the auditory nerves that carry those impulses to the brain. Age-related hearing loss and cumulative noise exposure over time are among the most common causes of sensorineural hearing loss.[3]

Conductive hearing loss occurs when sound waves are blocked from reaching the inner ear. Common causes include earwax buildup in the external ear canal or fluid accumulation in the middle ear (the space behind the eardrum).[4]

Mixed hearing loss involves a combination of the first two types.

Tinnitus

Tinnitus is another very common hearing problem. In the absence of actual noise, people with tinnitus still have the sensation of noise in one or both ears, or within or around their heads.[5] Tinnitus typically is perceived as ringing, buzzing, hissing, roaring or clicking.[6] The symptoms may be constant or intermittent.[7]

An estimated 50 million people in the U.S. have chronic tinnitus lasting for more than six months.[8] Like hearing loss, tinnitus occurs more often in older people.[9] Other risk factors for developing tinnitus are white race, male sex, smoking and hypertension (high blood pressure).[10] Tinnitus often accompanies sensorineural hearing loss due to increasing age or cumulative exposure to loud noises.

Ototoxic drugs

Many drugs can directly damage parts of the inner ear or the auditory nerves, resulting in sensorineural hearing loss, tinnitus or both. Drug-induced hearing loss may affect one or both ears.[11] The symptoms of hearing impairment or tinnitus may occur suddenly or develop gradually and may be temporary or permanent.[12]

Examples of Commonly Used Drugs Associated With Hearing Problems

*Limited Use
**Do Not Use except for serious fungal infections
***Do Not Use
†Combination products were excluded from this table.

The Table above lists the most well-known examples of ototoxic drugs, organized by drug class. Most of these drugs have been linked to both sensorineural hearing loss and tinnitus. Some of the major categories of ototoxic drugs include the following:

Aminoglycoside antibiotics. These antibiotics, when administered by injection, are among the most ototoxic of all drugs. They are used most often to treat hospitalized patients with certain serious bacterial infections. The labels for all injectable aminoglycosides have a black-box warning about their ototoxicity.[13],[14],[15],[16] Symptoms may include tinnitus, dizziness, vertigo (a sensation that the room is spinning; this results from damage to part of the inner ear that controls the sense of balance) and hearing loss, which may progress to complete deafness. In some patients, symptoms of hearing damage may not appear until after the antibiotic treatment is completed. These adverse effects usually are irreversible. The risk of aminoglycoside-induced hearing problems is increased with higher doses, longer treatment periods, use of other potentially ototoxic drugs and kidney disease.

Other antibiotics. Vancomycin (generic only) is another injectable antibiotic, used to treat serious bacterial infections, that rarely can cause hearing loss, tinnitus and vertigo. These adverse effects can be temporary or permanent.[17] Tinnitus may occur before hearing loss, and hearing loss may progress even after the drug is stopped.[18] Risk factors for vancomycin-induced hearing damage are similar to those for aminoglycosides.

Reversible hearing loss has been reported rarely in patients taking oral erythromycin (E.E.S., ERY-TAB, ERYC, ERYPED, ERYTHROCIN).[19],[20] Tinnitus and hearing loss also have been seen occasionally with use of oral minocycline (DYNACIN, MINOCIN, MINOLIRA, SOLODYN, XIMINO).[21],[22]

Antifungal drugs. Deafness has been seen in rare cases with use of the oral antifungal drugs griseofulvin (GRIS-PEG), itraconazole (ONMEL, SPORANOX, TOLSURA) and terbinafine (LAMISIL).[23],[24],[25] With itraconazole, the hearing loss may be temporary or permanent.[26] Tinnitus also has been reported with itraconazole and terbinafine use.[27],[28]

Erectile dysfunction drugs. In rare cases, sudden hearing loss, sometimes accompanied by tinnitus and dizziness, has been linked to avanafil (STENDRA), sildenafil (REVATIO, VIAGRA), tadalafil (ADCIRCA, ALYQ, CIALIS) and vardenafil (LEVITRA, STAXYN).[29],[30],[31],[32] The hearing impairment may be partial or complete and has occurred following a single dose, usually within 24 hours.[33],[34],[35] Typically, it occurs in only one ear and is irreversible.

Gout drug. Febuxostat (ULORIC) is prescribed to lower uric acid levels to prevent acute gout attacks. The drug has been linked to deafness and tinnitus.[36],[37]

Loop diuretics. These very strong “water pills” are available in oral and intravenous forms and are approved for treating hypertension and swelling due to heart failure, liver disease and kidney disease. Loop diuretics can cause reversible and irreversible hearing loss and tinnitus, most often when given by rapid injection, when combined with other ototoxic drugs or when used in patients with severe kidney disease.[38],[39],[40],[41] However, hearing impairment has occurred in patients using standard doses of oral loop diuretics.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and many other commonly used over-the-counter and prescription NSAIDs sometimes cause reversible hearing loss and tinnitus.[42],[43] The risk of ototoxicity is greatest when taking high doses of NSAIDs for prolonged periods.

Signs and Symptoms of Hearing Loss*[44]

• Muffling of speech and other sounds
• Difficulty understanding words, especially against background noise or in a crowd
• Trouble hearing consonants
• Needing to ask people to speak louder, more slowly and more clearly
• Needing to turn up the volume of the television or radio
• Withdrawing from conversations

*Source: Mayo Clinic website: Hearing loss

What You Can Do

For most people with hearing loss or tinnitus, the condition likely is age-related or due to exposure to loud noise. However, if you take any of the drugs discussed in this article, contact your doctor immediately if you experience new or worsening hearing loss or tinnitus, or are concerned that the drug may be causing a hearing problem (see Text Box above for signs and symptoms of hearing loss). Never stop taking a prescribed medication without first talking to your doctor.
 

References

[1] National Institute on Deafness and Other Communication Disorders. Quick statistics about hearing. December 15, 2016. http://www.nidcd.nih.gov/health/statistics/pages/quick.aspx. Accessed August 2, 2019.

[2] Weber PC. Etiology of hearing loss in adults. UpToDate. October 30, 2018.

[3] Ibid.

[4] Ibid.

[5] Dinces EA. Etiology and diagnosis of tinnitus. UpToDate. April 12, 2018.

[6] Mayo Clinic. Tinnitus. https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156. Accessed August 2, 2019.

[7] Dinces EA. Etiology and diagnosis of tinnitus. UpToDate. April 12, 2018.

[8] Ibid.

[9] Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med. 2010;123(8):711-718.

[10] Ibid.

[11] Drug-induced hearing loss. Prescrire Intl. 2014;23(155):290-294.

[12] Ibid.

[13] Fresenius Kabi USA. Label: amikacin sulfate injection. April 2019. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=c0f57839-1c9b-49e5-8c7a-708e2d16495d&type=display. Accessed August 19, 2019.

[14] Fresenius Kabi USA. Label: gentamicin injection. November 2016. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=be5b414e-d598-4721-80ee-5836156ad210&type=display. Accessed August 19, 2019.

[15] X-GEN Pharmaceuticals. Label: streptomycin sulfate injection. August 2019. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e&type=display. Accessed August 19, 2019.

[16] Fresenius Kabi USA. Label: tobramycin sulfate injection. April 2018. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=8cfeb84f-193a-458a-bdec-205d9274e1a4&type=display. Accessed August 19, 2019.

[17] Blue Point Laboratories. Label: vancomycin injection. May 2018. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=ed15e6c9-26c4-4d31-acbd-09a513a188e1&type=display. Accessed August 19, 2019.

[18] Drug-induced hearing loss. Prescrire Intl. 2014;23(155):290-294.

[19] Amneal Pharmaceuticals NY. Label: erythromycin. May 2019. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0aaf09b7-a78b-4525-a857-ef12e3f4b2f9&type=display. Accessed August 19, 2019.

[20] Drug-induced hearing loss. Prescrire Intl. 2014;23(155):290-294.

[21] Onset Dermatologics. Label minocycline (MINOCIN). January 2019. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=39aee369-b5dc-4ff4-98de-06fb4189c733&type=display. Accessed August 19, 2019.

[22] Drug-induced hearing loss. Prescrire Intl. 2014;23(155):290-294.

[23] Drug-induced hearing loss. Prescrire Intl. 2014;23(155):290-294.

[24] Janssen Pharmaceutical Companies. Label itraconazole (SPORANOX). May 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020083s063lbl.pdf. Accessed August 19, 2019.

[25] Novartis Pharmaceuticals Corporation. Label: terbinafine (LAMISIL). March 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020539s033lbl.pdf. Accessed August 19, 2019.

[26] Janssen Pharmaceutical Companies. Label itraconazole (SPORANOX). May 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020083s063lbl.pdf. Accessed August 19, 2019.

[27] Ibid.

[28] Novartis Pharmaceuticals Corporation. Label: terbinafine (LAMISIL). March 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020539s033lbl.pdf. Accessed August 19, 2019.

[29] Metuchen Pharmaceuticals. Label: avanafil (STENDRA). August 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/202276s018lbl.pdf. Accessed August 19, 2019.

[30] Pfizer Laboratories. Label: sildenafil (VIAGRA). December 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020895s048lbl.pdf. Accessed August 19, 2019.

[31] Eli Lilly and Company. Label: tadalafil (CIALIS). February 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021368s030lbl.pdf. Accessed August 19, 2019.

[32] GlaxoSmithKline. Label: vardenafil (LEVITRA). March 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021400s020lbl.pdf. Accessed August 19, 2019.

[33] Drug-induced hearing loss. Prescrire Intl. 2014;23(155):290-294.

[34] Maddox PT, Saunders J, Chandrasekhar SS. Sudden hearing loss from PDE-5 inhibitors: A possible cellular stress etiology. Laryngoscope. 2009;119(8):1586-1598.

[35] Khan AS, Sheikh Z, Khan S, et al. Viagra deafness — sensorineural hearing loss and phosphodiesterase-5 inhibitors. Laryngoscope. 2011;121(5):1049-1054.

[36] Takeda Pharmaceuticals America. Label: febuxostat (ULORIC). February 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021856s013lbl.pdf. Accessed August 19, 2019.

[37] Drug-induced hearing loss. Prescrire Intl. 2014;23(155):290-294.

[38] Validus Pharmaceuticals. Label: furosemide (LASIX). April 2019. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=2c9b4d8f-0770-482d-a9e6-9c616a440b1a&type=display. Accessed August 19, 2019.

[39] Validus Pharmaceuticals. Label: bumetanide (BUMEX). August 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/018225s028lbl.pdf. Accessed August 19, 2019.

[40] Drug-induced hearing loss. Prescrire Intl. 2014;23(155):290-294.

[41] Weber PC. Etiology of hearing loss in adults. UpToDate. October 30, 2018.

[42] Ibid.

[43] Drug-induced hearing loss. Prescrire Intl. December 2014;23(155):290-294.

[44] Mayo Clinic. Hearing loss. http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/risk-factors/con-20027684?p=1. Accessed August 19, 2019.