Drugs 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 the perception of sound. 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 15 percent of adults age 18 and over (37.5 million) report some hearing difficulty. Disabling hearing loss affects nearly one-tenth of adults ages 55 to 64. This increases to nearly a quarter in people ages 65 to 74 and 50 percent of those 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 electrical nerve signals — or to the auditory nerves that carry the electrical signals from the inner ear to the brain. Age-related hearing loss, called presbycusis, and cumulative noise exposure over time are among the most common causes of sensorineural hearing impairment.[3] Excessive noise exposure increases the severity of presbycusis.[4]

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).[5]

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.[6] Tinnitus typically is perceived as ringing, buzzing, hissing, roaring or clicking.[7],[8] The symptoms may be constant or intermittent.[9]

An estimated 16 million people in the U.S. report having frequent tinnitus.[10] Like hearing loss, tinnitus occurs more often in older people, affecting nearly 15 percent of people ages 60 to 69.[11] Other risk factors for developing tinnitus are white race, male sex, smoking and hypertension (high blood pressure).[12]

Tinnitus is caused most commonly by sensorineural hearing loss, including presbycusis and hearing loss due to 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.[13] The symptoms may occur suddenly or develop gradually.[14]

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

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 carry a black-box warning about their ototoxicity.[15],[16],[17],[18] 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 (VANCOCIN) is another injectable antibiotic. Used to treat serious bacterial infections, it can cause both hearing loss and tinnitus. These adverse effects can be temporary or permanent.[19] Tinnitus may occur before hearing loss, and hearing loss may progress even after the drug is stopped.[20] Risk factors for vancomycin-induced hearing damage are similar to those seen with aminoglycosides.

Reversible hearing loss has been reported rarely in patients taking oral erythromycin (E.E.S., E.E.S. 200, E.E.S. 400, ERYC, ERYPED, ERY-TAB, ERYTHROCIN STEARATE, PCE, PEDIAMYCIN, PEDIAMYCIN 400).[21],[22] Tinnitus and hearing loss also have been seen occasionally with oral minocycline (DYNACIN, MINOCIN, SOLODYN).[23],[24]

Antifungal drugs. Deafness has been seen in rare cases with the oral antifungal drugs griseofulvin (GRIFULVIN V , GRIS-PEG),[25] itraconazole (ONMEL, SPORANOX), [26],[27] and terbinafine (LAMISIL).[28],[29] With itraconazole, the hearing loss may be temporary or permanent.[30] Tinnitus also has been reported with itraconazole and terbinafine use.[31],[32]

Erectile dysfunction drugs. In rare cases, sudden hearing loss, sometimes accompanied by tinnitus and dizziness, has been linked to sildenafil (REVATIO, VIAGRA), tadalafil (ADCIRCA, CIALIS) and vardenafil (LEVITRA, STAXYN).[33],[34],[35] The hearing impairment may be partial or complete and has occurred following a single dose, usually within 24 hours.[36],[37],[38] Typically, it occurs in only one ear and is irreversible.[39],[40],[41]

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.[42],[43]

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.[44],[45],[46],[47] 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. 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.[48] ,[49],[50],[51],[52] ,[53],[54] The risk of ototoxicity is greatest when taking high doses of NSAIDs for prolonged periods.

Commonly Used Drugs Associated With Hearing Problems

* Limited Use
** Do Not Use except for serious infections
*** Do Not Use
**** Do Not Use for Seven Years (until February 2016)

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.

Never stop a prescribed medication without first talking to your doctor.

References

[1] National Institute on Deafness and Other Communication Disorders. Quick statistics. Last updated April 20, 2015. http://www.nidcd.nih.gov/health/statistics/pages/quick.aspx. Accessed August 18, 2015.

[2] Weber PC. Etiology of hearing loss in adults. Updated January 8, 2015. UpToDate.

[3] Ibid.

[4] Ibid.

[5] Ibid.

[6] Dinces EA. Etiology and diagnosis of tinnitus. Updated April 2, 2015. UpToDate.

[7] Ibid.

[8] Mayo Clinic. Diseases and conditions: Tinnitus: Symptoms. http://www.mayoclinic.org/diseases-conditions/tinnitus/basics/symptoms/con-20021487. Accessed August 21, 2015.

[9] Dinces EA. Etiology and diagnosis of tinnitus. Updated April 2, 2015. UpToDate.

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

[11] Ibid.

[12] Ibid.

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

[14] Ibid.

[15] Heritage Pharmaceuticals. Product label for AMIKACIN SULFATE - amikacin sulfate injection, solution. Revised January 2014. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=a43188fa-f228-4acd-8a5d- 9a3462034f4b&type=pdf&name=a43188fa-f228-4acd-8a5d-9a3462034f4b. Accessed August 21, 2015.

[16] APP Pharmaceuticals. Product label for GENTAMICIN - gentamicin sulfate injection, solution. Revised August 2012. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=ca625340-377b-4256-92e2- d62471a8d852&type=pdf&name=ca625340-377b-4256-92e2-d62471a8d852. Accessed August 21, 2015.

[17] X-GEN Pharmaceuticals. Product label for STREPTOMYCIN - streptomycin sulfate injection, powder, lyophilized, for solution. Revised October 2006. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=50972f39-a15b-4c90-b9e6- cf7f76cd6e99&type=pdf&name=50972f39-a15b-4c90-b9e6-cf7f76cd6e99. Accessed August 22, 2015.

[18] Akorn – Strides. Product label for TOBRAMYCIN - tobramycin sulfate injection. Revised March 2008. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=85117124-29bb-4a2b-9a82- f2fc2802aed1&type=pdf&name=85117124-29bb-4a2b-9a82-f2fc2802aed1. Accessed August 22, 2015.

[19] APP Pharmaceuticals. Product label for VANCOMYCIN HYDROCHLORIDE - vancomycin hydrochloride injection, powder, lyophilized, for solution. Revised August 2012. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d3147f2d-1a72-4923-874b- 8fdee2be625e. Accessed August 23, 2015.

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

[21] Arbor Pharmaceuticals Inc. Product label for ERYTHROMYCIN - erythromycin capsule, delayed release. Revised October 2013. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm? setid=ddd9ad9a-fc60-409a-a2b3-be51482ef751. Accessed August 25, 2015.

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

[23] Par Pharmaceuticals. Product label for MINOCYCLINE - minocycline hydrochloride tablet. Revised September 2012. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=37baf13f-cc65 -44a1-93d9-e5213875af1a. Accessed August 23, 2015.

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

[25] Ibid.

[26] Eon Labs. Product label for ITRACONAZOLE - itraconazole capsule. Revised October 2014. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=599dcdd0-df9b-41e2-a767- b1f44f466fbd. Accessed August 23, 2015.

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

[28] Novartis Pharmaceuticals Corporation. Product labeling for LAMISIL - terbinafine hydrochloride tablet. Revised February 2015. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm? setid=7c6c1494-fb92-4442-bcff-764b77397495. Accessed August 23, 2015.

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

[30] Eon Labs. Product label for ITRACONAZOLE - itraconazole capsule. Revised October 2014. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=599dcdd0-df9b-41e2-a767- b1f44f466fbd. Accessed August 23, 2015.

[31] Ibid.

[32] Novartis Pharmaceuticals Corporation. Product labeling for LAMISIL - terbinafine hydrochloride tablet. Revised February 2015. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7c6c1494-fb92-4442-bcff- 764b77397495. Accessed August 23, 2015.

[33] Pfizer Laboratories. Product label for VIAGRA - sildenafil citrate tablet, film coated. Revised March 2015. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196- 0c62-461c-94f4-9a35339b4501. Accessed August 23, 2015.

[34] Eli Lilly and Company. Product label for CIALIS - tadalafil tablet, film coated. Revised January 2015. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2- 4891-83db-24a0b0e25895. Accessed August 23, 2015.

[35] GlaxoSmithKline. Product label for LEVITRA - vardenafil hydrochloride trihydrate tablet, film coated. Revised April 2014. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a01def95-c0ef-43b9-bd9e- 5565b2385ad3. Accessed August 23, 2015.

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

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

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

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

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

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

[42] Takeda Pharmaceuticals America. Product label for ULORIC - febuxostat tablet. Revised November 2013. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=54de10ef-fe5f-4930- b91d-6bbb04c664bd. Accessed August 23, 2015.

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

[44] Sanofi-Aventis U.S. Product labeling for LASIX - furosemide tablet. Revised March 2014. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=eadfe464-720b-4dcd-a0d8- 45dba706bd33. Accessed August 23, 2015.

[45] Teva Pharmaceuticals USA. Product labeling for BUMETANIDE - bumetanide tablet. Revised September 2013. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=04236576-01c4 -43a6-ac8a-60e23b5dc692. Accessed August 23, 2015.

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

[47] Weber PC. Etiology of hearing loss in adults. Updated January 8, 2015. UpToDate.

[48] Bayer Corporation Consumer Care Division. Product label for BAYER ADVANCED ASPIRIN REGULAR STRENGTH - aspirin tablet. Revised March 2011. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=11086b35-760b-460d-b1b6- e20ad6baf764. Accessed August 23, 2015.

[49] G.D. Searle, Division of Pfizer. Product label for CELEBREX - celecoxib capsule. Revised June 2015. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8d52185d-421f- 4e34-8db7-f7676db2a226. Accessed August 23, 2015.

[50] Dr. Reddy's Laboratories. Product label for BUPROFEN - ibuprofen tablet, film coated. Revised March 2007. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=953cee06- 5c26-4f30-870a-46b9fbb66e79. Accessed August 23, 2015.

[51] Genentech. Product label for NAPROSYN - naproxen tablet; EC-NAPROSYN- naproxen tablet, delayed release; NAPROSYN- naproxen suspension; ANAPROX - naproxen sodium tablet; ANAPROX DS - naproxen sodium tablet. Revised April 2013. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm? setid=68848217-03c9-4377-9be6-6f567e629129. Accessed August 23, 2015.

[52] Epic Pharma. Product label for SULINDAC - sulindac tablet. Revised August 2015. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=96c73bd2-4577-487d-a642- bd8f91e94c3a. Accessed August 23, 2015.

[53] Weber PC. Etiology of hearing loss in adults. Updated January 8, 2015. UpToDate.

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