A wide variety of drugs can be ototoxic (see Table 1: Inner Ear Disorders: Some Drugs that Cause Ototoxicity).

Factors affecting ototoxicity include dose, duration of therapy, concurrent renal failure, infusion rate, lifetime dose, coadministration with other drugs having ototoxic potential, and genetic susceptibility. Ototoxic drugs should not be used for otic topical application when the tympanic membrane is perforated because the drugs might diffuse into the inner ear.

StreptomycinSome Trade Names
No US trade name
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tends to cause more damage to the vestibular portion than to the auditory portion of the inner ear. Although vertigo and difficulty maintaining balance tend to be temporary, severe loss of vestibular sensitivity may persist, sometimes permanently. Loss of vestibular sensitivity causes difficulty walking, especially in the dark, and oscillopsia (a sensation of bouncing of the environment with each step). About 4 to 15% of patients who receive 1 g/day for > 1 wk develop measurable hearing loss, which usually occurs after a short latent period (7 to 10 days) and slowly worsens if treatment is continued. Complete, permanent deafness may follow.

NeomycinSome Trade Names
NEO-FRADIN
NEO-RX
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has the greatest cochleotoxic effect of all antibiotics. When large doses are given orally or by colonic irrigation for intestinal sterilization, enough may be absorbed to affect hearing, particularly if mucosal lesions are present. NeomycinSome Trade Names
NEO-FRADIN
NEO-RX
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should not be used for wound irrigation or for intrapleural or intraperitoneal irrigation, because massive amounts of the drug may be retained and absorbed, causing deafness. KanamycinSome Trade Names
KANTREX
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and amikacinSome Trade Names
AMIKIN
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are close to neomycinSome Trade Names
NEO-FRADIN
NEO-RX
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in cochleotoxic potential and are both capable of causing profound, permanent hearing loss while sparing balance. Viomycin has both cochlear and vestibular toxicity. GentamicinSome Trade Names
GARAMYCIN
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and tobramycinSome Trade Names
NEBCIN
TOBI
TOBREX
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have vestibular and cochlear toxicity, causing impairment in balance and hearing.

VancomycinSome Trade Names
VANCOCIN
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can cause hearing loss, especially in the presence of renal insufficiency.

Chemotherapeutic (antineoplastic) drugs, particularly those containing platinum (cisplatinSome Trade Names
PLATINOL
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and carboplatinSome Trade Names
PARAPLATIN
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), can cause tinnitus and hearing loss. Hearing loss can be profound and permanent, occurring immediately after the first dose, or can be delayed until several months after completion of treatment. Sensorineural hearing loss strikes bilaterally, progresses decrementally, and is permanent.

Ethacrynic acidSome Trade Names
EDECRIN
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and furosemideSome Trade Names
LASIX
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given IV have caused profound, permanent hearing loss in patients with renal failure who had been receiving aminoglycoside antibiotics.

Salicylates in high doses (> 12 325-mg tablets of aspirinSome Trade Names
BUFFERIN
ECOTRIN
GENACOTE
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per day) cause temporary hearing loss and tinnitus. QuinineSome Trade Names
QUALAQUIN
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and its synthetic substitutes can also cause temporary hearing loss.

Table 1
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Some Drugs that Cause Ototoxicity Type Examples Antibiotics Aminoglycosides VancomycinSome Trade Names VANCOCIN Click for Drug Monograph Chemotherapeutic drugs Platinum-containing drugs (eg, cisplatinSome Trade Names PLATINOL Click for Drug Monograph ) Diuretics Ethacrynic acidSome Trade Names EDECRIN Click for Drug Monograph FurosemideSome Trade Names LASIX Click for Drug Monograph Other QuinineSome Trade Names QUALAQUIN Click for Drug Monograph Salicylates

Prevention

Ototoxic antibiotics should be avoided during pregnancy. The elderly and people with preexisting hearing loss should not be treated with ototoxic drugs if other effective drugs are available. The lowest effective dosage of ototoxic drugs should be used and levels should be closely monitored. If possible before treatment with an ototoxic drug, hearing should be measured and then monitored during treatment; symptoms are not reliable warning signs.

Key Points

• Drugs may cause hearing loss, dysequilibrium, and/or tinnitus.
• Common drugs include aminoglycosides, platinum-containing chemotherapy drugs, and salicylates.
• Symptoms may be transient or permanent.
• Drugs are stopped if possible, but there is no specific treatment.

Last full review/revision October 2012 by Lawrence R. Lustig, MD

Content last modified November 2012