Table of ContentsView AllTable of ContentsSymptomsCauses of OtotoxicityHow Is Ototoxicity Diagnosed?How Is Ototoxicity Treated?Is Ototoxic Hearing Loss Permanent?
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes of Ototoxicity
How Is Ototoxicity Diagnosed?
How Is Ototoxicity Treated?
Is Ototoxic Hearing Loss Permanent?
Ototoxicity is a term used to describe a drug side effect that causes damage to the inner ear or auditory nerve, resulting in hearing loss, a loss of balance, and sometimes deafness. There is an ever-increasing number of drugs known to cause ototoxicity to varying degrees, includingchemotherapy drugs, aspirin, and erythromycin.
Because ototoxic hearing loss can sometimes be irreversible, every effort should be made to prevent an inner ear injury before the hearing is significantly impaired. Some doctors are making a greater effort to monitor for hearing loss in people exposed to high-risk ototoxic agents.
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Ototoxicity Symptoms
Depending on which parts of the inner ear are affected, symptoms of ototoxicity may include:
Symptoms of ototoxicity may develop rapidly or over the course of months, depending on the drug involved and other factors.
Causes of Tinnitus That People Often Miss
Among the drugs of greatest concern are those used in chemotherapy, such as Eloxitan (oxaliplatin), nitrogen mustard, Paraplantin (carboplatin), and Platinol (cisplatin).
Drugs like Platinol may cause symptomatic ototoxicity in 50% of users. Because the drugs attack fast-replicating cells, they primarily target cancer cells, but they also can damage other fast-replicating cells—including auditory hair cells that amplify sound waves.
Exposure to chemotherapy drugs, aminoglycoside, and loop diuretics during pregnancy may not only affect the mother but may also cause hearing impairment in a fetus.
However there are more than 600 drugs known to have ototoxic effects. Aside from chemotherapies, those more likely to be ototoxic include:
Aminoglycoside and non-aminoglycoside antibiotics may cause ototoxic hearing impairment in up to 25% of users and vestibular dysfunction in up to 10% of users.
Loop diuretics and salicylates affect roughly 1% of users, most often the elderly.
Environmental chemicals and substances like arsenic, carbon monoxide, hexane, lead, mercury, tin, and toluene can also cause ototoxicity, particularly in industrial or occupational settings where there is ongoing exposure.
Ototoxic Medications That May Cause Hearing Loss
Risk Factors
There are other factors beyond the drugs or exposures themselves that may contribute to the risk of ototoxicity, including:
Genetics are also believed to play a part, given that ototoxicity to antibiotics like Gentak (gentamicin) often runs in families.
There are also gene mutations loosely associated with ototoxicity which appear to slow the rate in which certain drugs, especially chemotherapy drugs, are metabolized.
Common Causes of Hearing Loss
Because older people are at an increased risk, in part because they have higher rates of pre-existing hearing loss, the symptoms of ototoxicity may be missed or simply attributed to aging.
The same is likely inbabies and toddlersin whom progressive hearing loss may go unnoticed until it becomes severe.
Becausehigh-pitched sounds are usually affected first, people may not even notice that their hearing is impaired until the lower frequencies are also affected.
Audiologic Testing
Audiologic tests commonly used include:
These may be done if symptoms of ototoxicity are present. Hearing testing may also be done periodically if a highly ototoxic drug is used—ideally at the onset of therapy, during treatment, and after treatment has been completed. Such routine testing may help catch ototoxic effects before you notice them.
For example, the American Speech-Language-Hearing Association (ASHA) recommends that pure-tone air conduction testing be performed:
Despite evidence that doing so can detect ototoxicity before a person’s hearing is significantly impaired, the ASHA recommendations have not been implemented in most clinical settings.
How Hearing Loss Is Detected in Newborns
Stopping the offending drug or exposure can lead to symptom improvement in some cases, but not all. Prevention, therefore, is the only way to reduce the risk of hearing loss.
In 2022, the Food and Drug Administration (FDA) approved Pedmark (sodium thiosulfate) to reduce the risk of ototoxicity associated with Platinol in patients 1 month and older with localized, non-metastatic solid tumors.
Other otoprotective agents, such as amifostine and N-acetylcysteine, have been investigated in people undergoing Platinol chemotherapy. Although the drugs seemed promising in reducing the risk of hearing loss, they also appeared to reduce the efficacy of the chemotherapy.
If ototoxic hearing loss occurs, rehabilitation efforts may includehearing aids,assistive listening devices, andcochlear implantsalong with communication skills training for those with significant hearing impairment. Younger children may require the help of aspeech-language pathologist.
To improve balance, physical therapy can help retrain the brain to compensate for the impaired equilibrium.
Drugs like Valium (diazepam), Hyoscine (scopolamine), orPhenergan (promethazine)may also be prescribed if there is significant vestibular injury, particularly if it occurs in both ears.Only in the most severe cases is surgery indicated, and even then, it remains very controversial.
The likelihood of recovery from ototoxicity is dependent on:
There are no hard-and-fast rules as to who might be affected or to what degree hearing may be altered.
With that said, and generally speaking:
Causes of Rapid Hearing Loss and Sudden Deafness
A Word From Verywell
Ototoxicity is an under-recognized drug side effect that doctors and patients often miss until one’s hearing or balance has been significantly impaired.
Because ototoxicity is not frequently monitored according to ASHA standards, the onus is placed on you, the patient, to be proactive and request audiological testing if you going to be (or are being treated) with chemotherapy or aminoglycoside drugs. The sooner symptoms are detected, the better.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bisht M, Bist SS.Ototoxicity: the hidden menace.Indian J Otolaryngol Head Neck Surg. 2011;63(3):255-9. doi:10.1007/s12070-011-0151-8Paken J, Govender CD, Sewram V.Research protocol: Cisplatin-associated ototoxicity amongst patients receiving cancer chemotherapy and the feasibility of an audiological monitoring program.BMC Womens Health. 2017;17(1):129. doi:10.1186/s12905-017-0486-8Xie J, Talaska AE, Schacht J.New developments in aminoglycoside therapy and ototoxicity.Hear Res.2011;281(1-2):28-37. doi:10.1016/j.heares.2011.05.008Ganesan P, Schmiedge J, Manchaiah V, Swapna S, Dhandayutham S, Kothandaraman PP.Ototoxicity: A challenge in diagnosis and treatment.J Audiol Otol.2018;22(2):59-68. doi:10.7874/jao.2017.00360Huth ME, Ricci AJ, Cheng AG.Mechanisms of aminoglycoside ototoxicity and targets of hair cell protection.Int J Otolaryngol.2011;2011:937861.Konrad-Martin D, Reavis KM, McMillan G, Helt WJ, Dille M.Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA).J Rehabil Res Dev. 2014;51(1):81-100. doi:10.1682/JRRD.2013.04.0092Food and Drug Administration.FDA approves sodium thiosulfate to reduce the risk of ototoxicity associated with cisplatin in pediatric patients with localized, non-metastatic solid tumors.Hazlitt RA, Min J, Zuo J.Progress in the development of preventative drugs for cisplatin-induced hearing loss.J Med Chem.2018;61(13):5512-24. doi:10.1021/acs.jmedchem.7b01653Berisavac II, Pavlović AM, Trajković JJ, Šternić NM, Bumbaširević LG.Drug treatment of vertigo in neurological disorders.Neurol India. 2015;63(6):933-9. doi:10.4103/0028-3886.170097Schacht J, Talaska AE, Rybak LP.Cisplatin and aminoglycoside antibiotics: hearing loss and its prevention.Anat Rec (Hoboken).2012;295(11):1837-50. doi:10.1002/ar.22578Fuchs A, Zimmermann L, Bickle Graz M, et al.Gentamicin exposure and sensorineural hearing loss in preterm infants.PLoS ONE. 2016;11(7):e0158806. doi:10.1371/journal.pone.0158806
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bisht M, Bist SS.Ototoxicity: the hidden menace.Indian J Otolaryngol Head Neck Surg. 2011;63(3):255-9. doi:10.1007/s12070-011-0151-8Paken J, Govender CD, Sewram V.Research protocol: Cisplatin-associated ototoxicity amongst patients receiving cancer chemotherapy and the feasibility of an audiological monitoring program.BMC Womens Health. 2017;17(1):129. doi:10.1186/s12905-017-0486-8Xie J, Talaska AE, Schacht J.New developments in aminoglycoside therapy and ototoxicity.Hear Res.2011;281(1-2):28-37. doi:10.1016/j.heares.2011.05.008Ganesan P, Schmiedge J, Manchaiah V, Swapna S, Dhandayutham S, Kothandaraman PP.Ototoxicity: A challenge in diagnosis and treatment.J Audiol Otol.2018;22(2):59-68. doi:10.7874/jao.2017.00360Huth ME, Ricci AJ, Cheng AG.Mechanisms of aminoglycoside ototoxicity and targets of hair cell protection.Int J Otolaryngol.2011;2011:937861.Konrad-Martin D, Reavis KM, McMillan G, Helt WJ, Dille M.Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA).J Rehabil Res Dev. 2014;51(1):81-100. doi:10.1682/JRRD.2013.04.0092Food and Drug Administration.FDA approves sodium thiosulfate to reduce the risk of ototoxicity associated with cisplatin in pediatric patients with localized, non-metastatic solid tumors.Hazlitt RA, Min J, Zuo J.Progress in the development of preventative drugs for cisplatin-induced hearing loss.J Med Chem.2018;61(13):5512-24. doi:10.1021/acs.jmedchem.7b01653Berisavac II, Pavlović AM, Trajković JJ, Šternić NM, Bumbaširević LG.Drug treatment of vertigo in neurological disorders.Neurol India. 2015;63(6):933-9. doi:10.4103/0028-3886.170097Schacht J, Talaska AE, Rybak LP.Cisplatin and aminoglycoside antibiotics: hearing loss and its prevention.Anat Rec (Hoboken).2012;295(11):1837-50. doi:10.1002/ar.22578Fuchs A, Zimmermann L, Bickle Graz M, et al.Gentamicin exposure and sensorineural hearing loss in preterm infants.PLoS ONE. 2016;11(7):e0158806. doi:10.1371/journal.pone.0158806
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bisht M, Bist SS.Ototoxicity: the hidden menace.Indian J Otolaryngol Head Neck Surg. 2011;63(3):255-9. doi:10.1007/s12070-011-0151-8Paken J, Govender CD, Sewram V.Research protocol: Cisplatin-associated ototoxicity amongst patients receiving cancer chemotherapy and the feasibility of an audiological monitoring program.BMC Womens Health. 2017;17(1):129. doi:10.1186/s12905-017-0486-8Xie J, Talaska AE, Schacht J.New developments in aminoglycoside therapy and ototoxicity.Hear Res.2011;281(1-2):28-37. doi:10.1016/j.heares.2011.05.008Ganesan P, Schmiedge J, Manchaiah V, Swapna S, Dhandayutham S, Kothandaraman PP.Ototoxicity: A challenge in diagnosis and treatment.J Audiol Otol.2018;22(2):59-68. doi:10.7874/jao.2017.00360Huth ME, Ricci AJ, Cheng AG.Mechanisms of aminoglycoside ototoxicity and targets of hair cell protection.Int J Otolaryngol.2011;2011:937861.Konrad-Martin D, Reavis KM, McMillan G, Helt WJ, Dille M.Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA).J Rehabil Res Dev. 2014;51(1):81-100. doi:10.1682/JRRD.2013.04.0092Food and Drug Administration.FDA approves sodium thiosulfate to reduce the risk of ototoxicity associated with cisplatin in pediatric patients with localized, non-metastatic solid tumors.Hazlitt RA, Min J, Zuo J.Progress in the development of preventative drugs for cisplatin-induced hearing loss.J Med Chem.2018;61(13):5512-24. doi:10.1021/acs.jmedchem.7b01653Berisavac II, Pavlović AM, Trajković JJ, Šternić NM, Bumbaširević LG.Drug treatment of vertigo in neurological disorders.Neurol India. 2015;63(6):933-9. doi:10.4103/0028-3886.170097Schacht J, Talaska AE, Rybak LP.Cisplatin and aminoglycoside antibiotics: hearing loss and its prevention.Anat Rec (Hoboken).2012;295(11):1837-50. doi:10.1002/ar.22578Fuchs A, Zimmermann L, Bickle Graz M, et al.Gentamicin exposure and sensorineural hearing loss in preterm infants.PLoS ONE. 2016;11(7):e0158806. doi:10.1371/journal.pone.0158806
Bisht M, Bist SS.Ototoxicity: the hidden menace.Indian J Otolaryngol Head Neck Surg. 2011;63(3):255-9. doi:10.1007/s12070-011-0151-8
Paken J, Govender CD, Sewram V.Research protocol: Cisplatin-associated ototoxicity amongst patients receiving cancer chemotherapy and the feasibility of an audiological monitoring program.BMC Womens Health. 2017;17(1):129. doi:10.1186/s12905-017-0486-8
Xie J, Talaska AE, Schacht J.New developments in aminoglycoside therapy and ototoxicity.Hear Res.2011;281(1-2):28-37. doi:10.1016/j.heares.2011.05.008
Ganesan P, Schmiedge J, Manchaiah V, Swapna S, Dhandayutham S, Kothandaraman PP.Ototoxicity: A challenge in diagnosis and treatment.J Audiol Otol.2018;22(2):59-68. doi:10.7874/jao.2017.00360
Huth ME, Ricci AJ, Cheng AG.Mechanisms of aminoglycoside ototoxicity and targets of hair cell protection.Int J Otolaryngol.2011;2011:937861.
Konrad-Martin D, Reavis KM, McMillan G, Helt WJ, Dille M.Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA).J Rehabil Res Dev. 2014;51(1):81-100. doi:10.1682/JRRD.2013.04.0092
Food and Drug Administration.FDA approves sodium thiosulfate to reduce the risk of ototoxicity associated with cisplatin in pediatric patients with localized, non-metastatic solid tumors.
Hazlitt RA, Min J, Zuo J.Progress in the development of preventative drugs for cisplatin-induced hearing loss.J Med Chem.2018;61(13):5512-24. doi:10.1021/acs.jmedchem.7b01653
Berisavac II, Pavlović AM, Trajković JJ, Šternić NM, Bumbaširević LG.Drug treatment of vertigo in neurological disorders.Neurol India. 2015;63(6):933-9. doi:10.4103/0028-3886.170097
Schacht J, Talaska AE, Rybak LP.Cisplatin and aminoglycoside antibiotics: hearing loss and its prevention.Anat Rec (Hoboken).2012;295(11):1837-50. doi:10.1002/ar.22578
Fuchs A, Zimmermann L, Bickle Graz M, et al.Gentamicin exposure and sensorineural hearing loss in preterm infants.PLoS ONE. 2016;11(7):e0158806. doi:10.1371/journal.pone.0158806
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