Most people know medications come with side effects. Nausea, drowsiness, dry mouth. But hearing changes rarely make the list of things patients watch for. Some prescription and over-the-counter drugs can cause ringing in the ears, muffled hearing, or balance problems. These are called ototoxic medications, and if you take several of them at once, the risk goes up.
What does ototoxic mean?
Ototoxic literally means toxic to the ear. These medications can damage the delicate hair cells in the inner ear or affect the auditory nerve that carries sound signals to the brain. Some cause temporary changes that resolve when you stop or lower the dose. Others can cause permanent damage, especially at high doses or with prolonged use.
The tricky part is that hearing changes often develop gradually. You might not connect new ringing in your ears or difficulty following conversations in a busy restaurant to a medication you started weeks ago.
Symptoms to watch for
If you take any medication regularly, pay attention to these warning signs:
- Tinnitus: ringing, buzzing, hissing, or roaring sounds in one or both ears that were not there before
- Muffled hearing: sounds seem quieter or duller, especially in noisy environments like restaurants or family gatherings
- Difficulty understanding speech: you can hear that someone is talking but cannot make out the words clearly
- Dizziness or balance changes: the inner ear also controls balance, and ototoxic drugs can affect both systems
- A feeling of fullness or pressure: a sensation that your ear is plugged, similar to being on an airplane
These symptoms can appear days, weeks, or even months after starting a medication. Report them early. The sooner a medication change is made, the better the chance of recovery.
Which medications carry the highest risk?
Platinum-based chemotherapy
Cisplatin and carboplatin are among the most ototoxic drugs in use. They are essential cancer treatments, and the hearing damage they cause is often permanent. Oncology teams typically monitor hearing throughout treatment, but patients should report any changes immediately. Hearing loss from cisplatin affects high-frequency sounds first, making it harder to hear consonants in speech.
Aminoglycoside antibiotics
Gentamicin, tobramycin, amikacin, and streptomycin. These IV antibiotics treat serious infections and are used in hospital settings. The hearing damage can be permanent, which is why doctors monitor drug levels and kidney function closely during treatment. Gentamicin in particular can also affect balance.
Loop diuretics
Furosemide (Lasix), bumetanide, and ethacrynic acid. These water pills are commonly prescribed for heart failure, kidney disease, and severe swelling. Hearing changes from loop diuretics are usually temporary and dose-related. The risk increases significantly when combined with other ototoxic drugs, particularly aminoglycosides.
NSAIDs at high doses
Ibuprofen (Advil, Motrin), naproxen (Aleve), and other nonsteroidal anti-inflammatory drugs can cause tinnitus and hearing changes when taken at high doses or for extended periods. At standard doses for occasional pain relief, the risk is low. The effects are typically reversible once the medication is stopped or reduced.
High-dose aspirin
Aspirin at doses above 2 to 3 grams per day (far more than the standard 81 mg heart dose) can cause ringing in the ears. This is one of the oldest known ototoxic effects in medicine. It is almost always reversible. Low-dose aspirin for heart protection does not carry this risk.
Other medications to be aware of
Certain antimalarials (quinine, hydroxychloroquine), some macrolide antibiotics (erythromycin, azithromycin at high IV doses), and a few antidepressants have been associated with hearing changes in some patients. The risk varies widely and depends on dose, duration, kidney function, and individual susceptibility.
Who should be extra cautious?
- Seniors on multiple medications: polypharmacy (taking five or more medications) is common in older adults, and the chances of taking two or more ototoxic drugs at the same time increase with each prescription added
- People with existing hearing loss: if your hearing is already reduced, further damage from an ototoxic medication can have a bigger impact on daily life
- Patients with kidney problems: the kidneys clear many ototoxic drugs from the body. Reduced kidney function means higher drug levels and greater risk of ear damage
- Anyone taking more than one ototoxic drug: combining a loop diuretic with an aminoglycoside, for example, multiplies the risk beyond what either drug carries alone
What to do if you notice changes
The most important thing: do not stop your medication on your own. Some of these drugs treat serious or life-threatening conditions, and stopping abruptly can be dangerous. Instead:
- Report symptoms early: tell your pharmacist or doctor as soon as you notice ringing, muffled hearing, or balance changes. Early intervention gives you the best outcome.
- Ask for a medication review: your pharmacist can look at your full medication list and identify which drugs may be contributing to hearing changes
- Request alternatives: in many cases, a different medication in the same class can achieve the same therapeutic goal with lower ototoxic risk
- Get a baseline hearing test: if you are starting a known ototoxic medication (especially chemotherapy or aminoglycosides), ask your doctor about a hearing test before treatment begins so changes can be measured objectively
How your pharmacist at Acme Drug Mart can help
Every time we fill a prescription, we screen for interactions. That includes ototoxic combinations. If we see that you are on two or more medications with hearing-related risks, we flag it and talk to you about what to watch for.
We also offer comprehensive medication reviews covered by Alberta Health Care. During a review, your pharmacist goes through every prescription, over-the-counter product, and supplement you take. If something carries ototoxic risk, we discuss it with you and, where appropriate, coordinate with your doctor about alternatives.
If you have noticed new ringing in your ears or changes in your hearing since starting a medication, bring it up at the pharmacy counter. It is a quick conversation that could make a real difference.
Talk to us
(780) 443-0202. Unit 103, 15508 87 Ave NW, Meadowlark Place, Edmonton. Walk in during pharmacy hours or call to ask about your medications. Free delivery available Edmonton-wide.