Medications that can damage the ear, resulting in hearing loss and/or balance disorders are considered ototoxic. (Mudd, Edmunds, Glatz, Campbell, & Rybak, 2008) Literally, ototoxic means “ear poison.” There are over 100 known ototoxic prescription and over-the-counter medications on the market today. (Mudd, Edmunds, Glatz, Campbell, & Rybak, 2008) These include, but are not limited to, medicines used to treat serious bacterial infections, cancers, and heart disease.
What are the Effects of Ototoxic Medications?
The first sign of ototoxicity is most often ringing in the ears (tinnitus). Permanent, high frequency hearing loss may also occur. Although uncommon, hearing loss as a result of ototoxic medications may be temporary. The hearing loss often remains unnoticed by a person until speech understanding is affected.
In addition to hearing loss, a person may also experience a loss of balance and the feeling of bouncing vision from the medication. These side effects are often temporary as the human body can learn to adapt to theses deficits. (Guthrie, 2008)
Who is affected by Ototoxic Medications?
Use of ototoxic medications can have serious affects on its users’ quality of life. Not being able to hear conversation, or perhaps always feeling dizzy, may cause a person to stop participating in their usual activities. Therefore, it is important that the pros and cons be weighed before the start of a treatment plan.
All people who take ototoxic medications should be aware of its side effects. However, there are those who are at greater risk than others. Infants who are born prematurely are at a greater risk of ototoxicity than adults when taking medications known as aminoglycosides, which treat serious bacterial infections. Children are also at a greater risk for ototoxicity when using cisplatin (a drug used to treat cancer). (Garcia, Martinez, Agusti, Mencia, & Asenjo, 2001)
The elderly, those with kidney disorders, people who already have hearing loss, those who have previously used ototoxic medications, those using multiple ototoxic medications at one time, and those who have genes linked to ototoxic weakness, are also at a higher risk for experiencing ototoxic effects than others. (Garcia et al., 2001; Mudd et al., 2008; Vasquez & Mattucci, 2003)
The “who” is not the only factor to consider when thinking of vulnerability to ototoxic medications. The “how”is also important. The way that medications are delivered can play a role in severity of ototoxic effects. For example, medications put directly into the blood stream by intravenous injection may be more severe than those applied by liquid drops on the eardrum. (Guthrie, 2008)
Can a person protect themselves against ototoxicity?
There is a lot of research being done to develop ways of protecting a person from ototoxic medications. Animal experimentation shows promising results. However, the extent that the animal study results extend to humans is unknown at this time and human studies have not yet been performed. Therefore no protective strategy has been formally approved. (Guthrie, 2008)
What should a person do if they are going to begin using an ototoxic medication?
Monitoring the hearing and balance systems are very important. By thorough monitoring, if a change occurs, adjustments can be made by the doctor to try to save as much hearing and/or balance as possible. Adjustments in treatment can include, but are not limited to, changing the dose, the schedule of treatment, a switch to a less ototoxic medication, or possibly stopping the treatment temporarily. (Vasquez & Mattucci, 2003)
Prior to starting the treatment plan, a baseline evaluation should be conducted which includes a conventional hearing test, high frequency hearing test, word recognition test, otoacoustic emission test, and an electronystagmography or videonystagmography test when possible. Throughout the course of treatment, weekly tests should be performed consisting of at least conventional and high frequency hearing tests and the otoacoustic emission test. Post-treatment tests should also be performed as reactions to the drugs make not take affect right away and cannot be predicted. (Vasquez & Mattucci, 2003)
What can be done when treatment has ended and a person has hearing loss and/or balance problems?
Unfortunately, even with careful monitoring, ototoxic effects may be unavoidable as the primary concern is the treatment of the disease which requires the drug in the first place. If a person is left with tinnitus, hearing loss, imbalance, and/or dizziness, an audiologist can work to develop a rehabilitation plan. This plan may include lessons on better hearing strategies, hearing aids, and/or balance therapy.
If you suspect that you may have, or had, problems related to ototoxic medications, please feel free to make an appointment with our team of physicians and audiologists at Coastal Ear, Nose and Throat.
What are the Effects of Ototoxic Medications?
The first sign of ototoxicity is most often ringing in the ears (tinnitus). Permanent, high frequency hearing loss may also occur. Although uncommon, hearing loss as a result of ototoxic medications may be temporary. The hearing loss often remains unnoticed by a person until speech understanding is affected.
In addition to hearing loss, a person may also experience a loss of balance and the feeling of bouncing vision from the medication. These side effects are often temporary as the human body can learn to adapt to theses deficits. (Guthrie, 2008)
Who is affected by Ototoxic Medications?
Use of ototoxic medications can have serious affects on its users’ quality of life. Not being able to hear conversation, or perhaps always feeling dizzy, may cause a person to stop participating in their usual activities. Therefore, it is important that the pros and cons be weighed before the start of a treatment plan.
All people who take ototoxic medications should be aware of its side effects. However, there are those who are at greater risk than others. Infants who are born prematurely are at a greater risk of ototoxicity than adults when taking medications known as aminoglycosides, which treat serious bacterial infections. Children are also at a greater risk for ototoxicity when using cisplatin (a drug used to treat cancer). (Garcia, Martinez, Agusti, Mencia, & Asenjo, 2001)
The elderly, those with kidney disorders, people who already have hearing loss, those who have previously used ototoxic medications, those using multiple ototoxic medications at one time, and those who have genes linked to ototoxic weakness, are also at a higher risk for experiencing ototoxic effects than others. (Garcia et al., 2001; Mudd et al., 2008; Vasquez & Mattucci, 2003)
The “who” is not the only factor to consider when thinking of vulnerability to ototoxic medications. The “how”is also important. The way that medications are delivered can play a role in severity of ototoxic effects. For example, medications put directly into the blood stream by intravenous injection may be more severe than those applied by liquid drops on the eardrum. (Guthrie, 2008)
Can a person protect themselves against ototoxicity?
There is a lot of research being done to develop ways of protecting a person from ototoxic medications. Animal experimentation shows promising results. However, the extent that the animal study results extend to humans is unknown at this time and human studies have not yet been performed. Therefore no protective strategy has been formally approved. (Guthrie, 2008)
What should a person do if they are going to begin using an ototoxic medication?
Monitoring the hearing and balance systems are very important. By thorough monitoring, if a change occurs, adjustments can be made by the doctor to try to save as much hearing and/or balance as possible. Adjustments in treatment can include, but are not limited to, changing the dose, the schedule of treatment, a switch to a less ototoxic medication, or possibly stopping the treatment temporarily. (Vasquez & Mattucci, 2003)
Prior to starting the treatment plan, a baseline evaluation should be conducted which includes a conventional hearing test, high frequency hearing test, word recognition test, otoacoustic emission test, and an electronystagmography or videonystagmography test when possible. Throughout the course of treatment, weekly tests should be performed consisting of at least conventional and high frequency hearing tests and the otoacoustic emission test. Post-treatment tests should also be performed as reactions to the drugs make not take affect right away and cannot be predicted. (Vasquez & Mattucci, 2003)
What can be done when treatment has ended and a person has hearing loss and/or balance problems?
Unfortunately, even with careful monitoring, ototoxic effects may be unavoidable as the primary concern is the treatment of the disease which requires the drug in the first place. If a person is left with tinnitus, hearing loss, imbalance, and/or dizziness, an audiologist can work to develop a rehabilitation plan. This plan may include lessons on better hearing strategies, hearing aids, and/or balance therapy.
If you suspect that you may have, or had, problems related to ototoxic medications, please feel free to make an appointment with our team of physicians and audiologists at Coastal Ear, Nose and Throat.
Coastal Hearing and Balance Center
3700 Route 33
Neptune, NJ 07753
(732) 280-7855
