What Are The Symptoms Of Ototoxicity
Because ototoxicity impacts the inner ear, the symptoms are primarily related to hearing and balance.
The symptoms typically start off as mild and may get worse over time if left undiagnosed or untreated. The severity of symptoms also depends on the individual and their risk factors, as well discuss below.
Here are some of the symptoms of ototoxicity:
- Ringing in the ears
- Age
- Hereditary factors
Depending on how many of these factors are relevant, specific drugs may cause different symptoms for different people.
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Can My Meds Cause Hearing Loss
Some commonly prescribed and over-the-counter medications are known to cause irreversible hearing loss. If a drug has the potential to causes toxic damage to any of the inner ears structures the drug is considered to be ototoxic. Specific classes of drugs are listed as ototoxic based on their propensity to cause hearing damage. Over 100 classes of drugs have been associated with ototoxicity. Below is a guide with some basic information about drugs considered ototoxic, the current research, and what you should do if you take one of these medications.
Aspirin only harmful in large doses, such as 8-12 pills per day
NSAIDs Nonsteroidal anti-inflammatory drugs such as Advil, ibuprofen and naproxen
Antibiotics aminoglycoside antibiotics are the most likely to cause hearing loss. The risk is intensified for those with preexisting hearing loss or kidney issues.
Cancer Medications such as cyclophosphamide, cisplatin, and bleomycin.
Medicine Effects On Hearing
Commonly used medicinesboth over-the-counter and prescribedcan damage hearing or affect an existing problem. Any drug that might cause damage to structures of the inner ear is considered ototoxic . Oto means ear. toxic means poisonous. So, ototoxic means poisonous to the ear. These medicines can cause hearing loss or ringing in the ears, called tinnitus.
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What Can Medical Science Do About It
Unfortunately, its not possible to stop prescribing these antibiotics. They can save lives. Furthermore, there arent any alternatives for now.
But in the future, doctors will have a more precise idea of the damage caused by these drugs. They might also find better medication options.
Even if its not possible to avoid a certain type of drug, it is important to be aware of the damage it can cause.
So its clear that people with permanent hearing loss can benefit from wearing hearing aids. But if the hearing loss is more severe, cochlear implants can be a good option too. These devices can do a lot to help people with cystic fibrosis.
How To Treat Snhl
At Chesapeake Ear Nose & Throat, our goal is to help referring physicians maximize therapy options for their patients, and to assist in the treatment and management of otolaryngologic issues. During your initial consultation, one of our doctors will provide a comprehensive hearing evaluation using state-of-the-art audiology equipment. With this technology, we will immediately be able to determine your degree of hearing loss and the right treatment for you.
For some patients, hearing can be reversed when ototoxic medications are removed. But for high and long-term doses, damage may be permanent. In these cases, we can help you regain your hearing with auditory aids. Our wide range of auditory aids are discreet, and come in different sizes to meet your needs, enhance your hearing, and improve your overall quality of life.
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Medications Known To Cause Tinnitus
Tinnitus can be brought on by several different factors, but one common cause is medication. Higher dosages typically mean more severe cases of tinnitus, but there is a silver lining: if you can stop using these medications, your tinnitus symptoms may disappear. The following are some medications that can cause tinnitus :
- Antibiotics
Caffeine and nicotine can also lead to tinnitus.
Hearing Loss: Undesirable But Unavoidable Side Effect
As of right now, hearing loss and balance problems are considered unavoidable potential side effects to taking these life-saving antibiotics.
“Currently, it’s accepted that the price that some patients have to pay for surviving a life-threatening bacterial infection is the loss of their ability to hear,” said Dr. Peter Steyger, professor of otolaryngology, head and neck surgery at Oregon Health & Science University School of Medicine, in a 2015 news release. “The costs of this incalculable loss are borne by patients and society.”
Steyger’s research team studied the effect of aminglycosides on mice, finding that mice with severe infections were at greater risk of aminoglycoside-induced hearing loss than healthy mice given the same medications, according to the study. This means that inflammation caused by infection may increase the absorption rate, leading to a toxic level of medication in the ear.
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Why Take Medications That Could Cause Hearing Loss
You might wonder why doctors prescribe medications that could damage your ears at all. Aminoglycosides are very effective and have a long shelf life, which makes them a necessary choice in certain life-saving situations.
These antibiotics are also not the only drug that can cause ear damage. Currently, there are more than 200 known ototoxic medications on the market. Some are used to treat serious conditions like heart diseases and cancer.
If your medical team decides to treat you with an ototoxic drug, they will discuss the potential side effects with you and go over the pros and cons of using them. They may also evaluate your hearing and balance both before taking the medication as well as during use if the situation permits.
Why Certain Antibiotics Cause Hearing Loss
There are several common factors associated with hearing loss in Tucson.
Aging, noise exposure, disease and ototoxic medications can all contribute to hearing impairment.
Understanding the mechanisms behind hearing loss is a necessary step in managing the condition and possibly even coming up with ways to prevent it.
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Animal Studies And Mechanism Of Ototoxicity
The mechanism of ototoxicity associated with clarithromycin is unknown. Experiments in the guinea pigs administered clarithromycin 75 mg/kg i.v. reversible reduction of transient evoked otoacoustic emissions . The temporary diminution of TEOAE could likely be attributed to the transient dysfunction of outer hair cells .
What To Do If Youre Taking Drugs That May Cause Hearing Loss
Never stop taking a drug that has been prescribed by a doctor without talking to your doctor first. Before you speak with your doctor, you should take inventory of your medicine cabinet. If your doctor has you on one or more of these drugs that cause hearing loss, ask if there are alternatives that may reduce risk.
You can also make lifestyle changes to reduce your need for medications. In some cases, small changes to your diet and exercise routine can put you on a healthier path. These changes may also be able to reduce pain and water retention while strengthening your immune system.
If you are or have been using these ototoxic medications, you should make an appointment to get your hearing tested as soon as possible. Hearing loss can progress very slowly, which makes it less detectable at first. But make no mistake: it can impact your health and happiness in ways you may not realize, and catching it early gives you more options for treatment.
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Some Facts About Ototoxicity
What happens to trigger hearing loss after you swallow your medication. Certain drugs can damage your hearing in three different places:
- The stria vascularis Located in the cochlea, the stria vascularis generates endolymph, the fluid in the inner ear. Too much or too little endolymph has a considerable impact on both hearing and balance.
- The cochlea Thats the seashell-shaped element of the inner ear that takes sound and translates it into an electrical signal the brain can understand. Damage to the cochlea affects the range of sound you can hear, typically starting with high frequencies then expanding to include lower ones.
- The vestibule of the ear This is the area that sits in the center of the labyrinth that makes up the cochlea. It helps control balance. Vestibulotoxicity medications can make you dizzy or feel like the room is spinning.
Certain drugs only cause tinnitus and others lead to hearing loss. If you hear phantom noises, that might be tinnitus and it usually shows up as:
- Popping
- A windy sound
- Ringing
Normally if you quit using the medication the tinnitus will stop. However, permanent hearing loss can be caused by some of these drugs.
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What Is The Risk Level For Each Drug
The list of drugs which can cause temporary or permanent hearing loss may surprise you. You probably take some of these drugs when you are in pain and you might have some of them in your medicine cabinet right now.
Over the counter pain relievers are at the top of the list of ototoxic drugs:
- Ibuprofen
- Naproxen
Salicylates, better recognized as aspirin, can be added to this list. The hearing issues caused by these drugs are normally correctable when you quit taking them.
Antibiotics are a close second for well known ototoxic drugs. Not all antibiotics are ototoxic, however. You might have heard of some of these that arent:
- Erythromycin
- Vancomycin
- Gentamycin
The problem goes away once you stop taking the antibiotics just like with painkillers. The common list of other drugs include:
- Chloroquine
- Quinine
Substances That Trigger Tinnitus
Diamox, Bumex, Lasix and Edecrin are diuretics that trigger tinnitus but there are bigger offenders in this category:
- Nicotine
- Tonic water
When you get up every morning and drink your morning coffee you expose yourself to a substance that might cause tinnitus. After the drug is out of your system it will pass and thats the good news. Some drugs, ironically, that doctors prescribe to treat tinnitus are in fact on the list of offenders.
- Amitriptyline
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Effects Of Drugs Used For Treating Cancer On Hearing Loss
Drugs that are used for treating cancer are called cytotoxic drugs.
Cytotoxic drugs destroy cells or prevent their regrowth. This usually happens through chemotherapy.
These drugs attack healthy cells as well as cancerous ones, so they can cause a number of side effects.
Types of cytotoxic drugs that can cause hearing loss are:
- carboplatin, which is mainly used to treat ovarian and lung cancer
- cisplatin, which is mainly used to treat ovarian, testicular, lung or bladder cancer
- oxaliplatin, which is mainly used to treat bowel cancer.
Cytotoxic drugs are often used in combination with other drugs, which can affect how much hearing loss you experience.
If you are prescribed cytotoxic drugs, the effects will be carefully monitored. You should tell your doctor immediately if you are taking them and you:
- develop tinnitus
Any of these can be the first sign of hearing loss caused by ototoxic drugs.
Is Hearing Loss Permanent
For most people affected by ototoxicity, the damage is reversible, at least to some degree. Unfortunately, for some people, the damage can be permanent. Sadly, ototoxicity is often a trade-off for the treatment of a more severe condition, like cancer.
Whether ototoxicity can be reversed often depends on the dosage, duration, and type of medication. Damage caused by cisplatin is usually permanent. Aspirin, on the other hand, is temporary.
This is another reason why it is vital to be aware of the phenomenon of ototoxicity. If you are about to begin treatment with one of the known ototoxic agents, you can consult with your doctor on ways to avoid damage to your ears.
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Nicu Babies Often Receive Aminoglycosides
Of particular concern are infants in neonatal intensive care units . Eighty percent of all infants admitted to the NICU receive aminoglycosides that means each year 480,000 babies are at risk. The rate of hearing loss in babies who have been in the NICU is significantly higher than that of the general infant population, at 2 to 4 percent. In comparison, the rate of hearing loss in full-term infants from congenital causes is just 0.1 to 0.3 percent.
Can Antibiotics Protect Hearing
Antibiotics can in some situations cause hearing loss. The results of the tests with mice, which indicate the opposite, are therefore very surprising. The study has been carried out at the Washington University School of Medicine. Babies have the most sensitive earsBabies get gentamicin – an antibiotic – because it can protect them against a wide range of infectious bacteria, and it is the mildest antibiotic in its class. But it is also a drug that can cause hearing loss in people, especially in combination with noise. Babies are especially vulnerable to hearing damage. The studies with mice now show that, paradoxically, kanamycin protects the ears when given in extended low doses in very young mice.
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Why Does Permanent Hearing Loss Occur
There are many reasons why hearing loss can occur with use of the Fluoroquinolones, and why the hearing loss or tinnitus can be permanent. These include Fluoroquinolone-induced nutritional deficiencies, oxidative stress, and cellular damage.
Magnesium deficiency is one cause of hearing loss and tinnitus from Fluoroquinolone antibiotics. Fluoroquinolone drugs are well-known to be one of the many drugs that cause Magnesium Depletion. Several studies have shown that magnesium depletion can lead to hearing loss 3 while others have shown a reduction in hearing loss from magnesium supplementation 45.
Others have shown a greater susceptibility to in animals and humans with dietary magnesium deficiency. Mechanistically, low Mg might contribute to a loss of membrane potential, resulting in altered or decreased sensorineural function.
Additionally, this cellular damage occurs specifically to connective tissue, leading to serious and even life-threatening problems such as Aortic Aneurysm. The ear, too, is made up of connective tissue that would naturally be susceptible to the damage these drugs do to connective tissue, which could lead to hearing loss. Damage to the hair cells in the cochlea was another method of hearing loss observed in an animal model7.
Symptoms Related To Ototoxicity
The symptoms related to ototoxicity greatly depends on what part of the inner ear has been damaged. Damage to the inner ear can occur to either your cochlea or your vestibular complex . In both cases, the symptoms all relate to damaged sensory cells.
If your cochlea is damaged, your hearing will be impaired. The level of impairment directly correlates to the extent of damage resulting in mild tinnitus to complete hearing loss. Hearing loss can either affect one or both ears.
If the ototoxicity affects the vestibular complex, your balance will be affected. Like damage to your cochlea, damage can affect one ear or both ears. If the damage only affects one ear slowly, you will likely not experience any symptoms. However, if the damage occurs rapidly to one ear, you will likely experience:
- Vomiting
- Uncontrolled eye movement
Symptoms that occur rapidly may cause you to be bed-bound until the symptoms resolve gradually. If the damage occurs to both sides of your ear, you may experience:
- Headache
- Imbalance affecting your ability to walk
- Blurred vision that appears jerky
- Intolerance to head movement
- Walking with a wide stance
- Difficulty walking in the dark
- Unsteadiness
- Lightheadedness
- Fatigue
If the damage to your vestibular complex is severe, oscillopsia and difficulty walking at night will not improve. The other symptoms will likely improve over time. With severe damage, you can recover from the majority of the balance-related symptoms because of your body’s ability to adapt.
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What To Do If You Suspect You Have Hearing Loss
If you’ve recently take an aminoglycoside or another ototoxic drug, and are concerned you have hearing loss, don’t wait to get an evaluation. Not only does it rob you of hearing those around you, untreated hearing loss is associated with a higher risk of both physical and mental health dangers like depression and falling. Find a hearing care provider near you to make an appointment.
Ototoxic Medications: What Are They
Are you in the habit of checking the side effects of your medications?
In todays world, medical experts have provided us with a multitude of life-improving, often lifesaving, medications. Sometimes, we take them to relieve simple ailments like headaches or fever. Other times, we rely on them to treat more serious problems, such as cancer or malaria.
The word ototoxic can be broken down into two parts: oto, a medical prefix indicating the ear, and toxic, a word meaning poisonous or harmful. Therefore, ototoxic medications are those that may have ear-damaging side effects. The term otoxicity describes the tendency of a given drug to cause adverse effects to a persons hearing.
You might experience the following symptoms if you have been exposed to ototoxic medication:
- Hearing loss, temporary or permanent
- Hyperacusis, or increased sensitivity to certain frequencies or volumes
- Tinnitus, or a ringing in the ears
- Perception of phantom sounds
- Disequilibrium, or balance problems such as vertigo or ataxia
- Lightheadedness
- Physical damage to the hair cells of the inner ear, the cochlea, or the vestibular apparatus
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Some Antibiotics Are Ototoxic
Many antibiotics are probably relatively safe when used as directed and youre not allergic. But a certain type of antibiotic may increase the risk of hearing loss: Aminoglycoside.
Studies are in the initial stages so we havent seen solid data in human studies yet. But there have been some individuals who appear to have developed hearing loss after taking some antibiotics.
Results from animal-testing are convincing though. The medical community thinks there may be something to be concerned about.
Mice that took these antibiotics over a period of time eventually lost their hearing permanently, every time.
Aminoglycoside antibiotics are commonly used to treat:
- Bacterial meningitis
- Tuberculosis
- Some other respiratory diseases
Unlike most antibiotics, theyre more often used over an extended period of time to treat very persistent infections.
Until recently, Neomycin was actually a very common antibiotic used to treat childrens ear infections and pneumonia. Side effect concerns over the years have led doctors to prescribe alternatives.
More research is needed to determine why some antibiotics may contribute to hearing loss. It appears that they may cause inflammation in the inner ear that causes long-term damage.
