Ototoxic Medications ………………………………………………………………………………………………………………………………………………………………………………………………………

AUDIOLOGY INFORMATION SERIES

What is ototoxicity? Ototoxic medications known to cause permanent damage include Some medications damage the ear. This can  certain aminoglycoside antibiotics, such as cause hearing loss, ringing in the ear, or gentamicin, tobramycin, amikacin, and balance problems. These medications are streptomycin and considered ototoxic. Doctors know that the medications may be a risk and prescribe them  cancer chemotherapy medications, such as based on a treatment protocol for a medical cisplatin and carboplatin. condition. Medications known to cause temporary damage Sometimes, hearing and balance problems get include better when you stop taking the medication.  salicylate pain relievers (aspirin, to treat However, the damage doesn’t always go away pain relief and heart conditions), and can be permanent.  quinine (to treat malaria), and Your health care team will consider your hearing and balance system if you need an ototoxic  certain diuretics (to treat certain heart and medication to treat a serious illness or medical kidney conditions). condition. The team will discuss with you how these Your chance of damage increases by side effects will affect your quality of life.  taking more than one ototoxic medication, What are the effects I may notice from  having a family history of sensitivity to ototoxic medications? these medications, and

You may have ringing in the ears (tinnitus). You may  exposure to loud noise while taking ototoxic lose hearing. Hearing loss is hard to notice. Many medications. people notice only when the hearing loss affects

their ability to understand speech. Early changes Discuss with your doctor the potential for hearing often go unnoticed. At times, your loved ones or or balance damage from your medications. peers may be the first to ask if you can hear them. Sometimes, there are few other choices. Balance problems can also begin. You may feel like Treatment with a particular medication may you are spinning and unsteady on your feet. You provide the best hope for curing a life- may also have trouble seeing clearly while moving. threatening disease or stopping a life- Sometimes, these problems are temporary. Your threatening infection. body can learn to adapt to changes in balance. Can I protect myself from ototoxicity? The effects of ototoxic medications can affect your quality of life. It may feel too hard to Researchers are developing ways of preventing participate in conversations if you can’t ototoxicity treatment. Before starting the treatment, understand spoken words. Feeling dizzy may see an audiologist to get a baseline record of your make you unable to move around as much or hearing and balance. think clearly. When possible, the baseline record should include

(1) an audiologic hearing test focused on your ability What is happening inside my ear to to hear very high-pitched sounds; (2) word cause these effects? recognition tests; and (3) other tests. This information can help you and your doctor make any Ototoxic medications cause damage to the sensory important decisions to stop or change the organs used in hearing and balance. These organs medication therapy before your hearing is affected. are made of specialized neural tissue and are located in the inner ear. If the medications cannot be stopped or changed, the patient and the audiologist will manage the Which medications are ototoxic? effects.

More than 200 known ototoxic medications During the course of your medication (prescription and over-the-counter) are on the treatment, get periodic hearing tests as part of market today. These include medicines used to the monitoring process. This will help you to treat serious infections, cancer, and heart identify any hearing changes, ringing in the disease. ears, or balance problems. …………………………………………………………………………………………………………………………………………………………………. Audiology Information Series ©ASHA 2020 AUDIOLOGY INFORMATION SERIES

The following members of the American Speech- Language-Hearing Association (ASHA) contributed to this article: Barbara Cone, PhD, CCC-A, ASHA Fellow; Patricia A. Dorn, PhD, CCC-A; Dawn Konrad-Martin, PhD, CCC-A; Jennifer J. Lister, PhD, CCC-A; and Candice E. Ortiz, AuD, CCC-A.

Notes:

______For more information about hearing loss, hearing ______aids, or referral to an ASHA-certified audiologist, ______contact: ______2200 Research Boulevard ______Rockville, MD 20850 ______800-638-8255 ______Email: [email protected] ______Website: www.asha.org ______Compliments of American Speech-Language-Hearing Association For more information and to view the entire Audiology (ASHA) Information Series library, visit 2200 Research Boulevard, Rockville, MD 20850 * www.asha.org/aud/pei/. 800-638-8255