 YOUR HEALTH

Tinnitus Triggered by Ototoxic Drugs: Strategies to Protect Your Hearing Health By Neil Bauman, PhD and senior advisor of Public Citizen’s ing sound. I will never take this drug Worst Pills, Best Pills News, which can again because it seems I have to lis- Currently, I know of at least 657 be found at www.citizen.org. The result ten to this terrible sound for the rest drugs (and still counting) that list is that what might have been a minor of my life. I would never have chosen tinnitus as a possible side effect. In problem can become a major problem. this over my depression, if I had [had] addition, I know of 10 herbs and 31 even the slightest idea this could be chemicals that can do the same. a side effect. That I took this drug for Two common drugs you may not “What you can do depression is so ironic. realize that may cause tinnitus is the Another person wrote, anti-inflammatory drug Ibuprofen, and to reduce your risk I had an injury to my foot and took the selective serotonin reuptake inhib- Ibuprofen (Advil®, Motrin®) for the itor (SSRI) Citalopram®. In fact, more of getting tinnitus pain. Shortly thereafter, the ringing people complain to me via email about in my ears started. I had no idea this getting tinnitus from taking these two is look at reports of could happen and would never have drugs than from taking other drugs. tinnitus occurrence taken Ibuprofen, if I had known this Strategies to Avoid Tinnitus would happen. The following three strategies may for each drug.” Therefore, to reduce your risk of get- reduce your risk of getting tinnitus ting tinnitus, go easy on drugs. If you from drugs. choose to take medication, make sure Below are comments from people you know that the benefits will clearly Take medication only when who found that the side effects of outweigh the potential side effects. 1absolutely necessary. drugs their doctors prescribed were Ask your doctor to justify that a given Instead of always taking medication, worse than the conditions they were drug is really necessary—not the casual first seek to correct underlying health supposed to help. “let’s try this and see what happens,” problems. Typically, drugs only mask Three years ago, after taking because in some cases, one of the symptoms. Thus, you end up taking the Bupropion for 6 months for depres- risks is that tinnitus can manifest. drug “forever,” because when you stop, sion, I woke up with tinnitus. At that Before taking medications, make the symptoms reappear. By digging point, my tinnitus was a “static” lifestyle and dietary changes to im- down to the root cause of your health sound—not fun—but bearable. I was prove your health. The goal is to work problems and fixing them, in most told by my doctors that there was no with your physician, keeping them cases you may not need medication. connection between this drug and my informed of what you are doing and Unfortunately, Americans seem to be a tinnitus, but [I] stopped [the medica- who you are working with to eliminate nation of pill poppers. tion] anyway. I have had tinnitus ever underlying health problems, so medi- Sometimes, drugs are prescribed since. A few weeks ago, I started cations are less likely to be needed. unnecessarily, especially to older taking Bupropion again, falsely believ- Some alternatives for improving adults, as noted by Dr. Sidney Wolfe, ing it wasn't related to my tinnitus. and maintaining your health include: the Health Research Group founder Now my tinnitus is a louder, shriek-

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• Change your diet. Did you know natural sunlight, which enable your that more than 80 percent of body to make its own vitamin D. “Before taking health problems can be linked to • Learn more about other less-tradi- poor diet? According to prolific tional healthcare providers, such medications, make author and natural health advocate as naturopathic doctors (NDs), and Dr. Joseph Mercola, who’s an see them when appropriate. For lifestyle and dietary osteopathic physician, your diet instance, it may make sense to should consist of mostly raw and see an osteopathic doctor (DO), changes to improve lightly steamed vegetables and who is a fully licensed physician fruits. Cut way down on all sugars. trained to focus on the prevention your health.” Ideally, reduce your sugar intake of illness and maintaining a healthy from all sources to less than 25 lifestyle. Consider the role of a above. As a result, the risk of getting grams per day—that’s less than chiropractor trained to address tinnitus can increase unnecessarily. two tablespoons of sugar from all the upper cervical spine, because Choose the drug least likely to sources, including drinks, pro- some ear problems can stem from be ototoxic. cessed foods, fruits, etc. the top two vertebrae in the neck 2 If medication is required, talk to • Balance diet and lifestyle with not being aligned properly. your healthcare provider about which attention to the role of vitamins. For • Exercise more. Just get moving. drugs are least likely to aggravate or example, most people are low in • Get adequate sleep. If you short cause tinnitus. This may be a different Vitamin D3, and this affects many yourself on sleep, both your physi- drug in the same drug class, or a drug areas of your body, including your cal and mental health suffer. in a different class. Take the lowest mental health. (Vitamin D affects • Consider counseling rather than effective dosage possible. more than 3,000 genes.) To be ef- drugs, unless absolutely neces- Ask your doctor to prescribe the fective, your optimal blood vitamin sary, for depression, anxiety, and lowest dose that will treat your con- D3 levels should be in the range related issues. dition; many drugs do not exhibit oto- of 50-70 nanograms per milliliter My own philosophy is that drugs toxic side effects when taken in low (ng/ml). Many people’s levels are should be your last line of defense, not doses. For example, one woman told around the 20 ng/ml level—far your first line of attack. Too many peo- me her tinnitus became noticeably below the optimal level, and your ple take drugs as their first, and only, louder when her doctor put her on a health suffers as a result. So, go choice because it is easier to pop a pill higher dose of Irbesartan to control outdoors and absorb the benefits of than to make the effort to do any of the

Top 20 Drugs Linked to Triggering Tinnitus

Top 20 tinnitus-producing drugs, based on the number of reports submitted to the FDA’s database. The drugs are listed in descending order, from most reports (highest risk) to fewest reports (lower risk) and are listed by their generic name, followed by the common brand name in italics:

Alendronate (Fosamax®) Acetaminophen (Tylenol ®) Amlodipine (Norvasc®) Acetylsalicylic acid (aspirin) Hydrocodone (Vicodin®) Ibuprofen (Advil ®) Paroxetine (Paxil ®) Atorvastatin (Lipitor®) Lisinopril (Zestril ®) Alprazolam (Xanax®) Omeprazole (Prilosec®) Lorazepam (Ativan®) Bupropion (Wellbutrin®) Duloxetine (Cymbalta®) Sertraline (Zoloft ®) Venlafaxine (Effexor®) Clonazepam (Klonopin®) Quetiapine (Seroquel ®) Metoprolol (Lopressor®) Gabapentin (Neurontin®)

www.ATA.org TINNITUS TODAY SUMMER 2018 63  YOUR HEALTH

her high blood pressure. When she To consume the equivalent salicylates complained to her doctor, he reduced contained in six adult aspirin—the the dose to its old level and her tinni- amount of aspirin that could cause tus also dropped back to its old level. tinnitus—you’d have to choke down Take medication for the almost four pounds of pure curry Will My Tinnitus be Temporary shortest time possible, as powder—at one sitting! 3 or Permanent? recommended by your doctor. The same applies to raisins. Raisins If your tinnitus is secondary to Ask your doctor to prescribe medi- are relatively high in salicylates (6.62 drug-induced hearing loss, then you cations for the shortest duration pos- mg. per 100 g.). To get the equivalent could expect it to last as long as the sible, because some ototoxic drugs salicylates found in six adult aspirin, resulting hearing loss. Thus, if you do not damage your ears in the short you’d have to gorge yourself on 144 have temporary hearing loss from tak- term. However, if taken long term, pounds of raisins at one time. By the time you did that, tinnitus would be ing a certain drug, and you stop taking the risk of them damaging your ears that drug – and your hearing returns in increases. By taking a medication for the least of your worries. a few days to a few weeks – you could only two weeks, for example, you may Drug Results Are Unique to expect your tinnitus to fade away as avoid ototoxic side effects, where- Each Person your hearing returns. However, if your as taking the same drug for several Each one of us is unique, and so drug usage results in permanent hear- months may cause ear problems. is our response to drugs. This means ing loss, then don’t be surprised if your that a drug that gives me tinnitus may Can Foods and Herbal tinnitus also proves to be permanent. not cause your tinnitus to increase Medicines Cause Tinnitus? When tinnitus is a primary side and vice versa. As a result, it is hard A woman asked, effect, it is impossible to predict to know which drugs you should stay I wondered if you knew about the whether your tinnitus will be tempo- away from and which you can take ototoxicity of various foods. I read rary or permanent. With the use of safely if you want to avoid tinnitus or that tea is high in salicylates, as are some drugs, tinnitus will be tempo- other ototoxic side effects. a lot of fruits. Does this mean that rary for some people and permanent What you can do to reduce your drinking/eating these things can make for others. It doesn’t seem fair, but risk of getting tinnitus is look at reports my existing tinnitus worse? that is the way it is. Certain foods can cause tinnitus, of tinnitus occurrence for each drug. The more people who report getting but typically – as long as you don’t Neil Bauman, PhD, is the founder and CEO tinnitus from taking a given drug, the go off the deep end and consume at the Center for Hearing Loss Help. He copious amounts (or far more than the greater your risk, if you take that drug. is a hearing loss coping skills specialist, researcher, author, and speaker on hearing recommended dose) – you shouldn’t Unfortunately, there is no single source for this kind of information. loss. Bauman helps hard-of-hearing people worry about getting tinnitus from food. adapt successfully to hearing loss, tinnitus, You can do what I do and search For example, I’ve been asked and balance problems while minimizing future whether you can get tinnitus from through numerous drug books and damage to their ears—particularly from the effects of ototoxic drugs. He is the author of eating foods high in salicylates, which online databases to try to ferret out the risk of tinnitus (or other side eleven books and more than 1,000 articles on is the basic ingredient in aspirin and hearing loss topics, including more than 160 some other medications for pain relief. effects) that are reported for a given articles related to Some fruits, vegetables, and spices drug. This can be extremely time con- ototoxic drugs. suming, which is why I have compiled The third edition of are naturally high in salicylates, but, his book, Ototoxic this kind of information into a single even so, the amount they contain is far Drugs Exposed, less than what could cause tinnitus. source—the book Ototoxic Drugs Ex- describes over a thousand drugs, Curry powder is a good example. It posed—available at hearinglosshelp. com or through Amazon. herbals, and chem- has the highest salicylate content of icals that can (and any known food—218 mg. per 100 g. do) damage ears.

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