Remember the scene in Hamlet where the players reenact the murder of Hamlet’s father? They pantomime the moment when Claudius poured poison into the senior Hamlet’s ear. Now, Claudius wasn’t looking to poison just an ear. In fact, the poison he used probably worked because of the connection between the ears and the throat. But in modern day, there is a more common way you may be poisoning your ears.
That’s right, you can poison an ear…and without meaning to do it. Certain medications have properties that can damage the mechanisms we use to hear—causing hearing loss, tinnitus (ringing in the ears) and even vestibular/balance disorders. Drugs that can harm hearing are called “ototoxic” (oto = ear, from the Latin; toxic = poisonous).
Medications can cause hearing damage because the sense of hearing relies heavily on the bloodstream to keep it up and running. Tiny blood vessels in the inner ear are crucial to supporting the activity of hair cells and auditory nerves that send impulses to the brain, where those impulses are recognized as sound. When the bloodstream delivers a tainted supply, hair cells can be damaged or even killed, posing a significant risk of hearing loss and other hearing-related problems.
The results aren’t always dire.
Some drugs have only a temporary effect on hearing. Among those are known to cause temporary damage are:
- Salicylate Pain Relievers: The most well-known of these is aspirin.
- Quinine: Primarily in the treatment of malaria, you may be familiar with the bitter taste of quinine from tonic water
Please, don’t be afraid of taking an aspirin or drinking tonic water. Ototoxicity from these sources happens at high doses.
Another class of medications known to affect hearing are loop diuretics. These are used in the treatment of various conditions, including high blood pressure and fluid retention under the skin
Some threats are stronger than others.
As you might expect, the more powerful the medication, the more likely it is to cause more extensive hearing damage. Such medications include:
- Aminoglycoside Antibiotics: An antibiotic category that includes gentamicin, amikacin, tobramycin, neomycin, and streptomycin.
- Cisplatin: Ototoxicity may occur in as many as 50% of patients being treated with this chemotherapy agent.
- Platinum-Based Chemotherapy: Approximately 60% of children receiving such treatments experience hearing loss.
Monitoring and management are essential.
There are hundreds of drugs with ototoxic side effects, so ask your doctor about any and all side effects of any medication he or she prescribes. Should a physician prescribe a drug known for its ototoxic effects, you should have a baseline hearing test before treatment starts and periodic tests during the course of treatment to watch for any changes in your hearing.
Should a decrease in hearing, tinnitus or a balance issue be develop, your doctor can look into adjusting your dosage or prescribing a different medication, if a suitable one is available. If changing the medication or dosage isn’t a possibility, and the ototoxic effects appear to be long-term, a certified professional audiologist can help you with counseling, hearing aids, assistive listening devices and communication management.
