Most people never connect their medications to their ears. But some drugs are known to be ototoxic, meaning they can affect hearing or trigger tinnitus. Knowing which ones, and what to watch for, helps you catch a problem early. Here is a plain-language overview.
Important: never stop a prescribed medication on your own. If you notice a change in your hearing, talk to your pharmacist or doctor first.
Medications with the strongest evidence
Higher risk
- Platinum chemotherapy (cisplatin, carboplatin). About half of people treated with cisplatin experience some lasting hearing loss. This is usually permanent, so monitoring during treatment matters.
- Aminoglycoside antibiotics (gentamicin, tobramycin). Used for serious infections, these can cause permanent hearing loss.
Moderate risk
- Loop diuretics (furosemide, known as Lasix). The risk is rare at normal doses and goes up with high intravenous doses.
- High-dose aspirin. Can cause ringing and temporary loss, which usually reverses once the dose drops or stops.
Lower risk
- NSAIDs (ibuprofen, naproxen). Occasional use carries very little risk. The concern is regular use, several days a week, sustained over months or years.
- Antimalarials (quinine). Usually reversible at standard doses.
How ototoxic medications damage hearing
Ototoxic drugs affect the delicate hair cells inside the cochlea, the snail shaped organ in your inner ear that converts sound into electrical signals. These hair cells do not regenerate in humans, which is why some medication related hearing loss is permanent. In other cases, the drug causes temporary swelling or fluid changes in the inner ear, and hearing returns to normal once the medication is reduced or stopped.
The severity depends on the specific drug, the dose, how long you take it, and whether you are using other ototoxic medications at the same time. Combining a loop diuretic with an aminoglycoside antibiotic, for example, raises the risk significantly compared to either drug alone.
Other medications linked to hearing changes
Beyond the well studied categories above, a few other drug types have been associated with hearing effects in some patients:
- Certain antidepressants. Reports of tinnitus have been noted with some SSRIs and benzodiazepines, though the evidence is weaker and the effect is usually temporary.
- Erectile dysfunction medications (sildenafil, tadalafil). Rare cases of sudden hearing loss have been reported, and Health Canada includes this as a possible side effect.
- Some blood pressure medications. ACE inhibitors and beta blockers have been loosely linked to tinnitus, though large scale studies have not confirmed a strong connection.
- Opioid pain medications. Prolonged use at high doses has been associated with hearing changes in some cases.
If you are taking any of these and notice a shift in your hearing, it is worth mentioning to your pharmacist. They can review whether your specific medication and dosage carry meaningful risk.
Warning signs to notice
Watch for these, especially if you have started a new medication:
- Tinnitus: new ringing, buzzing, or roaring in your ears
- Muffled hearing: sounds seem filtered or far away
- Balance changes: dizziness or unsteadiness, which is less common
Who is at higher risk
Several factors raise your chance of medication related hearing effects:
- Age over 60. The inner ear becomes more vulnerable as we age, and older adults are more likely to be on multiple prescriptions.
- Kidney disease. Many ototoxic drugs are cleared through the kidneys. Reduced kidney function means the drug stays in your system longer and reaches higher concentrations.
- Existing hearing loss or tinnitus. If your hearing is already compromised, even a small additional change from a medication can be noticeable.
- Multiple ototoxic medications at once. Taking two or more drugs that affect the ear, even at safe individual doses, can multiply the risk.
Edmonton pharmacists can run a medication review to flag combinations worth watching. If you are starting chemotherapy at the Cross Cancer Institute or managing a chronic condition that requires ongoing medication, a baseline hearing test before treatment gives your care team a reference point to measure against.
What to do
If you notice any of the signs above, do not stop the medication yourself. Contact your pharmacist or doctor to review it, and book a hearing test so we can measure exactly what is happening. A baseline audiogram before and during high risk treatment, like chemotherapy, is especially valuable because it lets your care team catch changes early and adjust.
Our registered audiologist at Medicine Place Hearing Care can assess your hearing, document any change, and coordinate with your prescribing physician or pharmacist. We see patients at both Edmonton locations and our Calgary clinic. Contact us to book a hearing test.
This article is general information, not medical advice. Always talk to your doctor or pharmacist about your specific medications.