Ototoxic Medications: How Common Drugs Can Damage Your Hearing and What to Watch For

Many people don’t realize that common prescriptions can quietly damage their hearing-sometimes permanently. If you’re on long-term antibiotics, chemotherapy, or even certain antidepressants, you might be at risk for ototoxic medications without even knowing it. The damage doesn’t always show up right away. It starts with a faint ringing in your ears, or difficulty hearing high-pitched sounds like birds chirping or children’s voices. By the time you notice it, the harm is often irreversible.

What Exactly Is Ototoxicity?

Ototoxicity means poison to the ear. It happens when certain drugs attack the delicate hair cells inside your inner ear. These cells don’t regenerate. Once they’re gone, your hearing doesn’t come back. The cochlea, which turns sound into electrical signals for your brain, is especially vulnerable. So is the vestibular system, which controls balance. That’s why some people on ototoxic drugs don’t just lose hearing-they also feel dizzy, unsteady, or nauseous.

This isn’t rare. Around 600 prescription drugs are known to carry this risk, according to the American Speech-Language-Hearing Association. Some are life-saving. Cisplatin, for example, treats testicular, ovarian, and lung cancers. Gentamicin saves lives in severe infections. But they come with a hidden cost: up to 60% of patients on cisplatin develop hearing loss. For gentamicin, the rate can hit 63% after more than a week of use.

Which Medications Are the Worst Offenders?

Not all ototoxic drugs are created equal. Some are more dangerous than others, and the risk depends on how much you take and how long you’re on them.

• Aminoglycoside antibiotics - Gentamicin, tobramycin, amikacin, and streptomycin are the big ones. Used for serious infections like sepsis or drug-resistant TB, they can cause permanent hearing loss in 20-63% of patients. Damage usually starts at high frequencies (8,000-12,000 Hz), which is why standard hearing tests often miss it-they only go up to 4,000 Hz.
• Cisplatin chemotherapy - This drug is a major cause of hearing loss in cancer patients. Between 30% and 60% of adults and up to 80% of children develop hearing damage. What makes cisplatin worse is that it sticks around in the inner ear for months after treatment ends, slowly killing more cells. Kids are especially at risk-undetected hearing loss can delay speech and language development by 35%.
• Loop diuretics - Furosemide (Lasix) and bumetanide, used for heart failure or kidney issues, can cause temporary or permanent hearing loss, especially at high doses or when combined with aminoglycosides.
• Some antidepressants - Tricyclics like amitriptyline and SSRIs like sertraline and fluoxetine have been linked to tinnitus and hearing changes. The risk is lower, but it’s real. Patients often report ringing that started after beginning these meds.
• High-dose aspirin and NSAIDs - These can cause temporary hearing loss or tinnitus. It usually goes away when you stop taking them, but long-term heavy use may lead to lasting damage.

How Do These Drugs Actually Damage Your Ears?

It’s not just one mechanism. Different drugs attack in different ways:

• Oxidative stress - Cisplatin and aminoglycosides flood the inner ear with free radicals. These unstable molecules tear apart the hair cells’ DNA and mitochondria, causing them to die.
• Reduced blood flow - Some drugs narrow blood vessels feeding the cochlea, starving the cells of oxygen.
• Direct toxicity - Aminoglycosides bind directly to hair cell receptors, triggering cell death.
• Neurotransmitter disruption - Certain drugs interfere with the chemical signals between hair cells and the auditory nerve.

The damage usually begins at the base of the cochlea, where high-frequency sounds are processed. That’s why you might first notice trouble hearing birds, chimes, or the voices of women and children. Over time, the damage spreads to lower frequencies, affecting speech understanding.

Why Standard Hearing Tests Often Miss the Problem

Most clinics test hearing only up to 4,000 Hz. That’s not enough. Ototoxic damage shows up first at 8,000 Hz and beyond. A patient on cisplatin might lose 40 dB of hearing at 8,000 Hz after their third treatment cycle-but their doctor won’t know unless they specifically test those frequencies.

One Reddit user shared their story: after their third cisplatin cycle, they suddenly couldn’t hear their alarm clock. A standard audiogram showed nothing wrong. Only a high-frequency test revealed severe loss at 6,000 Hz. Their oncologist had never heard of the need for extended-range testing.

This is a gap in care. Only 45% of U.S. cancer centers follow recommended ototoxicity monitoring guidelines. Patients are being left in the dark.

How to Monitor for Ototoxicity-And What Works

Early detection saves hearing. Here’s what real monitoring looks like:

• Baseline audiogram - Before starting cisplatin, gentamicin, or other high-risk drugs, get a full hearing test that includes 8,000-12,000 Hz. If you’re getting cisplatin, this is non-negotiable.
• Serial high-frequency testing - For cisplatin: test after each cycle. For aminoglycosides: test after every 3-5 doses. Look for changes at 8,000 Hz and above.
• Otoacoustic emissions (OAE) - This test measures sound produced by healthy hair cells. If those sounds weaken, it means damage is happening-even before you lose hearing on a standard test. OAE is 25% more sensitive than regular audiometry.
• Vestibular testing - If you’re dizzy or unsteady, a balance test (like VNG or ENG) can detect inner ear damage before it affects hearing.
• Genetic screening - Some people have a mitochondrial DNA mutation (m.1555A>G) that makes them 100 times more likely to go deaf from aminoglycosides. Testing isn’t routine yet, but if you or a family member had sudden deafness after antibiotics, ask about it.

Studies show that patients who get regular monitoring are 30-50% less likely to end up with severe, disabling hearing loss.

What Can Be Done If Hearing Loss Starts?

Once hair cells die, they’re gone. But you can stop the damage before it spreads.

• Adjust the dose - Sometimes lowering the amount or spacing out doses helps.
• Switch medications - For cancer, carboplatin is less ototoxic than cisplatin (though not always as effective). For infections, vancomycin is a safer alternative to gentamicin in many cases.
• Use otoprotective agents - In November 2022, the FDA approved sodium thiosulfate (Pedmark) for children with liver cancer on cisplatin. It reduced hearing loss by 48%. Trials are ongoing for N-acetylcysteine to protect against aminoglycoside damage.
• Stop the drug - If hearing loss is detected early, stopping the medication may prevent further damage.

The Bigger Picture: Why This Matters

About 15 million Americans take ototoxic drugs each year. Cisplatin alone is given to over 500,000 cancer patients annually. The economic cost of medication-induced hearing loss? Over $1 billion in the U.S. each year-due to hearing aids, therapy, lost work, and social isolation.

Children with cancer who develop hearing loss are more likely to fall behind in school. Adults lose jobs, relationships, and independence. Tinnitus alone can ruin sleep, concentration, and mental health.

And the problem is growing. The WHO predicts a 22% rise in aminoglycoside use for drug-resistant TB by 2027. That could mean 300,000 more cases of preventable hearing loss each year.

What You Should Do

If you’re prescribed any of these drugs:

• Ask: “Is this medication known to affect hearing?”
• Ask: “Will you be monitoring my hearing with high-frequency tests?”
• Ask: “Is there a less ototoxic alternative?”
• Keep a journal: Note any ringing, fullness in ears, dizziness, or trouble hearing high voices.
• Insist on a baseline hearing test before starting treatment.

Don’t assume your doctor knows. Many don’t. Ototoxicity isn’t taught well in medical school. You have to be your own advocate.

What’s Next?

Researchers are working on better tools. Smartphone apps that test hearing at 8,000-12,000 Hz could make monitoring accessible to anyone with a phone. New drugs are being tested to protect the ear during chemotherapy. And guidelines are being updated to include genetic screening for high-risk patients.

But until then, the best defense is awareness. If you’re on a long-term medication, don’t wait until you can’t hear your grandchild’s voice. Get tested early. Ask the right questions. Your hearing might depend on it.