The Link Between Medications and Tinnitus
Tinnitus, the perception of sound like ringing or buzzing with no external source, can be a side effect of numerous medications [1.2.9]. This is known as ototoxicity, a condition where a drug damages the delicate structures of the inner ear, including the tiny hair cells in the cochlea responsible for interpreting sound [1.3.6, 1.3.7]. When these cells are damaged, they can 'leak' random electrical impulses to the brain, which are perceived as sound [1.3.6]. While hundreds of drugs list tinnitus as a potential side effect, some pose a much higher risk than others, especially at high doses or during prolonged use [1.3.6, 1.2.3].
High-Risk Drug Categories for Tinnitus
Several classes of drugs are consistently implicated in causing or worsening tinnitus. The risk often depends on dosage, duration of treatment, and individual patient vulnerabilities [1.5.9].
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
High doses of salicylates, particularly aspirin, are famously linked to temporary, reversible tinnitus [1.6.5, 1.6.7]. A 2022 study highlighted that frequent use of moderate-dose aspirin (over 325 mg) was associated with a 16% higher risk of persistent tinnitus in women under 60 [1.6.6, 1.6.9]. Other common NSAIDs like ibuprofen and naproxen have also been associated with an increased risk of nearly 20% with frequent use [1.6.8]. The mechanism is thought to involve reduced blood flow to the cochlea and disruption of outer hair cell function [1.6.5, 1.6.3]. Fortunately, for many NSAIDs, the tinnitus is often dose-dependent and subsides when the medication is stopped or reduced [1.5.3, 1.2.2].
Aminoglycoside Antibiotics
This powerful class of antibiotics, including gentamicin and tobramycin, is used to treat severe bacterial infections [1.2.3, 1.2.2]. They are among the most well-known ototoxic drugs and can cause permanent damage to the inner ear, leading to irreversible tinnitus and hearing loss [1.3.3, 1.2.8]. Research indicates that over 50% of patients requiring multiple intravenous rounds of these antibiotics experience hearing loss [1.2.8]. The damage occurs because these drugs can destroy the sensory hair cells within the cochlea [1.2.8]. Due to this high risk, patients receiving aminoglycosides are often monitored for changes in their hearing [1.5.1].
Platinum-Based Chemotherapy Drugs
Certain life-saving cancer medications are highly ototoxic. Platinum-based agents like cisplatin and, to a lesser extent, carboplatin, are primary examples [1.5.1, 1.2.5]. These drugs are effective at killing cancer cells but can also cause significant, often permanent, damage to the inner ear [1.5.1, 1.3.8]. One study found that tinnitus occurred in about 37% to 40% of participants receiving platinum-based and taxane-containing chemotherapy regimens [1.4.2]. The ototoxic effects force doctors to balance the life-saving benefits against the risk of long-term hearing damage [1.2.8].
Loop Diuretics
Used to treat high blood pressure and fluid retention, loop diuretics such as furosemide (Lasix) and bumetanide can cause tinnitus [1.2.8, 1.2.3]. This effect is usually associated with high doses, particularly when administered intravenously [1.2.8, 1.2.4]. These 'water pills' are thought to alter the ionic balance of the fluids in the inner ear, leading to tinnitus [1.2.8]. In most cases, the tinnitus caused by loop diuretics is temporary and resolves after the medication is discontinued [1.2.8].
Other Notable Medications
- Antidepressants: Certain antidepressants, particularly tricyclic antidepressants and SSRIs like Zoloft and Prozac, have been linked to tinnitus [1.2.4, 1.2.3]. Some studies suggest this may be related to the medication's effect on serotonin levels [1.5.1].
- Antimalarial Drugs: Medications like quinine and hydroxychloroquine can cause tinnitus, especially at higher doses [1.5.1]. The effect is typically reversible [1.5.1].
- Benzodiazepines: While sometimes used to treat tinnitus, withdrawal from anti-anxiety medications like Xanax and Valium can trigger tinnitus symptoms [1.2.7, 1.5.1].
Comparison of Common Ototoxic Drug Classes
| Drug Class | Common Examples | Risk Level & Typical Onset | Reversibility |
|---|---|---|---|
| NSAIDs | Aspirin, Ibuprofen, Naproxen | High doses, frequent use [1.6.8] | Often reversible upon discontinuation [1.5.3] |
| Aminoglycoside Antibiotics | Gentamicin, Tobramycin, Neomycin | High risk, especially IV administration [1.2.8] | Often permanent [1.2.8, 1.5.4] |
| Platinum-Based Chemo | Cisplatin, Carboplatin | High risk, cumulative dose [1.5.1] | Often permanent [1.5.1, 1.5.4] |
| Loop Diuretics | Furosemide (Lasix), Bumetanide | Higher risk with high IV doses [1.2.8] | Usually reversible [1.2.8, 1.2.3] |
| Antidepressants (SSRIs/TCAs) | Sertraline (Zoloft), Amitriptyline | Varies by individual [1.2.4, 1.2.6] | Can be reversible, may also be a withdrawal symptom [1.5.1] |
Managing and Preventing Drug-Induced Tinnitus
If you suspect a medication is causing tinnitus, the most crucial step is to consult your healthcare provider. Never stop taking a prescribed medication without medical advice [1.5.1, 1.4.1]. Your doctor can assess whether the drug is the likely cause and may be able to:
- Adjust the dosage [1.2.2].
- Switch to an alternative medication with a lower ototoxic risk [1.2.2].
- Recommend baseline and regular hearing tests to monitor for changes, especially before starting known ototoxic drugs like cisplatin or aminoglycosides [1.5.9, 1.5.1].
If stopping the medication is not an option, management strategies like sound therapy, hearing aids with masking features, and Cognitive Behavioral Therapy (CBT) can help make the tinnitus more tolerable [1.5.1, 1.2.2].
Conclusion
While high-dose aspirin is a classic example, powerful drugs like aminoglycoside antibiotics and platinum-based chemotherapy agents are most likely to cause severe and often permanent tinnitus. For many common over-the-counter and prescription drugs, the risk is linked to high doses and prolonged use, and the symptom is often reversible [1.5.1, 1.5.3]. Awareness and open communication with a healthcare provider are key to mitigating the risk and managing symptoms effectively.
For further reading on ototoxicity, a comprehensive list of medications is available from the American Tinnitus Association.
