Which of the following drugs can cause hearing loss?: A Guide to Ototoxic Medications

October 8, 2025 •

4 min read

Over 200 prescription and over-the-counter medications are known to be ototoxic, meaning they can damage the inner ear and cause hearing loss, tinnitus, or balance problems. If you're wondering which of the following drugs can cause hearing loss, it is essential to be aware of the medications that can potentially harm your auditory system.

Quick Summary

This guide details several categories of medications known to cause ototoxicity, including certain antibiotics, chemotherapy agents, and diuretics. It explains their effects on hearing and balance, factors influencing risk, and the difference between temporary and permanent damage. Early recognition of symptoms is highlighted as key to preventing further harm.

Key Points

Aminoglycoside antibiotics: Drugs like gentamicin and neomycin can cause permanent hearing and balance issues, especially with high doses or kidney problems.
Chemotherapy agents: Platinum-based drugs such as cisplatin and carboplatin frequently cause irreversible hearing loss, with risk increasing with cumulative dosage.
Loop diuretics: High intravenous doses of drugs like furosemide can cause temporary hearing loss and tinnitus, but it can become permanent, particularly with kidney failure.
NSAIDs and salicylates: Common pain relievers like ibuprofen, naproxen, and high-dose aspirin can cause temporary hearing loss and tinnitus that usually resolves when the medication is stopped.
Early detection is crucial: Tinnitus is often the first sign of ototoxicity, and promptly alerting your doctor can prevent more severe or permanent damage.
Risk increases with combined drugs: Taking multiple ototoxic medications simultaneously, like an aminoglycoside and a loop diuretic, can significantly amplify the risk of hearing damage.

What is Ototoxicity?

Ototoxicity, or "ear poisoning," is the medical term for damage to the inner ear caused by exposure to certain medications or chemicals. The delicate sensory hair cells in the cochlea, which convert sound vibrations into electrical signals for the brain, are particularly vulnerable. Once damaged, these cells in mammals do not regenerate, potentially leading to permanent hearing loss. Depending on the drug and dosage, this damage can also affect the vestibular system, causing balance problems.

Symptoms can manifest suddenly or gradually and may include:

Tinnitus (ringing, buzzing, or hissing in the ears)
Hearing loss (in one or both ears)
Balance problems or dizziness
A feeling of pressure or fullness in the ears

Major Ototoxic Drug Categories

Aminoglycoside Antibiotics

Used to treat serious bacterial infections, this class of potent antibiotics is known for its ototoxic effects, which can cause permanent damage to hearing and balance.

Examples: Gentamicin, streptomycin, amikacin, neomycin, and tobramycin.
Risk Factors: High dosage, prolonged use, kidney impairment, and a genetic predisposition can increase the risk of ototoxicity.

Chemotherapy Drugs

Certain cancer-fighting medications, particularly platinum-based agents, are highly ototoxic and can lead to significant, often irreversible, hearing loss.

Examples: Cisplatin and carboplatin.
Risk Factors: The risk of hearing damage is dose-dependent and cumulative, meaning the higher the cumulative dose, the greater the risk. Hearing tests are often monitored before and during treatment.

Loop Diuretics

Also known as "water pills," these medications are used to treat heart failure, kidney disease, and high blood pressure. While their ototoxic effects are often temporary and reversible, they can cause permanent damage in high doses, especially in individuals with kidney failure.

Examples: Furosemide (Lasix), bumetanide (Bumex), and ethacrynic acid.
Risk Factors: Intravenous administration and underlying kidney problems significantly increase the risk.

Pain Relievers (NSAIDs and Salicylates)

Many common over-the-counter pain relievers carry a risk of ototoxicity, particularly with frequent, high-dose use. The effects are typically temporary and reversible upon discontinuing the medication.

Examples (NSAIDs): Ibuprofen (Advil, Motrin), naproxen (Aleve).
Examples (Salicylates): High doses of aspirin.
Mechanism: These drugs may cause hearing issues by reducing blood flow to the inner ear or interfering with auditory neurotransmission.

Other Ototoxic Medications and Substances

Several other classes of drugs and chemicals can also cause ototoxicity:

Antimalarials: Quinine, chloroquine, and hydroxychloroquine can cause temporary hearing and balance problems.
Other Antibiotics: Vancomycin and erythromycin have been linked to hearing issues, particularly with intravenous use.
Environmental Chemicals: Lead, mercury, and certain industrial solvents like toluene and trichloroethylene are also considered ototoxins.

Understanding the Damage

The way ototoxic drugs cause damage can differ, but the result is a disruption to the auditory system. In many cases, the cochlea's hair cells, which are essential for high-frequency hearing, are the first to be affected, which can be difficult to detect initially. Some drugs interfere with the ion balance in the inner ear's fluid, while others, like NSAIDs, can reduce blood flow to the cochlea. Certain medications also generate reactive oxygen species (free radicals), leading to oxidative stress and hair cell death.

Comparison of Common Ototoxic Drug Classes


Drug Class	Examples	Typical Onset	Permanence of Hearing Loss	Key Mechanism
Aminoglycoside Antibiotics	Gentamicin, Neomycin	Can be delayed	Permanent	Hair cell death, oxidative stress, mitochondrial damage
Platinum-based Chemotherapy	Cisplatin, Carboplatin	Early in treatment	Permanent	Hair cell death, oxidative stress
Loop Diuretics	Furosemide, Ethacrynic Acid	Rapid, with high IV dose	Mostly temporary; permanent with renal failure	Disrupts inner ear ion balance, reduces blood flow
Salicylates (High Dose)	Aspirin	Onset with high dose	Temporary; reversible upon discontinuation	Interferes with cochlear amplification
NSAIDs	Ibuprofen, Naproxen	Varies; often with chronic use	Temporary; sometimes permanent with high doses	Reduces blood flow to the cochlea
Antimalarials	Quinine, Chloroquine	Dose-dependent	Temporary, especially with low doses	Can be similar to salicylates

What to Do If You Suspect Ototoxicity

If you are taking an ototoxic medication and notice any changes to your hearing, including tinnitus, dizziness, or a decline in hearing ability, it is crucial to speak with your healthcare provider immediately. Do not stop taking a prescribed medication without first consulting your doctor, as the benefits of the treatment may outweigh the risks. Your doctor can determine if the medication is the cause and, if so, may be able to adjust the dosage, switch to an alternative medication, or recommend monitoring. For cases of permanent hearing loss, hearing rehabilitation options, such as hearing aids, can be very beneficial.

Conclusion

While many medications are vital for treating serious health conditions, the potential for drug-induced hearing loss is a significant consideration. Awareness of which drugs can cause ototoxicity, understanding the associated symptoms, and communicating openly with your healthcare provider are the best ways to protect your hearing. Early detection and management are key to preventing further damage and ensuring that you can continue to treat your health conditions effectively while preserving your hearing. The American Academy of Audiology provides additional resources on ototoxicity and medication-related hearing loss for consumers.

Frequently Asked Questions

Ototoxicity is the medical term for inner ear damage caused by certain medications or chemicals, resulting in symptoms like hearing loss, tinnitus, or balance problems.

No, the permanence depends on the medication. Effects from drugs like high-dose aspirin and some diuretics are often temporary, but damage from aminoglycoside antibiotics and platinum-based chemotherapy is typically permanent.

The first sign is often tinnitus, which is a ringing, buzzing, or hissing sound in the ears. Other early symptoms include dizziness, balance problems, or difficulty hearing high-pitched sounds.

Yes, frequent or high-dose use of certain over-the-counter pain relievers like aspirin, ibuprofen, and naproxen can cause temporary hearing loss.

You should contact your healthcare provider immediately. Never stop taking a prescribed medication on your own, as your doctor can assess the situation and determine the safest course of action, such as adjusting the dose or switching to an alternative drug.

There is currently no way to reverse hearing damage once the inner ear's hair cells are destroyed. However, stopping the medication can prevent further damage. For irreversible damage, management options include hearing aids or other rehabilitative therapies.

Yes, some individuals have a genetic predisposition that makes them more susceptible to ototoxicity, particularly from aminoglycoside antibiotics.