Many of the readers of this newsletter are savvy enough to read the warning labels of prescription (and non-prescription) medications, so as to be certain of any potentially adverse effects. However, I continue to see well-educated, intelligent people trustingly take many medications without consideration of possible risks.

Most commonly-used medications have little likelihood of resulting in hearing loss in most people. There are, however, many common drugs that are known to be ototoxic; those which can cause hearing loss and/or tinnitus. Indeed, I believe that adverse drug symptoms are grossly under-reported, meaning that any list of known ototoxic medications is likely to be incomplete.

When medications known to be ototoxic are prescribed, it is sometimes because they are the only or the most effective medication needed for life-sustenance, as in the case of certain drugs used in chemotherapy. In those cases, it is advised that hearing be monitored to quantify the impact. In some cases when hearing is adversely affected, it may be possible to modify the course of meds so as to limit permanent damage. However, most physicians and patients will accept some degree of hearing loss for a more favorable outcome when fighting cancer (in this case) or some other life-threatening disorder.

If you come away from this article feeling comfortable that ototoxicity is limited to rare medications, then I will not have succeeded in emphasizing some important points. Indeed, some very common medications have been known to be ototoxic. Some shown to have potential risk include antibiotics such as streptomycin, pain relievers such as aspirin and ibuprofen, and diuretics such as furosemide (Lasix). As you can see, this covers both prescription and over-the-counter medications.

I mentioned aspirin as having ototoxic effects. With certain dosages in some people, tinnitus is experienced.  Lower dosages are not shown to have a measurable effect.

Just as I hope to be sure to emphasize that your medications may have potential for danger to the ear, I do not mean to “scare” readers into throwing away their drugs which may do more good than harm. Simply, I want readers to become informed consumers who will read about and consider the contraindications of everything in their medicine cabinets. With that information, one might become aware of possible changes and hopefully report them before permanent changes occur. 

While we certainly hope our physicians and pharmacists will make prescriptive choices that will be best for our overall health, it is ultimately safer and important for the patient to take some of the responsibility. This topic reminds me of a time 13 years ago when my wife was pregnant with our first child. My wife became ill with a fever and cough, and was prescribed by the ob/gyn an antibiotic. Upon filling the prescription, the pharmacist looked at my wife, asked whether she was pregnant, and then upon confirmation indicated he will refuse to fill the prescription since it has known side effects that include miscarriage! He called the doctor who agreed to select a less-risky drug. For that and other reasons, we opted to change obstetricians before the birth (which went well; we have a healthy 12 year old girl). We happened to be fortunate to have had an attentive pharmacist. I don’t know that we would have investigated the side effects had the pharmacist not intervened. Knowing what I know now, of course, I don’t fail to fully research medications before I or members of my family take anything. I also ask quite a few more questions of our physicians and pharmacists these days. Clearly, I am not the only one more informed in 2008 than I was at that time. It wasn’t too long ago that health professionals and consumers would only consult the annual physicians’ desktop reference book to research medications. As you might imagine, any printed reference is dated the moment it is printed; with use of the internet, information is more readily available. Additionally, drug information and known contraindications are printed with most prescriptions. Please be aware, though, that these are still only the “known” interactions.

Nothing is foolproof, of course. There is still much we do not know about drug effects. In light of the fact that there is a large and growing number of drugs on the market, some with less of a body of research than others, this can be of great concern.  Considering we have many people who take many drugs on an ongoing basis, there is the concern for potential drug interactions that may not have been fully explored. Additionally, seeing as drug effects likely go under-reported and some effects are delayed, it is quite possible to underestimate the danger of a product. It is for these reasons that we must be informed consumers, seeking as much information as exists, self-monitoring and reporting symptoms as they occur.

Be aware of the risk potential for drugs that you take. While most of the known-to-be highly-ototoxic medications are limited to those used for life-sustenance (chemotherapy for cancer treatment, quinine for malaria, etc.), there are some commonly-used drugs that can have an impact. Hearing loss and tinnitus can occur in some while not in others, and while the reasons behind the differential effects are not clear, what is clear is that taking some time to read about the known effects of YOUR medications (information is available online; see some resources listed below), considering the possible effects of drug interactions, monitoring yourself for potential symptoms (Did tinnitus begin or worsen? Does hearing seem to have changed?), and asking questions of your health professionals (particularly your prescribing physician and pharmacist) may help you to avoid ototoxicity.

Some resources for ototoxic medications:

The League for the Hard of Hearing has a brochure listing known ototoxic medications: http://www.lhh.org/about_hearing_loss/understanding/OtotoxicBrochure.pdf

Physicians’ Desktop Reference:

http://www.pdrhealth.com/home/home.aspx

Michael Bergen is the Director of Brooklyn College's Speech and Hearing Center and is on the faculty of the Doctor of Audiology (AuD) Program at the CUNY Graduate Center.   Michael is a NYS licensed,  ASHA certified audiologist. As Director, Michael oversees daily operations, supervising clinical sessions and teaching doctoral, masters and undergraduate students.  He was recently honored with the "Distinquished Service Award 2008"  by NYSSLHA and named Favorite Teacher" of the Dept. of Speech & Communication Arts & Sciences by Brooklyn College for 2007 and 2008.

Michael was elected NYSSLHA VP of Audiology 2006-07,  2008-09 and has chaired or
served on committees at the university, local, state and national levels, including for NYSSLHA, ASHA, AAA, CAPCSD and the Metro Council.