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Ototoxicity

What is Ototoxicity?

Ototoxicity means that a medicine or chemical has harmed the inner ear or the hearing nerve.

The inner ear helps with two important jobs:

  • Hearing
  • Balance

When the inner ear is affected, a person may have hearing symptoms, balance symptoms, or both.

What is Happening in My Body?

Some medicines and chemicals can damage tiny cells in the inner ear. These cells help send sound and balance signals to the brain.

Ototoxicity may affect:

  • The hearing part of the inner ear
  • The balance part of the inner ear
  • The hearing and balance nerve
  • More than one of these areas

Because of this, symptoms can be different from person to person.

Because of this, you may feel:

Ototoxicity may cause:

  • Ringing, buzzing, or roaring in the ear
  • Hearing loss
  • Ear fullness
  • Sound sensitivity
  • Dizziness
  • Vertigo, or a spinning feeling
  • Balance problems
  • Trouble walking in the dark
  • Blurry or bouncing vision when walking
  • Fatigue

Symptoms may start suddenly or slowly. They may happen in one ear or both ears. Some symptoms may improve, but others can be long-lasting or permanent.

It is important to know:

  • Your symptoms are real.
  • Ototoxicity can happen with some prescription medicines, over-the-counter medicines, and chemicals.
  • Common causes include some antibiotics, cancer medicines, high doses of aspirin, quinine, and loop diuretics.
  • Many ototoxic medicines are used to treat serious health problems.
  • Symptoms may start slowly or all at once.
  • Do not stop taking a medicine unless your provider tells you to.
  • Tell your provider right away if you notice new hearing, ringing, dizziness, or balance problems.

How is Ototoxicity Diagnosed?

Ototoxicity may be suspected when hearing, ringing, dizziness, or balance problems start after taking a medicine known to affect the inner ear. An audiologist or ENT doctor may help with diagnosis. There is no single test that finds every case of ototoxicity. Your provider may use your symptoms, medicine history, and hearing or balance tests.

What Your Provider May Ask

To learn more about your dizziness, your provider might ask you questions. You can prepare for this by thinking about, and even writing down, your answers to the following questions.

You may be asked:

  • Do you have new hearing loss?
  • Do you have new ringing in your ears?
  • Do you feel newly unsteady?
  • Do you have trouble walking in the dark?
  • Are you taking antibiotics, cancer medicines, or water pills called loop diuretics?
  • Have you been exposed to chemicals at work or home?

Common Tests Used to Confirm Diagnosis

There are a few different tests that your provider may use to confirm your diagnosis.

  • Audiology test: A hearing test.
  • High-frequency hearing test: A hearing test that may find early changes.
  • Auditory Brainstem Response: A test that checks how sound travels from the ear to the brain.
  • Vestibular testing: Balance tests such as VNG, ENG, VEMP, or vHIT.
An example of a hearing test. During this test, sounds are played through headphones to check how well you hear.

How is Ototoxicity Treated?

Treatment depends on the cause and how much damage has happened. Sometimes symptoms improve if the medicine is stopped or changed. This should only be done by your provider.

If the damage is long-term, treatment may include:

An example of balance exercises that may be used in vestibular therapy, if appropriate, to help improve walking and balance on uneven surfaces, as prescribed by a trained provider.

What Can I Expect Over Time?

Will I Get Better?
It depends. Some symptoms improve. Other symptoms may be long-term.

How Long Will It Take?
It depends on the medicine, the dose, and whether the damage is temporary or permanent.

Can I Live a Normal Life?
Yes. If symptoms are long-term, hearing devices and vestibular therapy can help you manage hearing loss, dizziness, and balance problems.

When Should I Call My Provider?

Call your provider if you have:

  • New hearing loss
  • New ringing in the ear
  • New dizziness
  • New balance problems
  • Trouble walking in the dark
  • Symptoms that start after a new medicine

When Should I Seek Emergency Care?

Seek immediate medical care if you have:

  • New weakness or numbness
  • Trouble walking
  • Trouble speaking
  • Double vision
  • Severe or “worst ever” headache
  • Fainting
  • Chest pain
  • Constant or worsening vertigo
  • Sudden hearing loss
  • Repeated vomiting
  • A fall with a head injury

Questions to Ask Your Provider

To learn more about your risk of ototoxicity, it may be helpful to ask your provider:

  • Are any of my medicines ototoxic?
  • Are there other medicine options with less risk to my ears?
  • What are the chances this medicine could affect my hearing or balance?
  • Should I have a hearing test before or during treatment?
  • What symptoms should I report right away?

Key Points to Remember

  • Ototoxicity can cause temporary or permanent damage to the inner ear.
  • It can affect hearing, balance, or both.
  • Some important medicines can be ototoxic.
  • Tell your provider right away if you notice new hearing, ringing, dizziness, or balance problems.
  • Do not stop a medicine without talking to your provider.

Additional Resources