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Ototoxic meds & hearing loss (RE-POST)

Steve Hoffman steve at accessone.com
Sat Mar 2 13:02:44 EST 1996

The following article from the SHHH Journal is posted with
permission.  The SHHH Journal is published bimonthly by SHHH
(Self Help for Hard of Hearing People, Inc.), an international
nonprofit volunteer organization devoted to the welfare and
interests of those who cannot hear well.  For membership and
other information, contact:

       7910 Woodmont Ave, Suite 1200
       Bethesda, MD  20814

       301-657-2248    Voice
       301-657-2249    TTY

       Email:  shhh.nancy at genie.com  (Nancy Macklin)


What You Should Know About Ototoxic Medications
by Stephen Epstein, M.D.  (SHHH Journal 10/95)

Ototoxic medications are those drugs that have the potential to
cause damage to the inner ear structures which may result in
temporary or permanent loss of hearing or an aggravation of an
existing sensorineural hearing loss.  If you have an existing
sensorineural hearing loss, regardless of the cause, when using
ototoxic medications, you are more vulnerable to aggravation of
that hearing loss.

As a result of using ototoxic medications, the degree of hearing
loss that occurs and the amount of recovery that follows depends
upon the amount and duration of the use of that particular
medication.  If you are consuming more than one ototoxic
medication, you are even more vulnerable to developing a
sensorineural hearing loss or aggravation of your existing
sensorineural hearing loss.  Some ototoxic medications such as
aspirin and aspirin-containing drugs -- regardless of the amount
and duration of usage -- when discontinued, result in complete
recovery of hearing and cessation of associated symptoms such as

Guidelines to Follow
In regard to the use of ototoxic medications, whether they are
over-the-counter or prescription, there are several important
facts you should know and several important rules you should

* Always inform your doctor that you have a sensorineural hearing
loss or nerve-type hearing loss.

* Always ask your doctor, when he is prescribing new medications
for you, to inform you of any potential side effects, especially
if the medication is ototoxic.

* Always read the labels or ask your pharmacist about the
potential ototoxic effects of over-the-counter medications.

* Always be aware of the early warning signs of ototoxicity.

Signs of Ototocity, Listed in Order of Frequency
1. The development of tinnitus (noises in the ears) in one or
both ears.

2. The intensification of existing tinnitus or the appearance of
another sound that didn't exist before.

3. Fullness or pressure in your ears -- other than being
secondary to an upper respiratory infection.

4. The awareness of a hearing loss in an unaffected ear or the
progression or fluctuation or an existing loss.

5. The development of vertigo or spinning sensation usually
aggravated by motion and may or may not be accompanied by nausea.

Should any of these symptoms develop while taking any
medication -- stop the medication immediately and call your

Ototoxic Medications
Finally, you should be aware of the common ototoxic medications,
how they are prescribed, and for what conditions they are given.

The following is a simplified list of ototoxic medications and
represents the most common drugs. (There are many other
medications that have been listed as potentially ototoxic;
however, the incidence is insignificant. Consult your physician
to be sure.) Keep this list for ready reference.

1. Salicylates - Aspirin and aspirin-containing products
* Toxic effects usually appear after consuming an average of 6-8
pills per day.
* Toxic effects are always reversible once medications are

2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) - Advil, Aleve,
Anaprox, Clinoril, Feldene, Indocin, Lodine, Motrin, Nalfon,
Naprosyn, Nuprin, Poradol, Voltarin
* Toxic effects usually appear after consuming an average of 6-8
pills per day.
* Toxic effects are usually reversible once medications are

3. Antibiotics - Aminoglycosides, Erythromycin, Vancomycin
  a). Aminoglycosides - Streptomycin, Kanamycin, Neomycin,
Gentamycin, Tobramysin, Amikacin, Netilmicin
*These medications are ototoxic when used intravenously in
serious life threatening situations. The blood levels of these
medications are usually monitored to prevent ototoxicity.
*Topical preparations and ear drops containing these antibiotics,
Neomycin and Gentamycin, have not been demonstrated to be
ototoxic in humans.

  b). Erythromycin - EES, Eryc, E-mycin, Ilosone, Pediazole, and
new derivatives of Erythromycin -- Biaxin, Zithromax
Erythromycin is usually ototoxic when given intravenously in
dosages of 2-4 grams per 24 hours -- especially if there is
underlying kidney insufficiency. The usual oral dosage of
Erythromycin averaging one gram per 24 hours is not ototoxic.
There are no significant reports of ototoxicity with the new
Erythromycin derivatives since they are given orally and in lower

  c). Vancomycin - Vancocin
This antibiotic is used in a similar manner as the
aminoglycosides; when given intravenously in serious life-
threatening infections, it is potentially ototoxic. It is usually
used in conjunction with the aminoglycosides which enhances the
possibility of ototoxicity.

4. Loop Diuretics - Lasix, Edecrin, Bumex
These medications are usually ototoxic when given intravenously
for acute kidney failure or acute hypertension. Rare cases of
ototoxicity have been reported when these medications are taken
orally in high doses in people with chronic kidney disease.

5. Chemotherapeutic Agents - Cisplatin, Nitrogen Mustard,
Vincristine:  These medications are ototoxic when given for
treatment of cancer. Their ototoxic effects can be minimized by
maintaining blood levels of the medications and performing serial
audiograms. The ototoxic effects of these medications are
enhanced in patients who are already taking other ototoxic
medications such as the aminoglycoside antibiotics and the loop

6. Quinine - Aralen, Atabrine (for treatment of malaria),
Legatrin, Q-Vel Muscle Relaxant (for treatment of night cramps).
The ototoxic effects of quinine are very similar to aspirin and
the toxic effects are usually reversible once medication is

Just as you are responsible for your overall health, you are
responsible for the preservation of your hearing or the
preservation of your existing hearing reserve. Being aware of
ototoxic medications and their potential warnings is a good
safeguard to protect your hearing -- and a sound investment!

Stephen Epstein, M.D., F.A.C.S., is an otologist and a fellow of
the American Academy of Otolaryngology - Head and Neck Surgery,
Inc., and the American College of Surgeons. He is the director of
The Ear Center in Wheaton, Maryland.

Special Tip for Filling Out Medical Forms
One SHHH member reports that when filling out medical
questionnaires, she lists ototoxic medications under "known
allergies."  The invariably results in questions from medical
staff, making them more aware of her hearing loss.

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