Are you taking medication for a serious illness? Have you suddenly started hearing a ringing in your ears while taking such medication, or have you started feeling dizzy and off-balance while walking? We often think that these are caused by the illness. But sometimes, the medication you are taking can be the cause. That is what we call Ototoxicity in medicine. Don't worry, let's talk about this simply.
Simply put, what is Ototoxicity?
When you hear the word ototoxicity, it may seem like a big deal. But its meaning is very simple.
Oto means ear, and toxicity means poisoning. In other words, we call it ototoxicity
when certain medications damage your ears . It's like "poisoning the ear." Our inner ear has very delicate sensory cells that help us hear and control our balance. Some medications, especially when taken in high doses, can damage these sensory cells. This is when you start to lose your hearing, hear different sounds in your ears (tinnitus), and feel out of balance.
The best thing is that if this condition is detected early , it can often be reversed once the medication causing it is stopped or changed. However, if it is caught too late, permanent damage to the ear may occur.
What medications and chemicals can cause ototoxicity?
Currently, more than 200 ototoxic drugs have been identified. Most of these are used to treat serious conditions such as cancer, severe infections, and heart disease. While these drugs are essential to saving lives, it is important to be aware of their potential side effects. The table below shows the main drugs and chemicals that pose this risk.
| Drug/Chemical Type | Examples and notes |
|---|
| Aspirin | High doses taken for a long time can cause hearing loss and ringing in the ears (tinnitus). |
| Medicines containing quinine | High doses of malaria medications such as Chloroquine and Quinidine can temporarily affect hearing and balance. |
| Loop Diuretics | Medicines such as Furosemide and Torsemide, which are used to remove water from the body, often have temporary effects. |
| Aminoglycoside Antibiotics | These are powerful antibiotics like Gentamicin, Amikacin, Kanamycin, which are given for severe bacterial infections. A major cause of ototoxicity. |
| Anticancer Drugs | Chemotherapy drugs such as Cisplatin and Carboplatin can also damage sensitive cells in the ear while killing cancer cells. |
| Environmental Chemicals | Exposure to substances such as mercury, lead, and carbon monoxide can also cause permanent hearing damage. |
Who is more at risk?
Not everyone who takes this medication will develop ototoxicity, but some people are at higher risk.
- Taking more than one ototoxic medication at the same time: For example, the risk is much higher when taking a loop diuretic and an aminoglycoside antibiotic together.
- People with kidney problems: These medications are removed from the body by the kidneys. If the kidneys are not working properly, the medication stays in the body for longer, increasing the risk of ear damage .
- Dosage and duration of medication : The risk increases as the dosage of the medication increases and the duration of treatment increases.
If you absolutely must take a life-saving medication like this,
talk to your doctor about the risk of ototoxicity before starting treatment.What are the symptoms of ototoxicity?
These symptoms may start suddenly, or they may gradually increase over time.
The first signs
- Tinnitus: This is the first sign that most people notice. A continuous sound in the ears, such as "ringing..." or "ringing."
- Mild hearing loss: Feeling as if words are not being heard clearly during normal conversation.
Symptoms that occur when the condition is severe
- Imbalance : Feeling unsteady while walking, as if you are out of balance.
- Vertigo : A feeling that you or your surroundings are spinning.
- Oscillopsia: Blurred vision or a sensation of jumping vision when shaking the head.
- Fullness in the ear: A feeling as if the ear is full of air.
- Difficulty walking: Difficulty walking in the dark, walking with your feet apart to maintain balance.
- Headache and excessive fatigue.
The nature of these symptoms varies depending on whether the damage is to one ear or both ears, and how quickly the damage occurred.
How to recognize this condition?
If you have any of the symptoms listed above, talk to your doctor about any medications you're taking. He or she will likely refer you to a hearing and balance specialist, or
an audiologist . They will run tests to confirm the diagnosis.
- Audiometric tests: Testing the levels of sound waves you can hear and cannot hear.
- Auditory Brainstem Response (ABR) test: Checks whether the signals from the inner ear to the brain are working properly.
- Otoacoustic Emissions (OAE) test: Tests the function of the sensory cells in the inner ear. (These ABR and OAE tests are especially used to diagnose hearing problems in young children.)
- Balance tests: These tests measure your body's balance by measuring things like eye movement (Electronystagmogram) and your ability to stand on different surfaces (Posturography).
How is it treated?
The best treatment is to stop the offending medication or switch to a different medication,
as directed by your doctor . In most cases, symptoms will return.
Most importantly: Never stop taking your medication or change the dosage without first consulting your doctor, as the medication may be essential to your life.
However, if the medication cannot be stopped or if permanent damage to the ear has occurred, there are treatments that can help you manage and live with the problems. 1.
Hearing Aids: These devices, which can be worn inside or outside the ear, help you hear the sounds around you better. 2.
Cochlear Implants: These devices are surgically implanted in people with severe hearing loss that is too severe to be helped by hearing aids. 3.
Balance Therapy / Vestibular Rehabilitation: This is similar to physiotherapy for balance. A physiotherapist teaches you various exercises to improve your posture, gait, and coordination.
Take-Home Message
- Ototoxicity is the damage caused by certain medications to the delicate cells inside the ear.
- If you experience ringing in the ears (tinnitus) or dizziness while taking strong medications for diseases such as cancer or severe infections, inform your doctor immediately.
- Avoid stopping your medication or changing the dosage without medical advice for any reason.
- Early detection of this condition can prevent permanent hearing damage or balance problems.
- If you suspect poisoning from exposure to a chemical in the environment, seek medical advice immediately. If necessary, further information can be obtained from the National Poisons Information Centre at the Colombo National Hospital .
Ototoxicity, hearing loss, medication side effects, tinnitus, dizziness, hearing loss, side effects, cisplatin, aminoglycoside, ringing in the ears
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