Have you ever thought that some medications, especially those used to treat serious illnesses, can damage our ears, which means our hearing and balance? This is a real possibility. In medicine, we call this condition ototoxicity. Don't worry, it's important to be aware of this. Let's talk about it in detail.
What is ototoxicity?
Simply put,
ototoxicity is damage to our inner ear as a side effect of some medications. If we look at the meaning of the word "ototoxicity", "oto" means "ear" and "toxicity" means "poisoning". That is, a condition like poisoning of the ear. Our inner ear has very delicate sensory cells. These cells help us hear and maintain balance in the body. Some medications, for example, medications for severe infections and medications for diseases such as cancer, can damage these sensory cells. That is when this condition called ototoxicity occurs.
What are the symptoms of ototoxicity?
These symptoms do not occur in the same way for everyone. Sometimes symptoms may appear immediately after starting the medication. For others, symptoms may develop gradually and gradually. Surprisingly, some medications can cause these symptoms to appear up to five years after starting the medication. Often,
the first sign is hearing a ringing sound in the ear. It may be like someone talking to someone else, or it may just be a "ringing" sound or a "whooshing" sound. Doctors call this
tinnitus . Tinnitus can also be the first sign of hearing loss. Other symptoms include:
- Hearing loss (in one or both ears).
- Feeling like you're losing your balance when walking, especially when climbing stairs.
- Difficulty walking at night or in dark places.
- Having to walk with your feet apart to maintain balance.
- Oscillopsia is the sensation that objects that are not moving seem to be spinning. This is called oscillopsia .
- Feeling dizzy, like your head is spinning, like your arms are spinning, or feeling tired.
Imagine how uncomfortable it would be if you suddenly felt dizzy while doing your daily tasks, or if you started to faint while walking? These are the signs we need to pay attention to.
How does this affect young children?
If this condition occurs in young children, especially those who are old enough to learn to talk, it can be a major obstacle to their learning and communication with others. As parents, we should be very attentive to these symptoms:
- Difficulty staying focused, whether at school or when studying something else.
- Getting tired quickly when you have to listen for a long time.
- Difficulty understanding what others are saying, being hesitant to speak, or not speaking at all. Sometimes this can also be a reason why a child's speech is delayed.
If a child is very interested in learning something, but suddenly loses interest in it, or if they constantly say they are tired, you should think about this a little more than just thinking that it is a mischief.
Why does this ototoxicity occur?
According to doctors,
there are more than 200 types of drugs that can damage our inner ear (ototoxic drugs). Some of these drugs require a prescription from a doctor. But some, for example, some painkillers, can be purchased at a pharmacy without a prescription.
The important thing is that many of the medications that are said to be harmful to the ear are actually essential life-saving medications. For example, medications for cancer, or medications for severe bacterial infections. In such cases, the benefit of taking the medication, which is to save a life , far outweighs the minor harm that may be done to the ear.
Also, some `(ototoxic)` drugs only cause harm if taken in very high doses. We don't usually take such high doses. There are several main classes of drugs that can harm the ear:
Aminoglycoside antibiotics
These are a type of antibiotic given to treat bacterial infections. Along with anticancer drugs, this class of drugs (aminoglycosides) is considered the main cause of ototoxicity. Here are some examples:
- `(Amikacin)`
- `(Gentamicin)`
- `(Kanamycin)`
- `( Neomycin )`
- `(Netilmicin)`
- `(Streptomycin)`
- `(Tobramycin)`
- `(Vancomycin)` (This is also sometimes included in this category)
Chemotherapy drugs
Medications used to treat various types of cancer. Some of these can be harmful to the ears:
Loop diuretics - "water pills"
These are medications that help the kidneys excrete excess salt and water from the body through urine. Some people also call them "water pills." Some of these include:
- `(Bumetanide)`
- `(Ethacrynic acid)`
- `( Furosemide )` (This is a medicine that many people know)
- `(Torsemide)`
Other medicines and chemicals
Although rare, ototoxicity can also be caused by:
- Quinine:Medicines given to treat malaria.
- Salicylates : These are over-the-counter pain relievers . Aspirin, which we all know, is a type of salicylate. However, it is when taken in high doses and for a long time that problems can occur.
- Chemicals in the environment: Sometimes this condition can be caused by things like mercury , tin, lead, and carbon monoxide in the environment.
What are the risk factors?
The risk of developing this condition of ototoxicity is not the same for everyone. Depending on the medication you are taking, your doctor will explain these risk factors to you. Some common factors include:
- The type of medication you are taking: Some medications carry a higher risk of this than others.
- Dosage of the medicine: How much to take.
- How long to take the medicine.
- Whether you are taking several medications that can be harmful to the ears at the same time. Doing so may increase the risk even further.
In addition, scientists have found that
some people's genes (DNA) may also have an effect . In particular, some people's genetic
makeup (or structure) may increase the risk of ototoxicity when taking certain aminoglycoside antibiotics.
Complications due to ototoxicity
The damage to the inner ear caused by these ``ototoxic`` drugs
is often ``irreversible`` . That means that long-term problems with hearing and balance can occur. Especially in young children, these hearing problems can hinder their ability to speak, learn language, and even develop the skills they need to communicate with others. Imagine, if a child can't hear words properly, how will they learn to use those words to speak? However, even if the damage can't be reversed, doctors can monitor your condition, treat symptoms if they arise, and provide the necessary support.
How to recognize this condition?
If you have these symptoms, you may need to see an ear, nose, and throat specialist (otolaryngologist or ENT specialist) or an audiologist. They will perform various tests to examine your inner ear, depending on your symptoms. The most important thing is
that your doctor can test your hearing and balance before giving you a medication that is suspected of being ototoxic.Also, you can have these tests done periodically while you're taking the medication. That way, if there's any change as a side effect of the medication, you can quickly identify it.
What tests are performed?
To see how your inner ear is working, your doctor may do tests like these:
- Audiogram: This tests how well you hear different sounds, i.e. soft sounds, loud sounds, high and low sounds (pitch), and how well you understand words.
- Auditory Brainstem Response (ABR) test: This tests how your auditory nerve responds to sounds and how that response travels to the brain.
- Otoacoustic Emissions (OAEs) test: Very fine hair-like structures in the inner ear (hair cells in the cochlea) emit very slow vibrations (sound vibrations) in response to sound. This test measures these vibrations to see how well the cells are working.
- Vestibular test battery: This is not a single test, but a series of tests to check for balance problems. For example, this may include tests such as `(Videonystagmography - VNG)` (watching eye movements), `(Vestibular Evoked Myogenic Potentials - VEMPs)` (watching the responses of the nerves involved in balance), `(Rotary chair test)` (testing while sitting in a rotating chair), and `(video Head Impulse Testing - vHIT)`.
How is ototoxicity treated?
Unfortunately, stopping an ototoxic medication
does not reverse the damage that has already occurred. However, stopping the medication or reducing the dose (if possible)
can help prevent further damage. However, as we have already mentioned, these ototoxic medications are often life-saving. Therefore, stopping them or making major changes to your treatment plan is not always possible. In such cases, your doctor will monitor your response to the medication and help you manage your symptoms.
Tools and methods to help manage symptoms
Although the damage cannot be reversed, there are ways to help you live with the symptoms:
- Hearing aids: These devices help people with hearing loss, especially those who are hard of hearing, to hear things better and to make communication easier.
- Cochlear implants: These are electronic devices that are surgically placed inside the ear. They are often used for people with severe hearing loss who do not respond well to regular hearing aids.
- Vestibular rehabilitation:This is a special training. You will work with a vestibular therapist or physical therapist to learn exercises and techniques that will help your body adapt to and cope with balance problems caused by inner ear problems. This can help reduce symptoms such as dizziness and difficulty walking.
Can ototoxicity be prevented?
This condition is not always completely preventable. Sometimes, it is necessary to give an ototoxic medicine to save your life. However,
if you recognize the symptoms early, your doctor can help you quickly and possibly take steps to reduce further damage. If you are taking a medicine that is more likely to damage your ears, your doctor will monitor you regularly. He or she will also tell you what symptoms to watch out for and what signs to see a doctor if you notice them.
How long will this situation last?
Damage to the inner ear caused by ototoxicity
is irreversible . This means that the damage is permanent. However, depending on your condition, your doctor may be able to change your treatment plan (if possible) to stop further damage and symptoms from getting worse. However, because it is often not possible to stop taking the medication, your doctor will develop a long-term treatment plan to help you manage your symptoms. Depending on your diagnosis and the medication you are prescribed, your doctor will talk to you about the risks of taking an ototoxic medication.
How can I take care of myself and my child?
- Talk to your doctor about the risks and side effects of any medication you are given. Don't be afraid to ask questions.
- If you notice any new changes in your hearing, balance, or any other symptoms after starting a medication that you suspect is ototoxic, even if it's minor, see your doctor immediately.
- If you are a parent or caregiver giving this medication to a young child, be very observant of any changes in your child. It can be difficult to recognize symptoms in young children. In addition to looking for signs of hearing or balance problems, be aware of any signs that your child is having trouble concentrating or is constantly tired. It is possible that the frustration your child is experiencing may be due to a hearing problem. If you have any concerns, see your doctor for advice.
How quickly does ototoxicity begin?
It varies from person to person.
Some people may experience side effects right away when they start taking the medication. For others,
these symptoms may not appear until five years after starting treatment. Some treatments and medications have delayed effects. This is why it is important to have regular hearing tests that your doctor recommends to monitor your hearing.
Remember, many of the medications associated with ototoxicity, such as antibiotics and chemotherapy drugs, are essential for life. Although they can cause damage to the inner ear, the benefits of taking them, whether it's treating the disease or saving a life, far outweigh the risks.
If you are taking a medication that is known to be harmful to your ears, talk to your doctor about any warning signs that may be developing in your inner ear.
The sooner you recognize changes, the sooner your doctor can help you and give you an appropriate care plan. The most important thing we need to remember! (Take-Home Message)
Okay, so let's take a look at a summary of what we've talked about to help you remember some of the most important points:
- Ototoxicity is damage to the inner ear caused by certain medications. This can affect hearing and balance.
- Be aware of symptoms such as tinnitus (ringing in the ears), hearing loss, and dizziness.
- Even though there are risks when taking life-saving medications, the benefits of the medication often outweigh the risks. However, it is important to be aware of the risks.
- If you have been prescribed an ototoxic medication, talk to your doctor about it and attend the scheduled tests.
- If you notice any new symptoms, even if they are minor, tell your doctor right away. Prompt treatment can help prevent the condition from getting worse.
It is your responsibility to take care of your health. We hope this information will help you do so!
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