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Triggers for Ringing: 5 Common Drugs That Cause Tinnitus

Young man feeling discomfort from tinnitus ringing sounds

Tinnitus (persistent ringing in the ears) often results from various health conditions or environmental factors. There is no definitive cure for this condition, but management strategies are deemed helpful. While many turn to prescription or over-the-counter medications for relief, it’s worth noting that some drugs can just trigger or worsen the symptoms. These medications are known as “ototoxic” (toxic to the ear) drugs.

Both prescription and non-prescription drugs can fall under ototoxic medications, and we’ll try to identify as many of them as we can here. In this guide, we will also examine their impact on hearing and the types of drugs most likely to cause tinnitus.

What Are Ototoxic Drugs?

Medically, “ototoxic” comes from “oto” (ear) and “toxic” (harmful). These drugs can damage the delicate hair cells in the cochlea, which are essential for transmitting sound signals to the brain. Ototoxic medications can damage the inner ear and cause hearing loss, tinnitus, or balance problems (dizziness).

There are over 200 known ototoxic drugs, including prescription and over-the-counter medications, that are widely accessible. These medications include aminoglycoside antibiotics, cancer chemotherapy drugs, and pain relievers. It’s a long list, and the truth is that the chances of developing drug-induced tinnitus are uncertain. The risks depend on several factors, including the dose and duration of treatment, the speed of infusion for intravenous drugs, and whether other ototoxic drugs are being taken.

How Do These Drugs Affect Your Hearing?

Most medicines come with side effects. These adverse reactions may include allergies, dizziness, or sensory impairments, including hearing. Ototoxicity, or drug-induced hearing loss, occurs when certain medications damage the inner ear. When they accumulate in the inner ear, they interfere with blood flow and auditory nerve function. This disruption may result in subjective tinnitus (heard only by the affected individual) or, more rarely, objective tinnitus (audible to others, often linked to middle ear conditions).

Unlike age-related hearing loss, which typically affects high-frequency sounds, ototoxic hearing loss can impact a wider range of frequencies. This explains the dizziness or balance problems due to inner ear disruption. Additionally, they can lead to temporary or permanent hearing issues.

Below, we’ll discuss five common drugs that can cause tinnitus and amplify perception.

5 Common Drugs That Cause Tinnitus

An expert treatment and consultation for managing tinnitus can identify and address medication-induced symptoms. If you’re experiencing tinnitus after starting a new medication, discussing alternatives with your healthcare provider or audiologist tinnitus specialist is crucial. Below, we explore five common types of drugs known to cause or worsen tinnitus.

1. Antibiotics

Certain antibiotics are strongly associated with tinnitus and hearing loss. These include:

  • Aminoglycosides (e.g., gentamicin, streptomycin, tobramycin)

  • Macrolides (e.g., erythromycin, azithromycin)

Aminoglycosides are the primary class of antibiotics most likely to cause tinnitus, often prescribed for severe bacterial infections. These antibiotics can accumulate in the inner ear, damaging the sensory cells responsible for hearing. Antibiotic ear drops like Cortisporin and Casporyn HC contains aminoglycosides. These can cause permanent hearing loss and should not be used for more than 10 days or on perforated eardrums.

Macrolides, although less ototoxic, can still affect individuals sensitive to auditory side effects. Regular hearing evaluations during prolonged antibiotic use can help detect any early signs of cytotoxicity.

2. Anti-Malarials

Antimalarial drugs are effective against malaria but can trigger tinnitus or worsen existing tinnitus. Examples of these antimalarials include:

  • Quinine (also treats nocturnal leg cramps)

  • Chloroquine (also used for autoimmune diseases)

  • Hydroxychloroquine (also treats lupus and rheumatoid arthritis)

Tinnitus caused by antimalarials is usually temporary and resolves once the medication is stopped, especially when taken at standard doses.

If you experience any signs of this side effect, discuss it immediately with your healthcare provider. Individuals with pre-existing hearing conditions or those on high doses of antimalarials may face an increased risk. These medications can interfere with nerve signals in the inner ear. Depending on your case, the impact can make tinnitus permanent.

3. Blood Pressure Medications

Beta-blockers, ACE inhibitors, and loop diuretics (e.g., furosemide) used to treat high blood pressure can sometimes cause tinnitus. There’s no exact reason for this, but one theory suggests it’s the reduced blood flow to the inner ear. This side effect of lowering blood pressure may contribute to the condition.

Loop diuretics, in particular, reduce fluid buildup in the body but can disrupt the delicate hair cells in the cochlea, leading to hearing problems. These “loop diuretics” include:

  • Furosemide (Lasix)

  • Ethacrynic acid

  • Bumetanide

While the effects are often temporary, individuals experiencing persistent symptoms should consult their provider about adjusting dosages or switching medications.

4. Cancer Medications

Many chemo drugs are considered “ototoxic,” meaning they can be harmful to the inner ear and lead to hearing loss and tinnitus. For example, cisplatin and carboplatin (platinum-based chemotherapy medications) are highly ototoxic. They can cause tinnitus as a side effect, as they can damage the sensitive tissues in the inner ear responsible for hearing.

Patients treated for cancers like ovarian, testicular, colon, and rectal cancer may experience tinnitus due to chemotherapy. High doses of these drugs can also increase the risk of developing tinnitus. A recent study found that up to 40% of cancer survivors taking platinum and taxane-containing drug regimens experienced tinnitus. In this study, the researchers haven’t inquired much into how chemotherapy can cause hearing loss, but they uncovered these two scenarios:

  • When children are treated with certain chemotherapy drugs, especially those containing platinum, they can sometimes lose some of their hearing.

  • Adults with testicular cancer or head and neck cancer who receive chemotherapy, particularly with platinum-based drugs, are also at risk for hearing loss.

5. Pain Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) are most frequently linked to tinnitus. Aspirin, ibuprofen, and naproxen are also known pain medications that can trigger symptoms. These medications can affect blood flow to the auditory nerve, leading to temporary or permanent tinnitus. High dosages of these drugs can heighten perception and make it worse for sufferers. Likewise, taking them regularly, even at moderate doses, can contribute to tinnitus.

Other Ototoxic Drugs

A broader range of drugs can develop tinnitus. Let’s delve deeper into the mechanisms and specific examples of these other ototoxic medications.

Accutane

Used to treat severe acne, Accutane can lead to temporary hearing loss or tinnitus in some cases. While the exact mechanism is not fully understood, it’s believed that Accutane might affect the delicate structures of the inner ear. Patients may experience a temporary ringing in the ears or reduced hearing acuity. Regular hearing tests during Accutane treatment can help detect any potential hearing issues early on.

Anti-Anxiety Medications

Benzodiazepines, commonly prescribed for anxiety, can impact the central nervous system, including the auditory pathways. This can lead to altered hearing perception and tinnitus. Prolonged use of benzodiazepines may result in persistent tinnitus.

Tricyclic antidepressants can also cause or worsen tinnitus. These include amitriptyline and nortriptyline (Pamelor). Other antidepressants that can cause tinnitus include selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro).

Note: Abruptly stopping antidepressants after long-term use can also cause tinnitus.

Anticonvulsants

Drugs used for epilepsy or nerve pain, such as topiramate, are linked to tinnitus development. In fact, tinnitus is a common side effect of this medication. Some anticonvulsants, particularly those that target specific neurotransmitters, can affect the auditory system.

Cardiac Medications

Certain drugs for heart failure or arrhythmias, including beta blockers, can reduce blood flow to the auditory system, worsening tinnitus.

Quinine-Based Medications

Quinine, often used for rheumatoid arthritis and leg cramps, can damage hearing nerves, leading to tinnitus sound disturbances. Tinnitus is a common side effect of quinine therapy, particularly with long-term use. This drug should be used with caution and under medical supervision, especially in individuals with pre-existing hearing problems.

Is There a Cure for Ototoxicity-Induced Hearing Loss?

Currently, no government-approved cure exists for ototoxicity-induced hearing loss. Once the damage is done to the delicate hair cells in the inner ear, it’s irreversible. However, there are strategies to manage the effects of ototoxicity and improve quality of life. These include:

  1. Hearing Aid: These devices can amplify sounds, helping to compensate for hearing loss.  

  2. Auditory Rehabilitation: This involves training the brain to better process sounds and understand speech.  

  3. Communication Strategies: Techniques like lip-reading and sign language can help with communication difficulties.  

It’s crucial to work closely with healthcare professionals, including experts from an audiology clinic in Toronto, to develop a personalized treatment plan for ototoxicity-induced tinnitus or hearing loss.

How Can You Avoid Ototoxicity?

While there’s no guaranteed way to completely prevent ototoxicity or treat tinnitus, for that matter, you can reduce the risk with the following strategies.

Medication-Related Prevention

  1. Consult your healthcare provider. Always discuss potential side effects, including ototoxicity, with your healthcare provider before starting any new medication.  

  2. Monitor your hearing. Regular hearing tests can help detect early signs of hearing loss.  

  3. Avoid taking more than what’s prescribed, as this can increase the risk of side effects.  

  4. If possible, discuss alternative treatments with your healthcare provider that may have fewer side effects.

Noise-Related Prevention

  1. Avoid exposure to loud noise, especially for extended periods.  

  2. Use hearing protection. Wear earplugs or noise-canceling headphones in noisy environments.  

  3. Lower the volume on your devices, such as TVs, stereos, and headphones.  

Lifestyle Factors

  1. Take care of yourself. Make sure you eat well and get enough sleep and regular exercise which all support your hearing health as part of your health overall.

  2. Manage stress. Stress can exacerbate tinnitus symptoms. Practice relaxation techniques, such as meditation or yoga.  

If you experience any changes in your hearing or notice symptoms like ringing in the ears, consult with a healthcare professional promptly.

What Should I Do If I Think Drugs Are Causing Tinnitus?

In most cases, tinnitus caused by ototoxic medications is an acute, short-lived side effect. If the patient stops taking the medication, the tinnitus symptoms typically recede. If you suspect a prescription medication is causing tinnitus:

1. Consult your prescribing physician immediately. Do not stop taking the medication without medical advice.

2. Visit a hearing center or audiologist for a full evaluation of your hearing health.

3. Explore tinnitus treatment options, including sound therapy, tinnitus retraining therapy, and hearing aids, to manage symptoms effectively.

Conclusion

Tinnitus induced by ototoxic medications can feel like more than just a side effect. It could become a separate new burden, affecting your daily activities and lifestyle. Understanding the link between them and how to avoid ototoxicity can help you protect your hearing health. Working closely with your healthcare provider or audiologist, monitoring symptoms, and exploring available treatments can effectively manage and prevent further hearing complications.