Ototoxicity

Ototoxicity

Up to 80% of adults have hearing loss after chemotherapy.1 

Ototoxicity refers to damage to the hearing and / or balance organs that occurs after exposure to medications or chemicals that affect the inner ear. Ototoxic medications can damage hearing, balance, or both. 


Hearing System 

Sounds travel from the outer ear through the ear canal and eardrum, through the middle ear, and finally to the hearing organ located in the inner ear. From here, sounds are converted into neural impulses that travel to the brain. The ears are fully formed at birth but mature through childhood. 

What are the Symptoms of Ototoxicity? 

Damage to the hearing organs can range from mild to profound hearing loss and may include tinnitus (ringing in the ears). If the balance organs are damaged, the individual may experience symptoms ranging from dizziness and nausea to imbalance and blurry vision (oscillopsia).  Symptoms may be temporary or permanent. 


Common Ototoxic Medications 

Many drugs and chemicals are known to be ototoxic. If you are taking any of these drugs, do not stop taking them. Contact your health care provider about your concerns. 
  • Aspirin 
  • Quinine  
  • Loop diuretics (e.g., Lasix) 
  • Aminoglycoside antibiotics (e.g., gentamicin, neomycin, streptomycin, amikacin) 
  • Chemotherapy (e.g., cisplatin, carboplatin) 

Common Environmental Chemicals 

It is also possible to be exposed to chemicals in the environment that can lead to hearing and balance problems. These include: 
  • Mercury 
  • Lead 
  • Carbon monoxide 

How is Ototoxicity Diagnosed? 

Diagnosis is made from the individual’s history, symptoms, and test results. There is no specific test for ototoxicity, but it is taken into consideration where there is a positive history of exposure to medicines or chemicals known to cause hearing loss. Additional testing to evaluate the inner ear may also be completed. 

Can You Reduce the Effects? 

If you are currently taking a medication and have concerns about your hearing and / or balance, talk to your health care provider.  
  • Use hearing protection 
  • Avoid loud noises 
  • Stay hydrated  
  • Monitor your hearing and balance, especially if you suspect a change 

Role of Audiologists 

Audiologists identify, diagnose, and provide treatment options for patients with medication-related hearing loss and dizziness. They work closely with physicians and are an important part of the management team. 

Do you think you or a family member may have an inner ear disorder? Find an Audiologist near you to set up an appointment. 


References

 Frisina RD et al. 2016. Comprehensive audiometric analysis of hearing impairment and tinnitus after cisplatin-based chemotherapy survivors of adult-onset cancer. J Clin Oncol 34(23): 2712-2720.