Yes, some medicines can bother your ears. The good news: with smart planning and simple check-ins, you can protect your hearing without skipping the treatment your body needs.

Wait—Medicine Can Harm Hearing?

It’s called ototoxicity: ear (oto) + toxicity. Certain drugs can irritate the inner ear, the auditory nerve, or balance system. Sometimes the effect is temporary (think ringing after high-dose aspirin). Sometimes it’s permanent (as can happen with certain chemotherapy drugs and IV antibiotics). Knowing your risk up front is prevention power.

Common culprits you might hear about

  • Chemotherapy: Cisplatin (higher risk), carboplatin (lower risk). Can cause high-frequency hearing loss and tinnitus.
  • Aminoglycoside antibiotics: Gentamicin, tobramycin, amikacin. Potent, life-saving drugs with ear and balance risks, especially with elevated blood levels or prolonged use.
  • Loop diuretics: Furosemide, bumetanide. Risk rises with rapid IV dosing or kidney problems; usually reversible when used appropriately.
  • Salicylates and NSAIDs: High-dose aspirin and some non-steroidal anti-inflammatory drugs can trigger reversible tinnitus and small threshold shifts at high or chronic doses.
  • Macrolide antibiotics: Azithromycin and erythromycin have been linked to temporary hearing changes, usually at higher doses or in older adults.
  • Others (less common or situational): Vancomycin (especially combined with aminoglycosides), quinine-class drugs, some immunosuppressants. Certain ear drops with aminoglycosides (like neomycin) can be risky if the eardrum is perforated or you have tubes.

Important: No one should stop a necessary medication because of something they read online. The goal here is to prevent problems through monitoring, smart dosing decisions, and quick responses if early symptoms appear.

Who’s More at Risk?

Personal factors

  • Existing hearing loss or troublesome tinnitus
  • Kidney or liver disease (affects how drugs are cleared)
  • Advanced age or very young age
  • Regular loud-noise exposure (work, hobbies, concerts)
  • Genetics (for example, a mitochondrial variant can raise aminoglycoside risk)

Treatment factors

  • High cumulative dose or fast IV push (loop diuretics)
  • Combining multiple ototoxic drugs (e.g., cisplatin + aminoglycoside)
  • Dehydration or low blood pressure episodes
  • Long hospital stays in noisy environments

Your Prevent-Before-You-Treat Checklist

Bring this list to your next appointment if you’re starting a potentially ototoxic medication. It makes the conversation faster and safer.

  • Get a baseline hearing check. Ask for a referral to an audiologist for a baseline audiogram. If available, include extended high-frequency testing (beyond 8 kHz) and otoacoustic emissions (OAEs). These can show early changes before you notice symptoms.
  • Ask about safer alternatives or dosing tweaks. Could the plan use a less ototoxic drug, a different route, slower infusion, or therapeutic drug monitoring (especially for aminoglycosides)?
  • Plan regular monitoring. For higher-risk regimens (cisplatin, aminoglycosides), set up mid-treatment and post-treatment hearing checks. Monitoring intervals vary—your care team can guide you.
  • Protect against noise. While on therapy, avoid concerts, loud tools, and long headphone sessions. Carry earplugs. Your inner ear is more vulnerable when inflamed by medication.
  • Stay hydrated and kidney-kind. Healthy hydration and kidney protection strategies your doctor recommends can help keep drug levels in check.
  • Avoid unnecessary drug stacking. Share all prescriptions, OTCs, and supplements with your pharmacist and care team to avoid double-ototoxic combinations.
  • Know the early warning signs. New tinnitus, fullness, trouble hearing speech in noise, distorted sound, or imbalance during treatment—report quickly.

Smart Questions for Your Care Team

Use these as prompts; you don’t have to ask them all. Pick the two or three that fit your situation.

  • “Am I receiving any medications known to affect hearing? If so, what is my personal risk?”
  • “Can we get a baseline audiogram before I start? How often should we monitor?”
  • “Are there dosing strategies that lower risk (slower infusion, therapeutic monitoring, spacing with other meds)?”
  • “What symptoms should I report immediately, and who do I call after hours?”
  • “If I develop hearing changes, can we pause, adjust, or switch without compromising outcomes?”
  • “For ear drops: Is my eardrum intact? If not, can we use a non-ototoxic alternative?”

At Home: Monitor Without the Anxiety Spiral

You don’t need a daily lab report. You do need a simple routine.

  • Weekly quick check: Use the same quiet room and a reputable hearing-check app or calibrated earbuds once a week during therapy. You’re looking for noticeable changes, not perfection.
  • Symptom snapshot: Jot down any new ringing, fullness, pitch changes, or balance issues. Note the date and which ear. Patterns help your care team.
  • Sound diet: Keep volumes modest. If you must be around loud sound, wear protection and keep exposure short.
  • Sleep and stress: Fatigue and stress make tinnitus feel louder. Protect your energy—your ears will thank you.

Special Situations That Deserve Extra Care

Chemotherapy (especially cisplatin)

Cisplatin is highly effective—and a known ototoxic agent. Hearing changes may start at very high pitches and creep lower.

  • Monitoring: Baseline + testing before each cycle is common in higher-risk cases. Report new tinnitus promptly.
  • Otoprotectants: In children, sodium thiosulfate has reduced cisplatin-related hearing loss in clinical trials. Adult use is still being studied; ask your oncologist if any protective strategies are appropriate for you.
  • Noise synergy: Avoid loud sound on treatment days and the days after infusion.

IV/ICU and hospital care

  • Diuretics: Rapid IV pushes of loop diuretics carry higher risk than slower infusions—this is a good discussion point with your team.
  • Noisy wards: Alarms and equipment can be loud. When safe and approved by staff, use soft earplugs for rest.
  • Drug combos: Aminoglycoside plus another ototoxic medicine increases risk—pharmacists are your allies in catching this.

Ear drops and eardrum status

If you have a perforated eardrum or tubes, some antibiotic ear drops that contain aminoglycosides (like neomycin) may be risky. Ask whether a non-ototoxic option (often a fluoroquinolone drop) fits your case.

Over-the-counter pain relief

For most adults using label doses for short periods, the hearing risk from OTC NSAIDs is low and reversible. Long-term high dosing is a different story. If you need daily pain relief, ask about options and dosing that are gentler on ears and kidneys.

If You Notice a Change, Act Early

Don’t wait for it to “settle.” Early action can prevent further damage or prompt a treatment tweak.

  • Call your prescriber promptly if you get new tinnitus, muffled sound, or balance issues during treatment. Share when it started and which ear.
  • Schedule an urgent hearing test with an audiologist. Bring your medication list and any home check results.
  • Don’t stop a prescription on your own. Many changes are reversible; your team can guide safe adjustments.

What About Supplements to “Protect” Hearing?

Antioxidants and minerals are being studied, but there’s no universal, proven ear-protective supplement for people on ototoxic drugs. Some can interact with cancer therapy or blood thinners. Before you add anything, run it by your oncologist, pharmacist, or ENT.

The Big Picture

Your ears don’t have a spare. But you also shouldn’t fear the meds that could save your life or mobility. The sweet spot is informed prevention: baseline testing, reasonable monitoring, smart dosing strategies, and fast reporting of changes. That’s how you protect hearing and health.

If you’re about to start an ototoxic medication—or you’re on one now—consider booking a baseline or follow-up with a licensed audiologist. It’s a small step with big peace-of-mind.

Further Reading

- Before You Swallow or Infuse: Outsmart Drug‑Induced Hearing Loss (Prevention) - Medicines Can Be Noisy: Preventing Drug‑Induced Hearing Loss and Tinnitus (Prevention) - Ear‑Safe Prescriptions: How to Spot and Prevent Drug‑Related Hearing Damage (Prevention) - When Noise Isn’t the Only Villain: How Solvents and Metals Turbo‑Charge Hearing Loss (Research)

Frequently Asked Questions

Are over-the-counter pain relievers safe for my hearing?

Used as directed and for short periods, most people won’t have lasting hearing effects from OTC NSAIDs or aspirin. High daily doses or long-term use can trigger reversible tinnitus or small hearing shifts. If you need daily pain control, ask your clinician about the safest choice and dose for your ears and kidneys.

Is hearing loss from chemotherapy permanent?

It can be. Cisplatin, in particular, may cause permanent high-frequency hearing loss and tinnitus. Monitoring before and during treatment helps catch early changes. Your oncology team can discuss dose adjustments and, in select cases, protective strategies under study. Don’t delay or change chemo without your oncologist’s guidance.

Can supplements protect me from ototoxic drugs?

There isn’t a proven, one-size-fits-all supplement that prevents drug-related hearing loss. Some antioxidants are under study, and sodium thiosulfate is used in specific pediatric cisplatin protocols. Always discuss supplements with your care team to avoid interactions and false security.

I take furosemide for heart failure—should I worry?

Furosemide can affect hearing, particularly with rapid IV dosing or in people with kidney issues. When used at typical oral doses and monitored appropriately, serious ear effects are uncommon. Keep your prescriber informed about any hearing changes, take the dose as directed, and ask whether periodic hearing checks make sense for you.

References