Medicine And Your Ears: Prevent Drug-Induced Hearing Loss Before It Starts

Some lifesaving medicines can be hard on your ears. The good news: with a plan, you can often reduce the risk of hearing loss or ringing (tinnitus) while still getting the treatment you need. Think of this as a playbook for protecting your hearing—without playing doctor. Never stop a prescribed medication without talking to your clinician.

Wait—are medicines really a risk to hearing?

Yes. Ototoxic medications are drugs that can damage the inner ear (cochlea or balance organs) or the hearing nerve. Sometimes effects are temporary—like the classic high-dose aspirin “ringing.” Other times, especially with certain chemotherapy drugs or IV antibiotics, changes can be permanent. Risk depends on the drug, dose, duration, delivery (IV vs. oral), your health, and even your sound environment.

Prevention isn’t about fear—it’s about teamwork and timing: know your risks, get a baseline hearing check, monitor changes, and adjust early if problems show up.

The usual suspects: common ototoxic medications

This isn’t a complete list, but these categories come up often. Do not discontinue any medication without medical guidance.

Chemotherapy: cisplatin (highest risk), carboplatin.
Aminoglycoside antibiotics (often IV): gentamicin, tobramycin, amikacin, streptomycin.
Loop diuretics: furosemide, bumetanide, especially high-dose IV or combined with other ototoxins.
Salicylates and NSAIDs: high-dose aspirin; chronic or high-dose ibuprofen/naproxen (risk is usually lower and sometimes reversible).
Macrolide antibiotics: erythromycin (particularly IV, high dose); clarithromycin in some cases.
Antimalarials: chloroquine, quinine (rare at modern doses but reported).
Ototoxic ear drops: drops containing aminoglycosides (e.g., neomycin) can be risky if the eardrum is perforated or you have tubes.

Many people take these drugs safely. Prevention is about identifying higher-risk scenarios and watching closely.

Whos more at risk?

High dose, IV infusions, or long courses, especially with cisplatin or aminoglycosides.
Combo therapies that stack risks (e.g., cisplatin + loop diuretic; aminoglycoside + loop diuretic).
Kidney disease or dehydration, which raises blood drug levels.
Older age or pre-existing hearing loss/tinnitus.
Loud noise exposure during treatment—noise and drugs can amplify each others damage.
Genetic susceptibility (e.g., MT-RNR1 variants increase aminoglycoside risk).
Eardrum perforation or ear tubes when using certain ear drops.

Build your prevention plan (step by step)

1) Make a meds map

List everything you take: prescriptions, over-the-counter pain relievers, decongestants, supplements, drops, and topicals. Share it with your prescriber and pharmacist. Ask directly, Any ototoxicity concerns here?

2) Get a baseline hearing check

Before starting a higher-risk drug, book an audiology appointment. Ask for:

Comprehensive audiogram including extended high frequencies (above 8 kHz). Early ototoxicity often shows up in the highs first—catch it there, and you can act earlier.
Otoacoustic emissions (DPOAEs) to pick up subtle hair cell changes.
Speech-in-noise testing and a quick tinnitus/hyperacusis snapshot, so you have a clear before picture.

Cant get in before the first dose? Schedule as soon as possible and note any changes you notice at home.

3) Set a monitoring schedule

Frequency depends on the drug and your risk:

Chemotherapy (cisplatin/carboplatin): test baseline, then before each cycle and shortly after. More often if changes appear.
Aminoglycosides: test baseline; then weekly or per protocol during therapy.
Loop diuretics or macrolides: monitor if high dose, IV, prolonged, or if you notice symptoms.

Red flags to trigger a prescriber conversation: a 10 dB shift at two adjacent frequencies, new tinnitus, sudden muffled hearing, or new dizziness.

4) Reduce combined risks

Turn down the noise: avoid concerts, loud tools, and high-volume headphones during treatment and recovery. If you must be in noise, wear well-fitted ear protection.
Hydrate and monitor kidney function if your clinician advises; this helps with drugs cleared by the kidneys.
Avoid stacking ototoxins: limit other potentially ototoxic meds unless theyre necessary—coordinate with your care team.

5) Optimize how the drug is given (with your prescriber)

Ask whether any of these are appropriate for you:

Alternative agents with lower ototoxic potential when clinically reasonable.
Dose adjustments or slower infusions to minimize peak levels.
Therapeutic drug monitoring (e.g., aminoglycoside troughs).
Protective strategies in specific cases—example: sodium thiosulfate may be used in pediatric patients receiving cisplatin to reduce ototoxicity risk. Adult use varies; ask your oncology team whats evidence-based for you.
Safer ear drop choices (e.g., fluoroquinolone drops) if you have a perforated eardrum or tubes.

6) Document and speak up early

Keep a simple log: dates, doses, any ear symptoms (ringing, fullness, muffled hearing, balance changes), and loud noise exposures. Report changes promptly to your prescriber and request a quick audiology re-check.

What monitoring looks like (and why it works)

Ototoxicity tends to show up at the highest frequencies first. Extended high-frequency audiometry and DPOAEs can detect microscopic inner-ear stress before you notice day-to-day trouble. Catching early shifts gives your team a chance to pause, adjust, or protect—often preserving your speech-range hearing.

In the clinic

Extended high-frequency audiogram to 12–16 kHz when possible.
DPOAEs for outer hair cell function.
Speech-in-noise to gauge real-world impact.

At home (between visits)

Symptom check-ins: brief daily note on ringing, fullness, or muffled sound.
Noise awareness: use your phones sound level app to avoid high exposures.
Headphone habits: keep volumes low; prefer over-ear, closed-back styles that isolate better at safer levels.

Ear drops: small bottle, big rules

Topical ear medications are generally safe—but theres a key exception. Aminoglycoside-containing drops (like neomycin) can be ototoxic if they pass through a perforated eardrum or tube into the middle ear and inner ear.

If you have tubes or a known perforation, ask for non-ototoxic options (often fluoroquinolone drops) unless your ENT advises otherwise.
Dont self-start old drops from the cabinet; get a fresh exam, especially if theres pain, drainage, or hearing changes.
Keep ears dry and ventilated as advised when treating infections; moisture can prolong problems.

Noise + drugs = double trouble

Loud sound stresses the same inner-ear cells that ototoxic drugs target. Together, the damage can add up. So during and shortly after higher-risk treatment:

Skip loud venues, or go with musicians earplugs that reduce volume evenly.
At work, ensure hearing protection is fit-tested and worn consistently.
Use quiet recovery windows—your ears heal best off-duty.

If symptoms show up, act now

New ringing, muffled hearing, or balance issues? Contact your prescriber as soon as you notice. Ask whether to pause, adjust dose, or switch—based on your medical priorities.
Book an urgent audiology check to document changes and guide decisions.
Sudden one-sided muffled hearing warrants same-day medical attention. Early care can make a difference.

Most medication decisions involve trade-offs. Your job is to flag changes early; your teams job is to weigh risks and benefits with the best data possible.

Conversation starters for your care team

Is this drug known to affect hearing or balance? Whats my personal risk?
Can we do a baseline and follow-up hearing test (including high frequencies and DPOAEs)?
Are there lower-ototoxic alternatives, dosing changes, or infusion rates that could help?
Which symptoms should prompt me to call you immediately?
While on this therapy, should I avoid other meds like high-dose NSAIDs?
If I have ear tubes or a perforation, which ear drops are safest for me?

Your hearing is part of your overall health. Bring an audiologist into the circle—especially if youre starting higher-risk meds, notice tinnitus, or feel suddenly muffled. A quick baseline today can prevent a long-term I wish wed known sooner.

Frequently Asked Questions

Should I avoid ibuprofen or aspirin altogether?

Not necessarily. Occasional, low-dose use for a short time is unlikely to cause lasting hearing changes for most people. Risk rises with high doses, long-term use, and when combined with other ototoxic drugs. If you need pain relief often, talk with your clinician about the lowest effective dose, shortest duration, and possible alternatives. Never stop a medication your doctor has recommended without consulting them.

If a medicine causes tinnitus, will it go away?

Sometimes. Tinnitus from high-dose salicylates (like aspirin) often fades after the dose is reduced or stopped under medical guidance. In contrast, tinnitus tied to inner-ear damage from drugs like cisplatin or aminoglycosides can persist. Reporting symptoms early and getting hearing monitored improves your chances of limiting long-term effects.

Are there proven supplements to prevent ototoxicity?

No supplement is universally recommended to prevent drug-induced hearing loss. Antioxidants such as N-acetylcysteine or D-methionine show promise in research but are not standard of care. One exception in practice is sodium thiosulfate for some children receiving cisplatin, prescribed by oncology teams. Always discuss supplements with your clinician to avoid interactions.

Are ear drops with neomycin safe if I have ear tubes or a perforation?

Caution is warranted. Aminoglycoside-containing drops (like neomycin) can be risky if they reach the middle ear through a perforation or tube. Ask your clinician about non-ototoxic alternatives, often fluoroquinolone drops, based on your diagnosis. Don’t use leftover drops without being re-examined.

Medicine And Your Ears: Prevent Drug-Induced Hearing Loss Before It Starts

Wait—are medicines really a risk to hearing?

The usual suspects: common ototoxic medications

Whos more at risk?