Some medications can damage your hearing, and the first sign is often tinnitus. These drugs are called ototoxic. A few cause temporary changes that settle once you stop them, while others can cause permanent hearing or balance loss.
Never stop a prescribed medication on your own. Speak to the doctor who prescribed it first.
What does “ototoxic” mean?
Ototoxic describes any medication or chemical that can harm the inner ear. The damage targets the hair cells that handle hearing and balance, and those cells do not regenerate once destroyed.
According to Healthdirect, ototoxicity is damage to the ear caused by medications or chemicals, and it can bring on hearing loss, tinnitus, dizziness and balance problems. More than 200 medicines are recognised as ototoxic, spanning prescription and over-the-counter drugs.
Because the hair cells are involved, the result is a sensorineural hearing loss. The earliest signal is often ringing in the ears, which is why new or louder tinnitus while on a medication is worth flagging to your doctor.
Which medications are ototoxic?
Ototoxicity is dose-related. Most reported cases involve high doses, long courses, or drugs given in hospital for serious illness. The table below covers the main classes.
| Drug class | Common examples | Main effect | Usually permanent or temporary |
|---|---|---|---|
| Aminoglycoside antibiotics | gentamicin, tobramycin | Hearing and balance | Can be permanent |
| Platinum chemotherapy | cisplatin, carboplatin | Hearing | Often permanent |
| Loop diuretics | furosemide (Lasix) | Hearing | Usually temporary |
| High-dose aspirin and NSAIDs | aspirin, ibuprofen | Tinnitus, hearing | Usually temporary |
| Macrolide antibiotics | azithromycin, clarithromycin | Hearing | Usually temporary |
The risk climbs when ototoxic drugs are combined. Australian Prescriber notes that aminoglycosides and loop diuretics potentiate the toxic effect of cisplatin on hearing, so a combination can cause far more loss than any one drug alone.
Is medication-related hearing loss reversible?
It depends on the drug and the damage. With many medicines, hearing and balance recover once the drug is stopped. With others, the loss is permanent.
According to Healthdirect, aspirin often leads to tinnitus and temporary hearing loss, but at high doses over a prolonged time the impairment can become persistent and irreversible. Temporary effects are more typical of aspirin, NSAIDs and loop diuretics.
Permanent damage is more associated with aminoglycoside antibiotics and platinum chemotherapy. Ototoxic change is usually noticed quickly, during treatment or shortly after, rather than months later, so early reporting gives your medical team the best chance to weigh up alternatives.
Ototoxic chemicals at work
Medicines are not the only ototoxic risk. Some workplace chemicals damage hearing too, and the danger multiplies around noise.
Safe Work Australia lists solvents such as toluene and styrene, heavy metals such as lead and mercury, and gases such as carbon monoxide among ototoxic substances. Hearing loss is more likely when a worker is exposed to both noise and these chemicals than to either on its own.
The risk is taken seriously enough that the workplace noise standard drops from 85 to 80 decibels when ototoxic chemicals are present. For anyone in manufacturing, painting, printing or similar trades, this overlaps with noise-induced hearing loss and can support an industrial deafness or WorkCover claim.
Early signs of ototoxicity to watch for
Catching ototoxicity early gives you the best chance of limiting it. The first symptoms are often not hearing loss but other warning signs.
- Tinnitus: new or louder ringing, buzzing or hissing is the most common first sign.
- Muffled hearing: voices and everyday sounds seem dulled or harder to follow.
- Fullness in the ears: a blocked or pressured feeling without a cold.
- Dizziness or unsteadiness: a sign the balance part of the inner ear is affected.
If any of these appear while you are taking a medication, mention it to your prescriber promptly. Do not wait for the symptom to pass.
Can over-the-counter painkillers harm your hearing?
Yes, though the risk for most people is low. Common pain relievers, including aspirin and other NSAIDs, have ototoxic potential at high doses or with prolonged use.
At recommended doses for a short period, the risk is small and any effect is usually temporary. The concern is high doses, long-term use, or people already prone to ototoxic effects, where even normal use can occasionally cause lasting damage.
The practical takeaway is simple. If your ears start ringing after regularly taking an over-the-counter painkiller, review it with your pharmacist or GP rather than ignoring it.
What to do if you notice a change in your hearing
Treat any sudden change in hearing as urgent. The steps below keep you safe without stopping treatment you may need.
- Do not stop a prescribed medication yourself. Talk to the doctor who prescribed it about the symptom and possible alternatives.
- Book a hearing assessment. A baseline hearing test, then follow-up tests, shows whether your hearing is changing and by how much.
- Flag your risk early. If you are about to start a known ototoxic drug, ask whether hearing monitoring is appropriate before you begin.
No specific treatment reverses ototoxicity once it occurs, which is exactly why early detection and monitoring matter. Where loss is permanent, hearing aids can help you manage it.
Take the next step
If you take a medication on this list and have noticed any change in your hearing, do not stop the drug. Speak to your prescriber, then book a free hearing assessment with a Freedom Hearing audiologist for a clear baseline. If you are about to begin treatment with a known ototoxic drug, ask about monitoring first, or call 1300 689 085.
Frequently Asked Questions About Medications That Can Damage Your Hearing
Can antibiotics cause permanent hearing loss?
Some can. Aminoglycoside antibiotics such as gentamicin and tobramycin are the main concern and can cause permanent hearing and balance damage, usually at high doses or over long courses. Most everyday antibiotics carry little risk. If you notice ringing or muffled hearing while on antibiotics, tell your prescriber rather than stopping the course yourself.
How soon after starting a medication can ototoxicity appear?
Often quickly. Ototoxic effects are typically noticed during treatment or shortly after, not months later. This is common with chemotherapy, where patients may report ringing soon after a dose. Because the onset is fast, reporting a new symptom early gives your medical team the best chance to adjust the dose or switch drugs.
Does ototoxic hearing loss show up on a hearing test?
Yes. A hearing test (audiogram) measures the quietest sounds you can hear across different pitches, and it reveals loss, including the high-frequency loss that ototoxic drugs often cause first. A baseline test before treatment, compared with later tests, is the clearest way to detect and track medication-related changes.
Can you prevent hearing damage from chemotherapy?
Not entirely, but the risk can be managed. Medical teams choose doses to balance the drug’s benefit against its effect on hearing, and monitoring during treatment helps catch changes early. The decision is usually a trade-off, since the medication may offer the best chance of treating a serious illness. Baseline and follow-up hearing tests support that balance.