When people think about medication side effects, the usual suspects come to mind: nausea, tiredness, maybe a bit of dizziness.
Hearing loss rarely makes that list, but it’s a genuine risk with a surprisingly wide range of medicines, both prescription and over-the-counter. The medical term for this is ototoxicity, which refers to damage caused to the inner ear by drugs or chemicals, and around 200 medicines are known to carry this risk in some form.
The inner ear is delicate, and the damage usually happens through harm to tiny hair cells in the cochlea or by disrupting the fluid balance that controls hearing and balance together. The tricky part is that these hair cells don’t regenerate once they’re damaged, which means some forms of hearing loss caused by medication are permanent rather than something that resolves once the drug is stopped.
The symptoms of ototoxicity aren’t always easy to spot straight away.
Symptoms can include tinnitus, which is ringing or buzzing in the ears, hearing loss that often starts with high-frequency sounds being harder to pick up, dizziness or balance problems, or a sensation of fullness or pressure in the ears. Whether these effects are temporary or permanent depends on several factors including which drug is involved, the dose, how long it’s taken for, and an individual’s personal susceptibility, which can vary quite a bit from person to person.
It’s worth being clear that none of this means these medicines should be avoided outright. In many cases, particularly for serious illnesses, the benefit of treatment far outweighs the risk to hearing. The goal here is awareness rather than alarm, so that if symptoms do appear, they get reported and investigated quickly rather than dismissed.
Certain antibiotics carry one of the strongest links to hearing damage.
A group of antibiotics called aminoglycosides, including gentamicin, tobramycin and streptomycin, are typically used for serious infections like sepsis, meningitis or tuberculosis, situations where fast and aggressive treatment can be lifesaving. These drugs are among the most well-documented causes of ototoxicity, and the hearing loss they cause can be permanent, particularly with high doses or extended use. Some people are also genetically more susceptible to this effect than others.
What makes these antibiotics particularly worth knowing about is that they can remain active in the inner ear for weeks or months after treatment finishes, meaning damage can continue to develop even after the course of medication has ended. Other antibiotics worth being aware of include macrolides such as erythromycin and azithromycin, along with vancomycin, both of which have been linked to hearing problems, especially in older adults or those with existing kidney issues.
Heart and blood pressure medicines can affect hearing too.
Loop diuretics like furosemide and bumetanide, commonly prescribed for heart failure or high blood pressure, can cause temporary hearing loss by disrupting the fluid and electrolyte balance inside the inner ear. This tends to happen more with high doses or when the medication is given intravenously, and around 3 percent of users may experience some degree of ototoxicity as a result.
Other blood pressure medications have also been associated with tinnitus, including ACE inhibitors like ramipril, which work by relaxing blood vessels, and calcium-channel blockers such as amlodipine, which lower blood pressure by limiting calcium entering cells in the heart and blood vessels. The evidence connecting these specific drugs to hearing issues is less extensive than for loop diuretics, and researchers are still working to understand the full extent of the effect.
Certain chemotherapy drugs carry a particularly high risk.
Platinum-based chemotherapy drugs, especially cisplatin and carboplatin, are known to be highly ototoxic. Cisplatin is widely used to treat testicular, ovarian, breast, and head and neck cancers, and it carries a big risk of permanent hearing loss, a risk that increases further if radiation is also being directed near the head or neck during treatment.
The scale of this is considerable. Up to 60 percent of patients treated with cisplatin experience some degree of hearing loss as a result. Researchers are actively exploring ways to adjust dosage and treatment frequency to reduce this risk without compromising how effectively the drug fights cancer, which remains an important area of ongoing research given how widely these drugs are used.
Even common painkillers have been linked to hearing changes.
High doses of everyday pain relief, including aspirin, NSAIDs like ibuprofen and naproxen, and even paracetamol, have been linked to tinnitus and hearing loss in some studies. One large study found that women under 60 who regularly took moderate-dose aspirin, 325 milligrams or more, six to seven times a week, had a 16 percent higher risk of developing tinnitus. Notably, this link wasn’t seen at low doses of 100 milligrams or less, suggesting dosage plays a meaningful role.
Frequent use of NSAIDs and paracetamol was also linked to a nearly 20 percent increased risk of tinnitus, particularly among women who used these medications often. A separate study found that long-term use of these painkillers was associated with a higher risk of hearing loss, especially in men under 60. The reassuring detail here is that in most cases, tinnitus, and hearing changes resolve once the medication is stopped, though this side effect typically only shows up after prolonged, high-dose use rather than occasional painkiller use.
Antimalarial drugs are another category worth knowing about.
Drugs like chloroquine and quinine, used to treat malaria and sometimes leg cramps, can cause reversible hearing loss and tinnitus. One study found that between 25 and 33 percent of people with hearing loss had previously taken one of these medications, which is a notably high proportion.
Hydroxychloroquine, prescribed for conditions like lupus and rheumatoid arthritis, has a similar chemical structure to these antimalarials and carries a comparable risk. While some people recover their hearing fully after stopping the drug, others experience permanent damage, particularly following long-term or high-dose use. Anyone on this medication long term for a chronic condition should be aware of this possibility and mention any hearing changes to their doctor.
Some people face a higher risk than others.
Certain groups are more vulnerable to ototoxic effects than the general population. People with pre-existing hearing loss, kidney disease, or a genetic susceptibility to these effects face higher risks, as do those taking multiple ototoxic medications at the same time, since the effects can compound. Children and older adults also tend to be more vulnerable to this kind of damage than healthy adults in midlife.
None of this means these medicines should be avoided when they’re genuinely needed. For serious conditions like cancer, sepsis or tuberculosis, the benefits of treatment usually far outweigh the risk to hearing, and stopping or avoiding necessary treatment because of this risk would generally cause far more harm than good. The sensible approach is being informed rather than worried.
What to actually do if you’re concerned
If you’re prescribed any of these medications, it’s reasonable to ask your doctor or pharmacist directly whether the specific drug carries any risk to hearing or balance. This is particularly worth doing if you’re already in one of the higher-risk groups, or if you’re being prescribed more than one ototoxic medication at the same time. A quick conversation at the point of prescription is a simple way to stay informed without it becoming a source of anxiety.
If you do start to notice ringing in your ears, dizziness, or muffled hearing while taking any medication, it’s worth reporting it to your doctor promptly rather than waiting to see if it passes on its own. Catching changes early gives the best chance of the effect being temporary rather than permanent, and in many cases adjusting the dose or switching medication can resolve the issue without compromising treatment for whatever condition is actually being managed.
