Tinnitus is described as noise or ringing in the ears. The sound and pitch can vary from person to person, but the noise can be disturbing and interrupt the acknowledgment of other sounds. MayoClinic.com notes that tinnitus is a symptom, usually of a deeper underlying condition or stemming from physical or chemical damage. When the tiny hairs in the ear that transpose vibrations from sound into electrical impulses to be interpreted by the brain become damaged, they may leak unprovoked impulses to the brain and random noises will persist. Some medications can cause chemical damage to the ear.
Antibiotics
The class of antibiotics known as the aminoglycosides have the known adverse effect of ototoxicity. Ototoxicity is the potential damage that a drug can have on the inner structures of the ear due to the toxic effects of the medication. A 1995 article by Stephen Epstein, M.D., published in the journal "Self Help for Hard of Hearing People," notes that signs of ototoxicity most frequently include the development of tinnitus in one or both ears. Additional effects of ototoxicity include worsening of existing tinnitus, presence of a different or new sound, fullness or pressure in the ears, awareness of hearing loss and vertigo.
Merck lists common aminoglycoside antibiotics as streptomycin, neomycin, kanamycin, amikacin, gentamicin and tobramycin. Neomycin was listed as having the most toxic effect on the auditory portion of all the antibiotics. Its ototoxic effects can be initiated by taking the medication both orally or by colonic irrigation. If this drug is used to clean an open wound, it can cause profound deafness. Kanamycin and amikacin are structurally similar to neomycin and can cause ototoxicity as well. The other aminoglycosides tend to cause more damage to the portion of the ear controlling balance and proprioception. Two antibiotics not of the aminoglycoside class that cause ototoxicity are erythromycin and vancomycin, according to Epstein. Their ototoxic effects usually become evident if coupled with aminoglycosides or if they are given intravenously.
Diuretics
Diuretics are medications used to remove water from the body. They are generally provided as a first line of therapy in the treatment of high blood pressure. They are also used to treat congestive heart failure; the syndrome of inappropriate antidiuretic hormone hypersecretion, or SIADH; kidney disease; and are often coupled with pain-relieving over-the-counter medications, such as Midol, to treat premenstrual cramps and bloating. There are at least four different types of diuretics, but the loop diuretic class is particularly associated with ototoxicity and tinnitus, notes Epstein. Loop diuretics include furosemide, or Lasix, ethacrynic acid and bumetanide. Most commonly, the loop diuretics are ototoxic when given intravenously for acute kidney failure, but Epstein states there have been rare cases that occurred with oral doses. The American Speech-Language-Hearing Association notes that while the aminoglycosides tend to cause permanent damage, diuretics are known to be only temporarily ototoxic.
Chemotherapy
There are chemotherapy drugs that use the precious metal platinum as an agent to halt the uninhibited growth of cancer cells. This category of chemotherapeutic drugs are known as platinum drugs. This group in particular can lead to tinnitus and hearing loss, according to Merck. The ototoxic results of this drug can be profound and permanent and can persist from the very first dose or take time to accumulate over the weeks or months following treatment. Merck further notes that the drug affects both ears. Epstein additionally remarks that the chemotherapy drugs nitrogen mustard and Vincristine can be ototoxic and their effects enhanced when used with other ototoxic medications.
Aspirin and NSAIDs
Chronic pain will often prompt the use of large doses of pain relievers such as aspirin and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as Advil and Aleve. Epstein and Merck note that these drugs can cause temporary ototoxic side effects such as tinnitus, but usually only in abnormally high doses. Epstein states that the toxic effects appear after taking six to eight pills per day, but can be relieved once the medication is discontinued. Merck suggests that a person must take an amount exceeding 12 aspirin tablets of 325 mg each to elicit the effect.
Other
There are a large number of drugs and chemicals that cause ototoxicity. The American Speech-Language-Hearing Association states that over 130 drugs are known to cause ototoxicity. Other less commonly used drugs and less well associated ototoxic drugs include quinine, used to treat malaria; anesthetics; glucocorticosteroids; muscle relaxants; other cardiac drugs; and mood-altering substances. Patients should always discuss with their doctor any changes in hearing, including tinnitus, that is associated with a new drug they are taking.
