Drug Induced Ototoxicity: Tinnitus, Hearing Loss and Vertigo

internal Ear Commons Image

There are three major locations where medications exert ototoxicity.

The Cochlea: 

The first location is the cochlea; medications that affect it are thought to exhibit cochleotoxicity. Ototoxicity involving the cochlea produces hearing loss, usually commencing with high frequencies but often eventually progressing to the lower frequencies that encompass speech, hearing loss may be one-sided or bilateral and may fluctuate in severity. Cochlear damage may also manifest as tinnitus or ringing in the ear. The tinnitus may be constant or fluctuate. Patients with preexisting tinnitus may notice the problem worsening or the appearance of a new sound that was not present before the medication was administered.

The vestibulum: 

This is the second site of action for ototoxic medications; these are known as vestibulotoxic medications. Vestibulotoxicity usually manifests as balance-related problems or vertigo (e.g., disequilibrium). The patient reports a spinning sensation that is often aggravated by motion and is associated with nausea.

The Stria Vascularis:

This is the third site of action for ototoxic medications. The stria vascularis is a type of epithelium that is uniquely able to produce endolymph in the cochlea. Excessive endolymph is responsible for Meziere’s syndrome (Triad of Hearing Loss, Tinnitus and Vertigo)


List of Articles of interest (in PDF) about drug induced toxicities everyone should review:

Ototoxic Drugs Exposed

Drugs that can cause hearing loss

List of Ototoxic Medications Brochure


What to do if you suspect your medication might be ototoxic ? 

  1. If you suspect that your current medication is ototoxic, and have noticed ringing in your ears, changes in balance or hearing loss, use the above links to see if the medication you are on is ototoxic and talk to your doctor about changing the medication to a non toxic alternative.
  2. Consider seeing a functional medicine doctor that will review and properly assess your physiology and address any potential shortcomings that might help reduce ototoxicity or any other potential toxic load, in addition to chronic systemic inflammation, and potential nutrient deficiencies.
  3. Get a HIGH FREQUENCY Audiogram (over 8Khz) most audiogram will evaluate frequencies up to 8Khz, early onset inner ear damage begin at higher frequencies.
  4. Get a Brain MRI in order to rule out other potential causes for the tinnitus, hearing loss or vertigo.
  5. Consider taking Anti-oxidants, in addition to Vinpocetine and Lipo-Flavinoids in order to reduce oxidative stress, and to promote blood flow to the inner ear. (only under doctor’s recommendations)



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