Some medicines used to treat serious infections, tuberculosis and cancer can also affect the inner ear. This is known as ototoxicity. Depending on the medicine and the individual, it may affect hearing, balance, or both.
This does not mean an essential medicine should be stopped. Instead, when a treatment carries a recognised ototoxic risk, hearing and balance may need to be monitored so that changes can be identified as early as possible.
What Happens Inside the Ear?
Inside the cochlea are specialised sensory hair cells that help convert sound vibration into electrical signals for the brain.
Certain medicines can damage these cells. Ototoxicity may affect hearing (cochleotoxicity), balance (vestibulotoxicity), or both. The effect varies with the medicine, dose, treatment duration and individual susceptibility.
Some medicines used to treat serious infections, tuberculosis and cancer can also affect the inner ear. This is known as ototoxicity. Depending on the medicine and the individual, it may affect hearing, balance, or both.
This does not mean an essential medicine should be stopped. Instead, when a treatment carries a recognised ototoxic risk, hearing and balance may need to be monitored so that changes can be identified as early as possible.
Ototoxic risk is not a reason to stop medication yourself. Any treatment change must be discussed with the prescribing medical team.
Which Medicines Can Be Ototoxic?
Not everyone taking these medicines develops hearing or balance problems. Risk depends on the specific medicine, dose, duration and the individual.
- Aminoglycoside antibiotics such as gentamicin, amikacin, tobramycin, streptomycin and neomycin.
- Platinum-based chemotherapy such as cisplatin and carboplatin.
- Loop diuretics, including furosemide in certain clinical circumstances.
- High-dose aspirin and related medicines, which may be associated with tinnitus and other auditory symptoms.
Some of these medicines are used for serious or life-threatening conditions. Never alter or stop prescribed treatment without speaking to the doctor responsible for your care.
What Ototoxicity Can Feel Like Changes may begin subtly rather than as obvious hearing loss. New tinnitus, difficulty hearing high-pitched sounds, reduced speech clarity, dizziness, vertigo or imbalance can all be relevant symptoms. If these appear during treatment, report them to your medical team rather than waiting for the next routine appointment.
Who May Be at Higher Risk?
Risk is influenced by the medicine and dose, treatment duration, exposure to more than one ototoxic medicine, pre-existing hearing loss, kidney problems, age, genetic factors and previous ototoxic exposure.
Children receiving treatments that can affect hearing need particular attention because hearing changes can influence speech, language and learning. Children may also find it harder to describe subtle tinnitus or hearing changes themselves.
How Is Ototoxicity Monitored?
There is no single hearing test that proves ototoxicity on its own. Monitoring is based on comparing hearing over time, alongside medication history and symptoms.
A baseline hearing assessment before treatment begins, or as early as practically possible, provides an important reference point. Follow-up testing can then identify changes that develop during treatment.
Tests Used in Ototoxicity Monitoring
The exact test battery depends on the person and treatment. It may include:
Case history and otoscopy. Medication history, previous hearing concerns and noise exposure are reviewed, and the ears are checked for other possible causes of hearing difficulty.
Pure-tone audiometry. Measures hearing sensitivity across standard test frequencies.
Extended high-frequency audiometry. Testing above the conventional range can be particularly useful because ototoxic changes may appear first at higher frequencies.
Otoacoustic emissions (OAE). An objective measure that can help assess cochlear function and may be especially useful when behavioural responses are difficult to obtain.
Speech testing and tympanometry. These may be used to understand communication impact and help rule out unrelated middle-ear problems.
ABR or vestibular testing. These may be considered when clinically appropriate, including for infants, people unable to provide reliable behavioural responses, or when balance is affected.
Reducing Risk Through Monitoring
Not every case of ototoxicity can be prevented, but structured monitoring can help identify changes earlier.
- Arrange baseline hearing testing before treatment when possible.
- Attend recommended follow-up monitoring.
- Report new tinnitus, hearing changes, dizziness or imbalance promptly.
- Tell the healthcare team about all medicines and supplements being taken.
- Avoid unnecessary additional noise exposure when hearing may already be at risk.
If Hearing or Balance Changes Occur
What happens next depends on the underlying illness, the medicine involved and the significance of the change. The medical team may consider treatment adjustments or closer monitoring when clinically appropriate. Any medication decision belongs with the prescribing doctor.
Why Children Need Extra Attention
Children may not be able to describe subtle hearing changes or tinnitus. Changes in response to sound, television volume, speech clarity, following instructions, school performance or balance should be reported promptly when a child is receiving treatment with known ototoxic potential.
Ototoxicity and Treatment in India
Ototoxicity monitoring is particularly relevant where medicines with recognised hearing risks are used for serious infections, drug-resistant tuberculosis or cancer treatment.
Indian research involving aminoglycoside treatment for multidrug-resistant tuberculosis has documented hearing changes during treatment, with high-frequency hearing often affected early.
The Key Message
Ototoxicity monitoring is a process rather than a single test: baseline assessment → ongoing monitoring → prompt reporting → coordinated medical and audiological care.
If you or a family member is prescribed a medicine with known ototoxic potential, ask the treating medical team whether baseline and follow-up hearing monitoring is appropriate. The purpose is not to second-guess essential treatment, but to identify hearing or balance changes as early as possible.
References
American Academy of Audiology. Position Statement and Practice Guidelines on Ototoxicity Monitoring.
American Speech-Language-Hearing Association (ASHA). Audiologic Management of Individuals Receiving Cochleotoxic Drug Therapy.
American Academy of Otolaryngology–Head and Neck Surgery. Position Statement: Ototoxicity.
National Institute on Deafness and Other Communication Disorders (NIDCD). Balance Disorders.
National Center for Rehabilitative Auditory Research (NCRAR). Ototoxicity Monitoring Tests.
Ototoxicity: A Challenge in Diagnosis and Treatment. Journal of Audiology & Otology, 2017.
Audiological Evaluation of Patients Taking Kanamycin for Multidrug Resistant Tuberculosis. Government Medical College, Patiala, India.
Fausti SA, et al. Research on high-frequency audiometric monitoring for early detection of aminoglycoside ototoxicity.
This article is for public awareness only and is not a substitute for professional medical or audiological advice. Do not stop or alter prescribed medication without consulting the prescribing doctor. Please consult an appropriate healthcare professional for individual assessment and treatment.