Medications That May Affect Your Hearing: What You and Your Pharmacy Should Know

Hearing loss is often thought of as the natural result of aging or exposure to loud noise. But there’s another less obvious culprit: medications. A growing body of evidence shows that certain commonly prescribed drugs can damage the inner ear’s delicate structures—a phenomenon called ototoxicity—and ultimately contribute to hearing loss. Pharmacies, with their direct link to patients at the point-of-dispensing, are uniquely positioned to help identify those at risk. By flagging patients on ototoxic medications, pharmacies can prompt referrals for a hearing check—and that’s where patients, pharmacies, and hearing centres can partner to ensure you are safe.

Why this matters - medications that affect hearing

According to the Cleveland Clinic, ototoxicity “is a medication side effect involving damage to your inner ear … It can cause problems related to hearing and balance.” Cleveland Clinic A longitudinal population‐based study of older adults in Wisconsin found that each additional ototoxic‐medication class used increased risk of hearing loss, and that use of loop diuretics and non‐steroidal anti‑inflammatory drugs (NSAIDs) was associated with progression of hearing loss over ten years. PMC And in a broader review, more than 150 medications were suspected of causing hearing‐loss risk in a large national dataset. PubMed Given that hearing loss has major implications for quality of life, social isolation, depression, and cognitive decline, this is far from a trivial side‐effect.

Which medications are of particular concern

Here are several classes of drugs that research has shown may affect hearing—and therefore represent referral opportunities for pharmacies related to medications that affect hearing.

Medication class	Common drugs	Hearing / ear risk notes
Aminoglycoside antibiotics	gentamicin, tobramycin, amikacin	These are well‑documented ototoxic agents, causing sensorineural (inner‑ear) hearing loss, sometimes irreversible. PMC+1
Platinum‐based chemotherapies	cisplatin, carboplatin	Used in cancer treatment; hearing loss often begins in high frequencies and may be permanent. PMC+1
Loop diuretics	furosemide (Lasix), bumetanide	These may cause hearing damage especially at high doses or when combined with other ototoxic drugs. PMC+1
High‑dose aspirin or chronic NSAIDs	aspirin, ibuprofen, naproxen	Research shows increased risk of hearing loss in long term/high dose use. PMC+1
Certain antibiotics (other than aminoglycosides)	high‑dose erythromycin, vancomycin	The risk is lower but present, especially in susceptible individuals. Healthy Hearing
PDE‑5 inhibitors	sildenafil (Viagra), tadalafil (Cialis)	Some case reports suggest reversible hearing loss associated with use—though the evidence is weaker and likely risk is low.
Antimalarials	quinine, chloroquine	These are known to have ototoxic potential—sometimes reversible, sometimes not. PMC+1

Why the inner ear is vulnerable

The inner ear (cochlea and vestibular apparatus) has hair cells and other delicate structures that convert mechanical sound vibrations into nerve signals. Many ototoxic drugs either (a) generate oxidative stress in hair cells, (b) interfere with ion homeostasis, or (c) disrupt blood flow to the cochlea. For example, research on cisplatin shows that genetic variance in DNA repair or efflux pump genes may heighten risk. PMC+1 Because these hair cells do not regenerate in humans, damage is often irreversible. Thus, early detection is key. Medscape

Why pharmacies matter — and what the referral approach could look like

Pharmacists and pharmacies are often the last line of defence before medication is dispensed—and they see patients across a broad spectrum including those at higher risk (older age, multiple medications, comorbidities).

Here’s how a pharmacy‑to‑hearing‑centre referral could work:

1. Medication flagged: The pharmacy identifies that a patient is prescribed one of the ototoxic medications listed above (especially if at high dosage, or used chronically, or combined with other known ototoxins).

2. Patient communication: The pharmacist gently educates the patient about possible hearing risks, and recommends a hearing screening if the patient has not had one within the past 12 months.

3. Referral to hearing centre: The pharmacy provides a referral contact (e.g., Innisfil Hearing Centre) where the patient can book an audiometric test. Optionally, the pharmacy could provide a voucher or informational printout.

4. Follow‑up: The pharmacy flags the record so that if the patient reports symptoms (tinnitus, hearing difficulty) the pharmacist can reinforce prompt referral and follow‑up with the prescriber.

This approach helps build trust (patients appreciate proactive care), strengthens the relationship between pharmacy and hearing‑care provider, and positions the hearing centre as a partner rather than a competitor.

Best practices & suggestions for patients

• Patients starting a high‑risk ototoxic medication such as cisplatin or gentamicin should ask for a baseline hearing test (audiogram) before treatment begins.

• If you are on long‑term use of high‑dose aspirin, NSAIDs, loop diuretics, or multiple medications, monitor for signs of hearing change: difficulty hearing speech, ringing (tinnitus), needing louder volumes, imbalance.

• If you notice any of these symptoms, book a hearing assessment promptly—ear‑damage is easier to slow than to reverse.

• Where possible and medically directed, request that prescribers consider auditory risk when evaluating alternative medications or lower dosages, especially in older adults.

• Keep your pharmacist informed: say something like, “I understand this drug might affect my hearing—should I get my ears tested regularly?” This opens dialogue.

Why it’s timely

With populations ageing and poly‐pharmacy becoming more common, the risk of hearing loss from medications adds a layer of preventable burden. A recent review warns that the incidence of acquired hearing loss is increasing globally—and ototoxic medications are a significant contributor. Frontiers+1For hearing‑care providers, this represents an opportunity: by educating pharmacies and prescribers about referral pathways, we can catch hearing changes earlier, improve outcomes, and underline the role of hearing health in overall wellness.

Key references & further reading

• Rybak LP, Ramkumar V. “Ototoxicity.” Kidney Int. 2007;72:931‑935. (Early review)

• Landier W. “Ototoxicity and cancer therapy.” Cancer. 2016;122:1647‑58. ACS Journals

• Skarzyńska MB, Król B, Czajka Ł. “Ototoxicity as a side‑effect of drugs: literature review.” J Hear Sci.2020;10(2):9‑19. Journal of Hearing Science

• “Drug‐Induced Ototoxicity: A Comprehensive Review and Reference.” Pharmacotherapy. 2020; (review) PubMed

• Annual Review article: “Ongoing Clinical Trials to Prevent Drug‑Induced Hearing Loss.” Annu Rev Pharmacol Toxicol. 2024. Annual Reviews

• EBM Consult: “What are the most common medications known to be ototoxic (i.e. cause hearing‐loss)?” EBM Consult

• Cleveland Clinic: “Ototoxicity: Symptoms, Causes & Treatment.” Cleveland Clinic

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