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Medical Precautions, Ototoxic Drugs and Auditory Integration Training
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Complete
On-line AIT Checklist
About Ototoxic Medications
Ototoxicity
is the property of being toxic to the ear, specifically the cochlea or
auditory nerve and sometimes the vestibular system, for example, as a
side effect of a drug. Some medications can have ototoxic
side effects, such as causing ringing in the ears, loss of balance,
internal noises in the auditory system, dizziness, etc.
Ototoxic medications cause
damage to the sensory cells used in hearing and balance. These sensory
cells are located in the inner ear. Certain medications can
damage the ear, resulting in hearing loss, ringing in the ear, or
balance disorders. Such drugs are considered ototoxic.
Advice on
Medical Precautions, Ototoxic Drugs and AIT
-
Try to avoid the
use of ALL medications that may
adversely affect the results of
Auditory
Integration Training.
-
This
is a partial listing of those medications about which we have information.
There are undoubtedly others which we are not yet aware of, and new drugs
become available constantly,
so this is NOT A COMPLETE LISTING.
-
It
is recommended that you check with your physician and pharmacist, or use
the Physician’s Desk Reference to check on medications.
There are more than 200
known ototoxic medications (prescription and over-the-counter) on the
market today. It is important to discuss with your doctor the
potential for hearing or balance damage of any drug you are taking.
Sometimes there is little choice. Treatment with a particular medication
may provide the best hope for curing a life-threatening disease or
stopping a life-threatening infection. These include medicines used to
treat serious infections, cancer and heart disease. Hearing and balance
problems caused by these drugs can sometimes be reversed when the drug
therapy is discontinued. However, sometimes the damage is
permanent. When a decision is made to treat a serious illness or medical
condition with an ototoxic drug, your health care team should consider
the effects of the medications on your hearing and balance systems. The
team should discuss with you how these side effects will affect your
quality of life.
Ototoxic Medication
Categories
List 1. Most Dangerous
Ototoxic (Toxic to the Ear) Medications
List
2: Controversial - Potentially
Ototoxic Medications
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Chloromycetin
-
Erythromycin (E-Mycin)
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Ibuprofen
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Imiprimine (Tofranil)
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Tea tree oil
List
3. In Rare Cases Are Ototoxic Medications
The
following medications also have potential side effects that might affect
the auditory system according to the
Physician’s
Desk Reference:
-
Bactrim
-
Benadryl
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Beta Blockers (Propranolol, Corgard)
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Desipramine
-
HCI (Norpramin, Gantricin, Garamycin,
Naltrexone (Trexan)
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Periactin
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Septra
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Suprax
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Tegretol IV Ceclor reportedly may
cause auditory hypersensitivity
Discussing The Ototoxic
Medications
-
Aminoglycosides and
Ototoxicity: These include
kanamycin, neomycin, amikacin,
streptomycin, and gentamicin. They are toxic to the cochlea and
also affect the stria vascularis, causing vestibular problems. They
produce damage through the ability to generate free radicals in the
inner ear. Babies have suffered congenital deafness when their mothers
took kanamycin or streptomycin during pregnancy.
Neomycin is the worst
offender relating to cochlear toxicity. Aminoglycosides are especially
toxic when instilled into the ear.
Gentamici is both
vestibular otoxic and causes vertigo or is cochlear toxic, causing
hearing loss.
-
Antineoplastics:
Cisplatin affects the
cochlea and stria vascularis through its ability to generate free
radicals within the inner ear. Researchers have examined various
compounds with possible protective activity that might be administered
concomitantly with cisplatin to prevent ototoxicty.However, none of
those investigated are clearly effective.
-
Loop Diuretics:
Loop diuretics include
furosemide, ethacrynic acid and bumetanide. They affect the
potassium gradient of the stria vascularis, as well as the electrical
potential of the endocochlear structure. They produce
tinnitus and
hearing loss. The hearing loss may be perceptible or may be
apparent only with audiometric testing. Their toxicity is dose-related.
Ototoxicity is more likely when the patient receives a rapid infusion of
injectable loop diuretics in renal failure, which allows the medications
to accumulate. Ototoxicity from
furosemide is usually reversible but may be permanent in rare
instances Ethacrynic acid no
longer used due to the potential for ototoxicity, especially when given
intravenously those whose regimen also included aminoglycosides
-
Antineoplastics:
Cisplatin affects the
cochlea and stria vascularis through its ability to generate free
radicals within the inner ear. Researchers have examined various
compounds with possible protective activity that might be administered
along with cisplatin to prevent ototoxicty. However, none of those
investigated are clearly effective.
-
Quinine:
Quinine has the potential to cause tinnitus, loss of hearing or vertigo.
The hearing loss may be irreversible. It was once widely sold as a
non-prescription product. However, the FDA found its traditional use for
nocturnal leg cramps was ineffective. They issued an opinion that
it is outdated as an anti-malarial as well.The Patients who take 200 to
300 mg of quinine over a sustained period experience a 20% risk of
hearing loss.
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Salicylates:
Salicylates impact the cochlea. In high doses, they cause
tinnitus and loss of hearing. Both are
usually seen only with higher doses and stop the low on discontinuation
in most instances. The relationship between salicylate serum
concentrations and the level of hearing loss is linear. Serum
concentrations below 20 to 50 mg/dL produce little risk of hearing loss.
Concentrations exceeding this level expose the person yo a possible
hearing loss of 30 decibels or above. Hearing loss could occur with
topical administration of counterirritants containing
methyl salicylate. It is
preferable to consider the use of therapeutic heat wraps as a safer
alternative for knee or back pain or for pains in the shoulder-to-arm
area, particularly in patients with risk factors that would predispose
them to ototoxicity.
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Taking More Than One
Ototoxic Medication At A Time: If more than
one potentially ototoxic medication is given to the same person, the
effect can be increase. If a person is already taking a potentially
ototoxic medication, any addition should be examined carefully to detect
additional ototoxins.
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Tea Tree Oil:
Tea tree oil is an alternative medical treatment
effective for bacteria and fungi. In one article, researchers discovered
that it may be toxic to the cochlea, producing deficiency in the
high-frequency region of hearing. Therefore, it must be used with
caution and using tea tree oil in the ears for an infection appears
unwarranted due to the lack of information on efficacy and should also
be avoided to prevent possible cochlear toxicity. Use
homeopathy for ear infections instead!
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Topical Ear
Preparations. Treatment of ear disease can be
accomplished with the use of systemic or topical preparations. Drug
therapy cannot achieve the concentrations allowed with the use of
ototopical drops, so topical drops also have the advantages of rapid
delivery, good compliance and lower cost. Some drops are combinations of
two or more ingredients. If the product is used for otitis externa, the
danger in the application of potentially ototoxic medications is that
the person might have a perforation in the eardrum. This perforation
might have occurred as a result of trauma, otitis media, or following
placement of ventilation tubes. If a perforation is present,
instillation of preparations with ototoxic potential could lead to inner
ear damage. Topical medications, such as those containing
neomycin/polymyxin B, may
produce vestibular and/or cochlear toxicity when the person has a
perforated ear drum.
Note: Otitis externa (inflammation
or infection of the external auditory canal)
can
be treated with quinolones, such as ofloxacin otic drops (Floxin Otic),
without fear of ototoxicity.
Importance of Dose and Dosing Interval of Ototoxic Medications
If a medication has ototoxic
potential, its blood levels should remain as low as possible. This may require
assessing blood levels frequently and adjusting the dosage downward if blood
levels exceed those required to gain the desired therapeutic effect.
Side
Effects From Ototoxic Medications
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Tinnitus:
Usually the first sign of ototoxicity is ringing in the ears, called
tinnitus.
A hearing loss may also develop over time. This hearing loss may go
unnoticed until your ability to understand speech is affected.
-
Balance Problems:
Balance problems can also occur as a result of ototoxic medications. A loss
of balance and and feeling unsteady on your feet may occur. Sometimes these
problems are temporary because the human body can learn to adapt to reduced
balance control. Hearing and balance problems caused by ototoxic drugs
can sometimes be reversed when the drug therapy is discontinued.
-
Dizziness: The effects
of ototoxic medications can affect your quality of life. Not being able to
hear conversations or feeling a little dizzy may cause you to stop
participating in usual activities.
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Hearing: Hearing
problems that are caused by ototoxic drugs can sometimes be reversed when
the drug therapy is discontinued.
-
Dizziness:The effects
of ototoxic medications can affect your quality of life. Not being able to
hear conversations or feeling a little dizzy may cause you to stop
participating in usual activities.
-
Permanent Damage:
Ototoxic medications known to cause
permanent damage include certain
aminoglycoside antibiotics,
such as gentamicin (note: a family history may increase
susceptibility) and cancer chemotherapy drugs, such as
cisplatin and carboplatin.
-
Temporary Damage: Drugs
known to cause temporary damage include
salicylate pain relievers,
aspirin, used for pain relief and to treat heart conditions),
quinine (to treat malaria)
and loop diuretics, to treat
certain heart and kidney conditions).
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Loud Noise Exposure: In
some instances, exposure to loud noise while taking certain drugs will
increase their damaging effects.
How
Medications Cause Ototoxicity
There are three major locations
where medications cause ototoxicity.
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Cochlea: Some ototoxic
medications are "cochleotoxicity". Ototoxicity involving the cochlea
produces hearing loss, usually commencing with high frequencies but often
eventually progressing to the lower frequencies that encompass speech. The
hearing loss may be one-sided or both sides and may fluctuate in severity.
Cochlear damage may also manifest as tinnitus.
The tinnitus may be constant or fluctuate. Those
with preexisting tinnitus may notice the problem
worsening or the appearance of a new sound that was not present before the
medication was administered.
-
Vestibulum: Some
ototoxic medications are "vestibulotoxic" medications. Vestibulotoxicity
shows often as balance-related problems or disequilibrium. The person
reports a spinning sensation that is often aggravated by motion and is
associated with nausea.
-
Stria Vascularis: Some
ototoxic medications effect the stria vascularis. The stria vascularis is a
type of epithelium that is uniquely able to produce endolymph, which is the
the fluid in the membranous labyrinth of the ear, in the cochlea. Too much
endolymph causes Meniere's syndrome.
How To Monitor Use Of Ototoxic Medication
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You should monitor your
hearing and balance systems before and during treatment. Before starting the
treatment, a baseline record of your hearing and balance can be recorded by
an audiologist. The baseline record should include an audiologic hearing
test that uses high-pitched testing, word recognition, and other tests
when possible. This information can help you and your doctor make any
important decisions to stop or change the drug therapy before your hearing
is damaged.
-
For cases in which the drugs
cannot be stopped or changed, the patient and the audiologist can take steps
to manage the effects of the hearing loss that results.
-
During the course of your
treatment, you should have periodic hearing tests as part of the monitoring
process. This will help enable you to report any hearing changes, ringing in
the ears, or balance problems that you may notice.
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