Causes Of Hearing Loss
Hearing loss can be caused by many different factors. Factors include ear infections, excess fluid, a hole in the eardrum, or earwax buildup. You could have damage from attending too many loud concerts without proper ear protection or repeated exposure to loud noises.
Did you know? Noise-induced hearing loss is one of the most common forms of hearing loss.
Effects Of Drugs Used For Treating Cancer On Hearing Loss
Drugs that are used for treating cancer are called cytotoxic drugs.
Cytotoxic drugs destroy cells or prevent their regrowth. This usually happens through chemotherapy.
These drugs attack healthy cells as well as cancerous ones, so they can cause a number of side effects.
Types of cytotoxic drugs that can cause hearing loss are:
- carboplatin, which is mainly used to treat ovarian and lung cancer
- cisplatin, which is mainly used to treat ovarian, testicular, lung or bladder cancer
- oxaliplatin, which is mainly used to treat bowel cancer.
Cytotoxic drugs are often used in combination with other drugs, which can affect how much hearing loss you experience.
If you are prescribed cytotoxic drugs, the effects will be carefully monitored. You should tell your doctor immediately if you are taking them and you:
- develop tinnitus
Any of these can be the first sign of hearing loss caused by ototoxic drugs.
Some Facts About Ototoxicity
What happens to trigger hearing loss after you swallow your medication. Certain drugs can damage your hearing in three different places:
- The stria vascularis Located in the cochlea, the stria vascularis generates endolymph, the fluid in the inner ear. Too much or too little endolymph has a considerable impact on both hearing and balance.
- The cochlea Thats the seashell-shaped element of the inner ear that takes sound and translates it into an electrical signal the brain can understand. Damage to the cochlea affects the range of sound you can hear, typically starting with high frequencies then expanding to include lower ones.
- The vestibule of the ear This is the area that sits in the center of the labyrinth that makes up the cochlea. It helps control balance. Vestibulotoxicity medications can make you dizzy or feel like the room is spinning.
Certain drugs only cause tinnitus and others lead to hearing loss. If you hear phantom noises, that might be tinnitus and it usually shows up as:
- A windy sound
Normally if you quit using the medication the tinnitus will stop. However, permanent hearing loss can be caused by some of these drugs.
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Definition And Grades Of Ototoxicity
The definition and criteria for ototoxicity has been established by the American Speech-Language-Hearing Association , the National Cancer Institute Common Terminology Criteria for Adverse Events , and by Brock.
ASHA define ototoxicity as: 20db or greater decrease in pure-tone threshold at one frequency, 10db or greater decreased at 2 adjacent frequencies, or loss of response at 3 consecutive test frequencies in which responses were previously obtained, when OAE or ABR is used.
The CTCAE and Brock have determined grades to further define ototoxicity as follows:
CTCAE ototoxicity grades 1-4
Grade 1 – Threshold shift or loss of 15-25 dB relative to baseline, averaged at two or more contiguous frequencies in at least one ear.
Grade 2 – Threshold shift or loss of > 25-90 dB, averaged at two contiguous test frequencies in at least one ear
Grade 3 – Hearing loss sufficient to indicate therapeutic intervention, including hearing aids
Grade 4 – Indication for cochlear implant and requiring additional speech-language related services
Brock’s hearing loss grades
Tips For Managing Hearing Problems
The following can help you manage hearing problems:
Ask your health care team if you should avoid alcohol, tobacco products, and caffeine, which can make tinnitus worse.
Drink plenty of water and other fluids. Getting dehydrated can also make tinnitus worse.
Ask friends, family members, and co-workers to speak clearly without yelling. Yelling or shouting can make it harder to hear. It can also damage your ears more.
Practice relaxation techniques and get lots of sleep. Being stressed or tired can make tinnitus worse.
Control your blood pressure. High blood pressure can cause hearing problems.
Ask your doctor about medications for nausea or dizziness if you have these problems.
Protect your ears from loud noises. Loud noise can make hearing problems caused by chemotherapy or other drugs worse.
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Home Remedies For An Ear Infection
If you or your child has a typical ear infection without severe symptoms, you might try some of these home remedies:
- Pain relievers. A dose of over-the-counter medication such as acetaminophen or ibuprofen can reduce the pain and fever.
- Compresses. Whether you prefer a warm compress or an ice pack, this method is safe for children and adults. You can even alternate them if doing so helps you feel better.
- A change in sleeping position. Try putting extra pillows under your head to help your ear drain when you go to sleep at night.
- Distraction. If your child is really fussy, try a distraction technique to take their mind off their painful ear. A favorite toy, snack, or game might do the trick.
Using Gentamycin On Adults
Some adults who received Gentamicin develop symptoms that they attribute to just getting older when in fact, the problems they are having are due to Gentamycin toxicity. Hearing loss, vertigo or dizziness, tinnitus or ringing in the ears can be caused by previous Gentamicin administration. Some older adults even develop difficulty with walking or balance and appear as if they are intoxicated. This unsteady gait is caused by damage to the vestibular system in the ear that is responsible for balance. Adults who developed this Gentamycin induced balance difficulty have labeled themselves as wobblers and have formed support groups to help other individuals who have been harmed by Gentamycin.
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List Of Ototoxic Medications
There are more than 450 prescription and over-the-counter drugs that can trigger tinnitus, make existing tinnitus worse, or cause a new tinnitus sound to appear. In fact, most drug classes have tinnitus-causing drugs sprinkled throughout. For example, antibiotics, painkillers, anti-anxiety, and anti-depression drugs, antimalarial medications, anti-cancer drugs, and blood pressure controlling medications to name a few can all trigger tinnitus. In most cases, this type of tinnitus is an acute, short-lived side effect if the patient stops taking the medication, the tinnitus symptoms typically recede. Familiarity with a complete list of ototoxic medications is unnecessary, but knowing which ones are known to cause more permanent tinnitus symptoms can save you a lot of frustration.
Research Reveals Possible Causes Of Hearing Loss From Antibiotics
For years, scientists have been uncertain as to why these antibiotics can lead to hearing loss. One study reveals the reason for hearing loss is most likely inflammation. While that may not seem groundbreaking, it potentially is. Because if your doctor determines these antibiotics are crucial to your recovery, they can also take measures to make sure that you dont suffer from inflammation at the same time, thereby limiting your risk for hearing loss.
In addition, there are details that can help you recognize an adverse reaction when sensory cells within the inner ear become damaged. An early warning sign of ototoxicity is tinnitus followed by hearing loss. The ability to understand speech can be affected as well as your sense of balance. Ototoxicity may be initially overlooked as it can start when a round of treatment has ended, with the onset of symptoms developing slowly thereafter.
Despite their undesirable effects, these broad-spectrum antibiotics remain vital for their potency and efficacy. They are hypoallergenic especially important in an emergency situation and indispensable for certain diseases such as tuberculosis and bacteria in patients with cystic fibrosis. Factor in the fight against the rise of multi-drug resistant bacteria, as well as the low cost of production, and you have a solution for infections that are getting harder to fight and for vulnerable and economically disadvantaged populations.
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What Is An Ototoxic Drug
According to Neil Bauman, Ph.D., Ototoxic drugs are those medications that can cause ototoxic side effects to your ears. Such drugs can cause hearing loss, hyperacusis, tinnitus, and other phantom sounds and a whole host of balance problems. Although physician-prescribed medications may effectively treat a specific health condition, they can also damage the fragile hair cells in the inner ear, impacting a persons ability to hear and balance .
Tinnitus, of course, does not afflict everyone who takes drugs. Even if a drugs description lists tinnitus as a side effect, it does not mean that you will develop tinnitus if you take it. Some people do. Many dont. However, it is still important to learn the side effects of any drug you take. That way, you can react accordingly if you do develop a side effect. To evaluate your level of tinnitus or hyperacusis, take our tinnitus and hyperacusis impact surveys.
Drugs That Have Hearing Loss And Tinnitus As Side Effects
Contributed by Joy Victory, managing editor, Healthy HearingLast updated November 4, 20212021-11-04T00:00:00-05:00
Many drugs cause side effects, including hearing loss or tinnitus . In fact, there are currently more more than 200 medications linked to hearing loss and balance disorders, according to the American Speech-Language-Hearing Association .
Medically, this is known as ototoxicity. It’s also sometimes referred to as drug-induced hearing loss.
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Why Does Permanent Hearing Loss Occur
There are many reasons why hearing loss can occur with use of the Fluoroquinolones, and why the hearing loss or tinnitus can be permanent. These include Fluoroquinolone-induced nutritional deficiencies, oxidative stress, and cellular damage.
Magnesium deficiency is one cause of hearing loss and tinnitus from Fluoroquinolone antibiotics. Fluoroquinolone drugs are well-known to be one of the many drugs that cause Magnesium Depletion. Several studies have shown that magnesium depletion can lead to hearing loss 3 while others have shown a reduction in hearing loss from magnesium supplementation 4 5.
Others have shown a greater susceptibility to in animals and humans with dietary magnesium deficiency. Mechanistically, low Mg might contribute to a loss of membrane potential, resulting in altered or decreased sensorineural function.
Additionally, this cellular damage occurs specifically to connective tissue, leading to serious and even life-threatening problems such as Aortic Aneurysm. The ear, too, is made up of connective tissue that would naturally be susceptible to the damage these drugs do to connective tissue, which could lead to hearing loss. Damage to the hair cells in the cochlea was another method of hearing loss observed in an animal model7.
Tinea Can Be Worsened By Vitamins
Its extremely important to be getting a combination of vitamins in the right proportions. If you fail to do this, your body can suffer. Tinnitus seems to be one of the various types of illnesses in which this may have a negative effect. Hearing problems may be caused by lack of certain vitamins, according to scientific evidence.
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S Of Audiologic Monitoring
Baseline testing should be obtained before the start of chemotherapeutic agents, especially cisplatin and carboplatin. In those patients taking aminoglycosides, baseline testing should be obtained within 72 hours of the start of treatment. Patient selection, complicating medical factors, level of consciousness, and age play a role in selecting methods for early detection.
Baseline testing, when possible, should be comprehensive. At a minimum bilateral pure-tone air-conduction thresholds at standard audiometric frequencies from 0.25 to 8 kHz should be obtained. If equipment allows threshold frequencies about 8 kHz should also be measure. Additional testing would include a case history including family history, otoscopic examination, immittance or bone-conduction testing, speech reception thresholds, and word recognition scores.
For patients unable to cooperate or tolerate standard testing objective testing with otoacoustic emission , EChochG, and/or auditory brainstem response testing should be obtained for documentation and monitoring. OAE testing is specifically sensitive to the status of the outer hair cells in the cochlea and is a relatively efficient objective test to assess cochleotoxicity. EChochG is a more invasive and time-consuming transtympanic test that evaluates cochlear and neural responses. ABR is also a time-consuming test and is additionally limited to stimuli responses to frequencies between 1 and 4 kHz.
What Drugs Put You At Risk
You may be shocked by the list of drugs which can cause temporary or permanent hearing loss. Its likely that you take some of these drugs when you are in pain and you might have some of them in your medicine cabinet right now.
Over the counter pain relievers top the list of ototoxic drugs:
Salicylates, better recognized as aspirin, can be added to this list. The hearing problems caused by these medications are normally correctable when you stop taking them.
Ranking a close second for well known ototoxic medications are antibiotics. Not all antibiotics are ototoxic, though. You may have heard of some of these that arent:
Once you quit taking the antibiotics the problem goes away as with painkillers. Other drugs on the common list include:
Tinnitus Can be Triggered by Several Common Compounds
Diamox, Bumex, Lasix and Edecrin are diuretics which trigger tinnitus but there are bigger culprits in this category:
- Tonic water
You are exposing your body to something that may cause tinnitus every time you have your morning coffee. Once the drug is out of your system it will pass and thats the good news. Ironically, some drugs doctors prescribe to deal with tinnitus are also on the list of possible causes such as:
- Hearing loss on one or both sides
- Blurring vision
- Poor balance
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Ototoxicants In The Environment And Workplace
Ototoxic effects are also seen with quinine, pesticides, solvents, asphyxiants, and heavy metals such as mercury and lead. When combining multiple ototoxicants, the risk of hearing loss becomes greater. As these exposures are common, this hearing impairment can affect many occupations and industries. Examples of activities that often have exposures to both noise and solvents include:
- Weapons firing
- Pesticide spraying
Ototoxic chemicals in the environment or in the workplace interact with mechanical stresses on the hair cells of the cochlea in different ways. For mixtures containing organic solvents such as toluene, styrene or xylene, the combined exposure with noise increases the risk of occupational hearing loss in a synergistic manner. The risk is greatest when the co-exposure is with impulse noise.Carbon monoxide has been shown to increase the severity of the hearing loss from noise. Given the potential for enhanced risk of hearing loss, exposures and contact with products such as fuels, paint thinners, degreasers, white spirits, exhaust, should be kept to a minimum. Noise exposures should be kept below 85 decibels, and the chemical exposures should be below the recommended exposure limits given by regulatory agencies.
What To Do If You Think Your Drugs Are Causing Hearing Loss
You should talk to your doctor if you think that a drug you are taking is:
- causing hearing loss
- causing tinnitus
- making existing hearing loss worse.
You should not reduce your dose or stop taking the medication altogether without speaking to your doctor.
Your doctor may be able to prescribe you a different drug that wont affect your hearing in the same way.
If this isnt possible, you should ask your doctors advice and decide whether the benefits of taking the drug outweigh the possibility of permanently damaging your hearing.
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Symptoms Associated With Ototoxicity
Symptoms associated with ototoxicity largely depend on which part of the inner ear is damaged. Inner ear damage may occur to your cochlea or to your vestibular complex . In both cases, symptoms were associated with damaged sensory cells.
If your cochlea is damaged, your hearing is damaged. The degree of damage is directly related to the degree of damage that can lead to mild tinnitus to complete hearing loss. Hearing loss may affect one or both ears.
If ototoxicity affects the vestibular complex, your balance can be affected. As with damage to the cochlea, the damage can affect one or both ears. If the injury affects only one ear slowly, you may not experience any symptoms. However, if the damage occurs quickly to one ear, you may experience:
- Uncontrolled eye movements
Symptoms that appear quickly may leave you bedridden until symptoms gradually subside. If you have injuries on both sides of your ears, you may experience:
- Imbalance can affect your ability to walk
- blurred vision, jerky
- walk with a wide stance
- Difficulty walking in the dark
If your vestibular complex is severely damaged, tremors and difficulty walking at night will not improve. Other symptoms may improve over time. In the event of a severe injury, you can recover from most balance-related symptoms due to the bodys ability to adapt.
Using Gentamycin On Infants & Children
Many newborns that are born with an infection are frequently placed on Ampicillin and Gentamicin. In infants and children, the appropriate dose for the antibiotic is calculated by the childs weight. If the childs weight is inaccurate or if there was an error in the drug calculation, a baby can be overdosed with Gentamicin.
If your child was prescribed Gentamycin you would want to make sure the doctors and nurses are performing peak and trough level blood tests. Those tests will show if your baby is getting too much medication. Many parents are under the impression that their childs hearing loss was due to an infection, sepsis, prematurity, Group B strep, meningitis, a high bilirubin or kernicterus when, in fact, the deafness was caused by the Gentamycin.
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