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When Jonathan took a course of erythromycin prescribed by his doctor, the last thing on his mind was that this drug would cause him to lose his hearing in one ear, give him hyperacusis (some normal sounds seem very loud) and balance problems and result in
horrific bilateral (in both ears)
Drugs and Tinnitus:
Put Yourself in the Driver’s Seat
No one warned Eunice that taking the anti-depressant
about the side effects of any drug before you begin
drug amitriptyline (Elavil®) would result in screaming
taking it. Be particularly cautious until you know that
a condition much worse than her original
any given drug won’t adversely affect your ears.
depression. Without warning, the drugs prescribed for Jonathan (mentioned above) and Eunice to treat other
health issues resulted in loud, intrusive tinnitus, making
There are more than 450 prescription and over-the-
their lives almost unbearable. These stories are true, though I’ve changed the patients’ names for this article.
counter drugs from acebutolol (Sectral®) to zuclopen-thixol (Clopixol®) that can trigger tinnitus, make exist-ing tinnitus worse or cause another (new) tinnitus sound to appear.
The author’s comprehensive book, Ototoxic Drugs Exposed,
Most of the drug classes have tinnitus-causing drugs
sprinkled throughout. For example, antibiotics, pain-
killers, anti-anxiety and anti-depression drugs, anti-
trigger tinnitus, about 300 drugs associ-
malarial medications, anti-cancer drugs and blood pressure controlling medications, to name a few, can
of drugs that affect balance and cause other ototoxic side effects. This book, as
Neil Bauman, Ph.D.
well as Dr. Bauman’s When Your Ears
Ring (Cope with Your Tinnitus–Here’s How),
is available with member
discount pricing in the online ATA Store at www.ata.org.
Tinnitus arising from taking ototoxic drugs may, or may not, be permanent. The good news is that tinnitus
Annual Physician’s Desk Reference (PDR) guides are available by
resulting from taking such drugs is often temporary
contacting ATA at (800) 634-8978 x219 or email@example.com.
and goes away in a few days to a few weeks after you stop taking the drug. For example, ototoxic anti-
inflammatories such as acetylsalicylic acid (aspirin), ibuprofen (Advil®) and naproxen (Aleve®) generally
Ototoxic (OH-toe-TOKS-ik) drugs are those medica-
cause temporary tinnitus. But there are no guarantees.
tions that can cause ototoxic (ear damaging) side effects to your ears. Such drugs can cause hearing
The bad news is that the resulting tinnitus may be
loss, hyperacusis, tinnitus and other phantom sounds
permanent. For example, if you are taking an amino-
and a whole host of balance problems. This does not
glycoside antibiotic, you are lucky if the tinnitus stops
happen to everyone who takes drugs, by any means,
within a couple of weeks after you finish the drug
but it does happen to a significant number of unfortu-
therapy. For a good number of people, this kind of
Note this well.
Even though a drug’s description lists tinnitus as a side effect, this does not mean that you
will develop tinnitus if you take it. Some people do.
Many don’t. The problem is that you don’t know into
Drug-induced tinnitus usually first appears as a con-
which class you will fall. Therefore, you should learn
tinuous high-pitched sound in both ears. However,
and quinine (and related drugs) is generally a
Just because a drug label does not list tinnitus as a
possible side effect, does not mean it will not cause
tinnitus. For example, when Sarah’s doctor doubled
her dose of irbesartan (Avapro®), her existing tinnitus
became noticeably louder. When she complained to her
doctor, he reduced her dose and her tinnitus returned
to its previous level. But still, irbesartan is not listed
begin taking an ototoxic medication, or it may take
several days for it to become obvious to you. For
any given medication. For example, Joan takes
example, tinnitus from loop diuretics may start just
celecoxib (Celebrex®) for her arthritis. When she
minutes after you begin receiving them intrave-
takes it, her tinnitus gets louder, but her arthritis
nously (directly into a vein). In contrast, tinnitus may
pain improves. She chooses the increased tinnitus
not show up until two or three days after taking an
(which doesn’t really bother her) over the arthritis
aminoglycoside antibiotic. Strangely enough, with
pain (which she definitely doesn’t like). That is her
certain drugs, such as the benzodiazepines (a class of
choice, and she is content to live with it.
tranquilizers), tinnitus may only start after you have
Harold, on the other hand, began taking amitrip-
tyline and soon noticed he had severe tinnitus. As he says, his tinnitus was driving him “buggy,” so he
contacted me for help. I suggested the amitriptyline
Hearing loss and tinnitus often go together. I have
might be causing his tinnitus. With his doctor’s
seen it reported that about 70 percent of people
permission, he stopped taking the drug. Twelve days
with hearing loss also have tinnitus. Therefore, if
later, he joyfully reported that his tinnitus went away.
you preserve your hearing, you can help yourself
That was his choice and he is glad he made it.
avoid unnecessary tinnitus. To this end, you should
When it comes to your ears, don’t let ototoxic drugs
be aware that there are around 300 drugs associated
flip your world upside down! Remain in the driver’s
with hearing loss. Taking such drugs may result in
seat and take control by reading, asking questions
and making the best choices you can.
Tinnitus often precedes or accompanies hearing
Neil Bauman, Ph.D. is the Executive Director of
loss. In fact, tinnitus is the number one indicator
the Center for Hearing Loss Help. His mission is
that you may be doing damage to your ears from
educating and helping people successfully live
an ototoxic drug. It also may be the only warning
with their hearing losses, tinnitus and other ear
conditions. Dr. Bauman is both a speaker and the author of ten books and hundreds of articles
What You Can Do About TinnitusKnowledge is power.
When you are aware of the
many drugs that can damage your ears, and the
many risk factors that can make you even more
Pain Management Pocket Tool 1. Ask the patient about the presence of pain. 2. Accept the patient’s report of pain. 3. Perform a comprehensive pain assessment, including: • Onset, duration, and location • Quality • Intensity (use appropriate scale) • Patient’s goal • Effect on function and • Response to prior • What makes the pain better or worse • History/physic
VETERINARY ONCOLOGY CENTER Helping Pets with Cancer FOLLOW-UP BLOODWORK Dear Doctor Our mutual patient is due for recheck blood work soon and may come to your clinic for this to be performed. If you have any questions please call me. • The type of bloodwork needed will be indicated on the last set of discharge instructions (feel free to run additional bloodwork as deemed neces