From the Guidelines
Hydroxychloroquine (HCQ) can cause ototoxicity, primarily manifesting as sensorineural hearing loss, tinnitus, and vertigo, with the risk increasing with higher daily doses, longer duration of treatment, pre-existing hearing problems, kidney dysfunction, and advanced age. The mechanism involves direct damage to the cochlear hair cells and the eighth cranial nerve, with HCQ accumulating in melanin-rich tissues including the inner ear, leading to cellular damage 1. Patients on HCQ should undergo baseline audiometric testing before starting treatment and regular hearing assessments during therapy, typically every 6-12 months, as recommended by the American Academy of Ophthalmology 1. If ototoxicity symptoms develop, prompt medical evaluation is essential as hearing loss may be reversible if the medication is discontinued early, although in some cases, the damage may be permanent even after stopping the drug 1. Patients should be educated about potential ear symptoms and instructed to report any hearing changes, tinnitus, or balance problems immediately. Key factors to consider include:
- Higher daily doses (>5 mg/kg/day) increase the risk of ototoxicity
- Longer duration of treatment (>5 years) increases the risk of ototoxicity
- Pre-existing hearing problems, kidney dysfunction, and advanced age also increase the risk
- Regular hearing assessments and prompt medical evaluation are crucial in managing ototoxicity
- Patient education on potential ear symptoms and the importance of reporting any changes is vital.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Ear Effects of Hydroxychloroquine
The ear effects of hydroxychloroquine (HCQ) treatment have been reported in several studies, including:
- Ototoxic effects, such as hearing loss, tinnitus, and imbalance 2, 3, 4, 5, 6
- Sensorineural hearing loss, which can be temporary or persistent 2, 3, 4, 5, 6
- Cochleovestibular damage, including changes in the stria vascularis and lesions in sensory hair cells 4
- Abnormal cochleovestibular development in newborns after maternal treatment with chloroquine or hydroxychloroquine during pregnancy 2
Types of Ear Effects
Some of the specific ear effects reported include:
- Tinnitus, which can be reversible or irreversible 3, 6
- Sensorineural hearing loss, which can be unilateral or bilateral 2, 3, 4, 5, 6
- Peripheral vestibular syndrome 3
- Imbalance and abnormal gait 2, 6
Reversibility of Ear Effects
The reversibility of the ear effects of HCQ treatment is still debated, but some studies suggest that:
- Hearing loss and tinnitus can be reversible if the medication is stopped and appropriate therapy is instituted 5
- Abnormal auditory brainstem responses can resolve after discontinuation of HCQ 6
- However, some cases of sensorineural hearing loss and tinnitus have been reported to be irreversible 2, 3, 6