Which medications are known to cause sensorineural hearing loss?

Medications That Cause Sensorineural Hearing Loss

The medications most strongly associated with sensorineural hearing loss are cisplatin, aminoglycoside antibiotics, loop diuretics (particularly furosemide), carboplatin (especially at high doses >1500 mg/m²), and phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil). 1, 2

Primary Ototoxic Agents

Chemotherapy Agents

• Cisplatin is the most well-established ototoxic chemotherapy agent, causing dose-dependent sensorineural hearing loss through oxidative damage to cochlear outer hair cells 1, 3
• High-dose carboplatin (cumulative doses >1500 mg/m²) also causes hearing loss, though it primarily damages inner hair cells rather than outer hair cells 1, 3
• The combination of cisplatin and carboplatin produces more severe ototoxicity than either agent alone, with cisplatin being the primary contributor 3

Aminoglycoside Antibiotics

• Aminoglycosides are extensively documented as causing sensorineural hearing loss through direct toxicity to the inner ear 2, 4, 5
• The ototoxic effect is dose-dependent and duration-dependent, with hearing loss potentially worsening even after drug discontinuation 2

Loop Diuretics

• Furosemide and other loop diuretics cause hearing loss, particularly when combined with other ototoxic medications 1, 2

Phosphodiesterase-5 Inhibitors

• Sildenafil (Viagra), tadalafil, and vardenafil can cause sudden sensorineural hearing loss, typically unilateral (88% of cases) 6, 7
• Hearing loss occurs within 24 hours of ingestion in 66.7% of reported cases 6
• Sildenafil accounts for over 50% of PDE-5 inhibitor-related hearing loss cases 6

Additional Medications with Evidence

NSAIDs and Acetaminophen

• Sulindac, ibuprofen, and acetaminophen show associations with self-reported hearing loss, though formal audiometric confirmation is limited 8
• Acetaminophen-narcotic combinations have demonstrated profound hearing loss in some instances 8

Critical Risk Factors That Amplify Ototoxicity

The following factors significantly increase the risk of drug-induced hearing loss and should trigger heightened surveillance: 1, 2

• Age: Younger children and elderly patients are at higher risk
• Renal impairment: Reduced drug elimination increases ototoxic exposure
• Dehydration: Concentrates ototoxic drugs
• Concurrent ototoxic medications: Aminoglycosides combined with cisplatin or furosemide dramatically increase risk 1
• Cranial radiation ≥30 Gy to the cochlea: Particularly when combined with platinum chemotherapy 1
• CSF shunts: Moderate-quality evidence shows increased ototoxicity risk in brain tumor survivors 1

Important Clinical Pitfalls

• Ototoxic ear drops: Substances that are ototoxic can cause irreversible hearing loss when a perforated eardrum allows passage into the inner ear 2
• Delayed recognition: Drug-related hearing loss may not be suspected until months or years after exposure 2
• Progressive deterioration: Hearing loss can continue worsening after drug discontinuation 2
• Carboplatin underestimation: While less ototoxic than cisplatin alone, carboplatin potentiates ototoxic effects when combined with other agents 3

Surveillance Recommendations

For patients treated with cisplatin, high-dose carboplatin (>1500 mg/m²), or cranial radiation ≥30 Gy, surveillance for hearing loss is strongly recommended. 1

• Baseline audiometry should be performed before initiating ototoxic therapy 1
• Serial audiometric monitoring is essential during and after treatment, as hearing function can deteriorate over time in some patients while remaining stable or improving in others 1
• Patients with CSF shunts warrant consideration for surveillance given their elevated risk 1