1-844-576-1110​
Page Title

Ototoxicity and your Hearing Health
Prepared in observance of OSHA Safe and Sound Week, 2021
What is ototoxicity
Ototoxicity is hearing impairment caused by exposure to ototoxins - medications and chemicals that can be inhaled, absorbed through the skin, or consumed.
The condition is worsened when the exposure is combined with other risk factors for hearing impairment such as hazardous noise, certain underlying health conditions, certain lifestyle habits, genetic factors.
​
What are known ototoxins?
​
1. Drugs
Several categories of drugs that are used commonly including some that have been recently approved by health authorities have varying levels of ototoxicity. The table below summarizes drugs (generic names) and the medical condition for which they are commonly prescribed or available over-the-counter. There are several hundred brand names associated with these drugs.
Acetazolamide - Edema
Acetaminophen - Pain, fever
Alendronic acid - Osteoporosis
Amikacin - Bacterial infections
Amphotericin B - Fungal infections
Artemether - Malaria
Aspirin - Pain, fever
Avanafil - Erectile dysfunction
Azithromycin - Mycobacterial infections
Bismuth subsalicylate - Diarrhea
Boceprevir - Hepatitis C
Bortezomib - Cancer
Bromocriptine - Acromegaly, Parkinson’s
Bumetanide - Edema
Carboplatin - Cancer
Celecoxib - Pain
Chlormethine - Cancer
Cisplatin - Cancer
Clonazepam - Seizure, panic
Cyclosporine - Organ transplantation
Docetaxel - Cancer
Deferasirox - Iron overload
Deferiprone - Iron overload
Deferoxamine - Iron overload
Ethacrynic acid - Edema
Enalapril - High blood pressure
Erythromycin - Bacterial infection
Febuxostat - Gout
Fenoprofen - Arthritis, Pain
Flumazenil - Drowsiness
Furosemide - Edema
Gabapentin - Neuralgia
Gentamicin - Bacterial infection
Hydroxychloroquine - Malaria
Ibuprofen - Pain
Interferon alpha - Hepatitis C
Isotretinoin - Acne
Itraconazole - Fungal infection
Kanamycin - Bacterial infection
Leuprolide - Cancer
Meropenem - Bacterial infection
Mefloquine - Malaria
Naproxen - Arthritis
Neomycin - Bacterial infection
Nicotine - Smoking cessation
Nilotinib - Cancer
Ofloxacin - Ear infection
Plazomicin - Urinary tract infection
Pramipexole - Parkinson’s disease
Quinine - Malaria
Ribavirin/Intron A - Hepatitis C
Rivastigmine - Dementia
Ropinirole - Parkinson’s disease
Ropivacaine - Anesthesia
Sildenafil - Erectile dysfunction
Sodium valproate - Epilepsy
Streptomycin - Bacterial infection
Sumatriptan - Migraine
Tacrolimus - Transplant
Tadalafil - Erectile dysfunction
Teprotumumab - Thyroid eye disease
Terbinafine - Fungal infection
Thalidomide - Cancer
Tobramycin - Bacterial infection
Topiramate - Seizure
Vancomycin - Bacterial infection
Valproic acid - Seizure
Vardenafil - Erectile dysfunction
Verteporfin - Eye disorder
Vinblastine - Cancer
Vincristine - Cancer
Vinorelbine - Cancer
Viomycin - Tuberculosis
Zoledronic acid - Osteoporosis
​
2. Chemicals
Can be used as part of occupational or personal activities.
Acrylonitrile
Arsenic
3-Butenenitrile
Carbon Disulfide
Carbon Monoxide
Chemical Warfare Agents
Cis-2-pentenenitrile
Cis-crotononitrile
Cyanide
Diesel fuel
Ethylbenzene
Fuels
Germanium dioxide
Heptane
Hydrogen cyanide
3,3’-iminodipropionitrile
Jet fuel
JP-8 fuel
Kerosene fuel
Manganese
Mercury
Methyl Ethyl Ketone
Methylstyrene
N-Hexane
N-propylbenzene
Nitriles
Organic lead
Organic tin
Pesticides
P-xylene
Paraquat
Perchloroethylene
Polychlorinated biphenyls
Stoddard Solvent
Styrene
Tobacco smoke
Toluene
Trichloroethylene
Xylene
These chemicals are used in construction, firefighting, manufacturing, mining, military, utilities related activities with sub sectors such as:
Appliance and Component (including batteries)
Chemical (including glue, paint, plastics)
Furniture
Electrical Equipment
Fabricated metal
Firefighting
Fueling vehicles an aircraft
Leather and Allied Product
Machinery
Pesticide spraying
Paper
Petroleum
Painting
Printing
Radiator Repair
Solar Cell
Textile and Apparel
Transportation Equipment (e.g. ship and boat building)
Weapons firing
​
Other risks worsening ototoxicity
-
Hazardous noise: The effect is synergistic (combined effect greater than individual sum). Several activities listed in table above include combination of ototoxicants and unsafe noise exposures
-
Habits: Such as smoking (including second-hand smoke), vaping, recreational marijuana use, alcohol intake
-
Pre-existing ear conditions: Such as recurrent ear infections, ear damage due to impact, damaged tympanic membrane, pre-existing hearing loss
-
Other: Such as increasing age, gender (males are more susceptible), genetic susceptibility, chronic diseases such as diabetes, hypertension
​
How you can be affected
Drug induced ototoxicity is dependent on factors such as dose, multiple dosing regimen, duration of therapy, concurrent renal failure (which could lead to drug accumulation), co-administration with other drugs with ototoxic potential.
​
Chemical induced ototoxicity is generally due to repeated inhalation and skin absorption at doses exceeding safe limits. The effects are amplified as several of these activities are accompanied by unprotected hazardous noise levels.
​
Health consequences of ototoxicity
Common symptoms of hearing impact include tinnitus (ringing in the ears), ear ache, temporary hearing difficulties and in some cases sudden and permanent hearing loss.
In addition, you could experience temporary vertigo and difficulty maintaining balance and in some cases have severe loss of vestibular sensitivity which may persist permanently. Loss of vestibular sensitivity can cause walking difficulties and oscillopsia (affected eye movement or the eye’s ability to stabilize images).
Loss of hearing can impact social engagement, academic and job performances, pay and career advancements - overall affecting quality of life.
Loss of hearing is also associated with serious conditions such as depression, dementia, increased falls, hospitalizations.
DIY-Protection and Prevention
Protection
-
If you have been prescribed an ototoxic drug, discuss with your healthcare provider
-
If you are being exposed to ototoxic chemical(s), seek training on health and safety information and review Safety Data Sheets (SDS)
-
Understand occupational and environmental standards for chemicals and if they are being followed
-
Wear appropriate Personal Protective Equipment including respiratory protection and chemical-protective gloves, arm sleeves, aprons and other appropriate clothing to reduce dermal exposure
-
Wear hearing protection and conduct audiometric testing of noise exposure at your workplace (i.e., an 85-decibel 8-hour time-weighted average)
-
If you perceive hearing difficulties, self-test with Questionnaire from National Institutes of Health (NIH) and decide on visiting a hearing care professional
Prevention
-
Check if you can replace a hazardous chemical with a less toxic chemical
-
Ensure workplace noise levels align with appropriate safe standards
-
Take steps to control recreational noise exposure by lowering volume, taking listening breaks, distancing yourself from sound source, wearing hearing protection if loud noise is unavoidable
-
Be aware of additional risks worsening ototoxicity that are applicable to your lifestyle and health and discuss with your healthcare provider
-
Get more information on hearing and hearing loss prevention from reliable sources:
Centers for Disease Control and Prevention (CDC). Too Loud! For Too Long! Loud noises damage hearing
Department of Defense (DoD), Hearing Center of Excellence
Food and Drug Administration (FDA): What are the signs and symptoms of hearing loss
National Institute for Occupational Safety and Health (NIOSH): Noise and hearing loss prevention
National Institute for Deafness and other Communication Disorders (NIDCD). Noise-induced hearing loss
Occupational Safety and Health Administration (OSHA): Preventing Hearing Loss Caused by Chemical (Ototoxicity) and Noise Exposure
World Health Organization (WHO): World Report on Hearing