Inner ear problems and drugs that can damage ears

May 6, 2011

This article is very imformative and relays what many of us experience from psyche drug exposure and subsequent withdrawal.

Equally important to note: I have experienced so many of these symptoms during WD, and to the extreme, however, I am totally recovered from these effects. So, do not become alarmed but rather informed and learn how to protect your ears.

This link no longer goes to the information http://www.hearinglosshelp.com/articles/ototoxicaudiology.htm

June 2020: This is a link to the same site where I searched for ototoxic. These are the search results: https://hearinglosshelp.com/?s=ototoxic

Drugs That Can Damage Your Ears (Ototoxic Drugs)

Ototoxicity—The Hidden Menace

(First published in Audiology Online and Healthy Hearing December 1, 2003.)

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Now read Ototoxicity—The Hidden Menace, Part II to learn even more about ototoxic drugs and how you can protect yourself from their nasty side effects. Although written specifically for audiologists, Part II is still easy-to-read, and contains valuable information that will help anyone concerned about ototoxic drugs and their side effects.

What Is Ototoxicity?

To many doctors, ototoxicity just means hearing loss or tinnitus. Others consider only drug side effects that affect the inner ear as being ototoxic. However, Stedman's Medical Dictionary11 defines ototoxicity as the "property of being injurious to the ear." Therefore, any side effect of a drug that damages our ears in any way is ototoxic whether it damages the outer, middle or inner ear.

How Common Are Ototoxic Side Effects?

How common are ototoxic side effects? The short answer is, "No one really knows." We apparently only see (and record) the tip of the iceberg. For extremely ototoxic drugs such as Cisplatin (used in the treatment of cancer), virtually everyone that takes this drug ends up with hearing loss. According to some researchers, not a single person escapes its ravages—100% of the people taking Cisplatin damage their ears.5 The resulting hearing loss "is usually irreversible (permanent)."8

Another very ototoxic class of drugs are the AMINOGLYCOSIDE antibiotics. Researchers estimate that between one and four million Americans receive AMINOGLYCOSIDE antibiotics (such as Gentamicin, Neomycin, Tobramycin) each year.7 According to one study, a person has a 25-30% chance of incurring hearing loss from taking any of the AMINOGLYCOSIDES.9 Another study pegs the figure at 63%.5

This means that between 250,000 and 1,200,000 people (and maybe as high as 2,520,000 people) in the USA incur hearing losses each year from taking just this one class of drugs. Add to these figures the untold numbers of people who experience other side effects from taking these same drugs—such as tinnitus, dizziness, vertigo and numerous other cochlear and vestibular (balance) problems—and you have a figure of alarming proportions. It is even more alarming when you realize we are just talking about a handful of ototoxic drugs in 2 of the more than 150 classes of ototoxic drugs!

Ototoxic Drugs are Everywhere!

There are at least 743 drugs that are known to be ototoxic.4 Here are just 84 of them. This gives an inkling of just how all-pervading ototoxic substances are in the medications we take without having a clue that these drugs may be harming our ears.

ACE INHIBITORS such as Enalapril (Vasotec),2 Moexipril (Univasc), Ramipril (Altace)

ACETIC ACIDS such as Diclofenac (Voltaren), Etodolac (Lodine), Indomethacin (Indocin), Ketorolac (Toradol)

ALPHA BLOCKERS such as Doxazosin (Cardura)

AMINOGLYCOSIDES such as Amikacin (Amikin), Gentamicin (Garamycin), Kanamycin (Kantrex), Neomycin (Neosporin), Netilmicin (Netromycin), Streptomycin, Tobramycin (Tobradex)

ANGIOTENSIN-2-RECEPTOR ANTAGONISTS such as Eprosartan (Teveten), Irbesartan (Avapro)

ANTI-ARRHYTHMIC DRUGS such as Flecainide (Tambocor), Propafenone (Rythmol), Quinidine (Cardioquin), Tocainide (Tonocard)

ANTI-CANCER DRUGS such as Buserelin (Suprefact), Carboplatin (Paraplatin), Cisplatin (Platinol), Vinblastine (Velban), Vincristine (Oncovin)

ANTI-CONVULSANT DRUGS such as Carbamazepine (Tegretol), Divalproex (Depakote), Gabapentin (Neurontin), Tiagabine (Gabitril), Valproic acid (Depakene)

ANTI-MALARIAL DRUGS such as Chloroquine (Aralen), Mefloquine (Lariam), Quinine (Legatrin)

ANTI-RETROVIRAL PROTEASE INHIBITORS such as Cidofovir (Vistide), Ganciclovir (Cytovene), Ritonavir (Norvir)

BENZODIAZEPINES such as Diazepam (Valium), Estazolam (ProSom), Midazolam (Versed)

BETA-BLOCKERS such as Atenolol (Tenormin), Betaxolol (Betoptic), Metoprolol (Lopressor)

BICYCLIC ANTI-DEPRESSANTS such as Venlafaxine (Effexor)

CALCIUM-CHANNEL-BLOCKERS such as Diltiazem (Cardizem), Nifedipine (Adalat), Nisoldipine (Sular)

COX-2 INHIBITORS such as Celecoxib (Celebrex), Rofecoxib (Vioxx)

H1-BLOCKERS such as Cetirizine (Zyrtec), Fexofenadine (Allegra)

IMMUNOSUPPRESSANT DRUGS such as Cyclosporine (Neoral), Muromonab-CD3 (Orthoclone OKT3), Tacrolimus (Prograf)

LOOP DIURETICS such as Ethacrynic acid (Edecrin), Furosemide (Lasix), Torsemide (Demadex)

MACROLIDE ANTIBIOTICS such as Clarithromycin (Biaxin), Erythromycin (Eryc)

OPIATE AGONIST DRUGS such as Codeine (Codeine Contin), Hydrocodone (Vicodin), Tramadol (Ultram)

PROPIONIC ACIDS such as Flurbiprofen (Ansaid), Ibuprofen (Motrin), Naproxen (Anaprox)

PROTON PUMP INHIBITORS such as Esomeprazole (Nexium), Lansoprazole (Prevacid), Rabeprazole (Aciphex)

QUINOLONES such as Ciprofloxacin (Cipro), Ofloxacin (Floxin), Trovafloxacin (Trovan)

SALICYLATES such as Aspirin, Mesalamine (Asacol), Olanzapine (Zyprexa)

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) such as Fluoxetine (Prozac), Fluvoxamine (Luvox), Sertraline (Zoloft)

SEROTONIN-RECEPTOR AGONISTS such as Almotriptan (Axert), Naratriptan (Amerge), Sumatriptan (Imitrex)

THIAZIDES such as Bendroflumethiazide (Corzide), Indapamide (Lozol)

TRICYCLIC ANTI-DEPRESSANTS such as Amitriptyline (Elavil), Clomipramine (Anafranil)

Ototoxic Side Effects

Ototoxic side effects can damage our ears in many different ways. You may experience one, several or no side effects from taking any given drug. The average ototoxic drug exhibits about 3.5 ototoxic symptoms.4 Here are a number of the ototoxic side effects you could experience.

When you know which ototoxic side effects can occur, you can watch for them. If they do occur, immediately contact your physician, stop taking the offending drug (with your doctor's consent—of course) to try to limit the damage to your ears.

1. Cochlear side effects

Tinnitus: Tinnitus, commonly called "ringing in the ears," is the number one indicator that you may be damaging your ears from an ototoxic drug. At least 447 drugs are known to cause tinnitus.4 Tinnitus can manifest itself as a wide variety of sounds. It may be a ringing, roaring, beating, clicking, banging, buzzing, hissing, humming, blowing, chirping, clanging, sizzling, whooshing, rumbling, whistling or dreadful shrieking noise in your head. It may also sound like rushing water, radio static, breaking glass, bells ringing, owls hooting or chainsaws running.3

Hearing loss: More than 230 drugs are known to cause hearing loss.4 Hearing loss can range from mild to profound and may be temporary or permanent. One of the insidious things about ototoxic drugs is they generally first destroy hearing in the very high frequencies which are not normally tested (those above 8,000 Hz). Thus, you're not even aware you are losing your hearing until it is too late to do anything about it.

Distorted hearing: Some drugs, instead of causing hearing loss (or in addition to causing hearing loss), cause hearing to be distorted so we do not understand some (or much) of what we are hearing.

Hyperacusis: Hyperacusis is a condition where normal sounds are perceived as being much too loud. It is as though the body's internal volume control is stuck on "high." At least 38 drugs can cause this condition.4

Feelings of fullness in your ears: You can experience this feeling for a few reasons. One, because your ears really are blocked by a middle ear infection or by earwax. Two, because your ears feel "blocked" because of sudden hearing loss. Three, exposure to loud sounds can result in a feeling of "fullness" too.

Auditory hallucinations: At least 8 drugs can cause you to hear phantom sounds—voices and music that are not there. Another 165 drugs can cause hallucinations, some of which may be of the auditory variety.4 Most of these hallucinations seem to be the result of a damaged auditory system rather than the effects of a mental illness.

2. Vestibular Side Effects

Dizziness: Dizziness is the most common ototoxic symptom. At least 588 drugs have this ototoxic side effect.4

Vertigo: Vertigo is the perception of movement (normally a spinning sensation) when the body is really not moving. At least 432 drugs are known to cause vertigo.4

Ataxia: Ataxia is the loss of your ability to coordinate your muscles properly and can be a result of a damaged vestibular system. As a result you may walk with a staggering gait, just as though you were drunk. At least 288 drugs can cause this side effect.4

Nystagmus: Nystagmus is abnormal rapid rhythmic back-and-forth involuntary eye movement, usually from side to side. Although technically an eye problem, it fundamentally is the result of a damaged vestibular system. At least 102 drugs can cause this side effect.4

Labyrinthitis: Labyrinthitis is a catch-all term that simply means something is wrong in your inner ear (cochlear and vestibular systems).

Loss of balance/equilibrium disorder: Some drugs cause a person to lose their balance. These terms too, are mostly catch-alls for various kinds of balance conditions.

Oscillopsia: Oscillopsia is "bouncing vision." This is the result of damage to the vestibular system such that it no longer works together as the vestibulo-ocular reflex. Oscillopsia can result when your vestibular system in both ears is severely damaged.

Emotional problems: When you lose much of your sense of balance, emotional problems such as anxiety, frustration, anger and depression can surface.7 Your feelings of self-confidence and self-esteem may plummet.

Fatigue: Damage to the vestibular system can result in exhaustion, because you now have to consciously work at maintaining your balance.

Memory problems: Memory problems can result because areas of your brain that were previously used for thought and memory, must constantly work on keeping you balanced. As a result, you may grope for words, forget what was just said, be easily distracted or have trouble concentrating.

Muscular aches and pains: Another seemingly-unlikely result of vestibular ototoxicity are muscle pains due to failure of the vestibulo-spinal reflex (the reflex dictating automatic muscle changes in response to changing movement). If the reflex fails, you have to consciously control it. You may make your muscles rigid as you strain to keep your balance.

Nausea: Nausea is a relatively common side effect of vestibular damage that results from your brain's confusion over vestibular sensory inputs.

Visual problems: A host of visual problems can result if the vestibulo-ocular reflex (the reflex that stabilizes your eyes in space) is damaged. As a result, you may have trouble reading since everything seems blurry or fuzzy. You may have trouble focusing your eyes—particularly on moving or distant objects.6

Vomiting: Vomiting is a common result of a damaged vestibular system. Often vomiting and vertigo go together.

Vague feelings of unease: Sometimes you can't put your finger on exactly what is wrong, but you feel vaguely uneasy. You may feel that things seem wrong or unreal.7 This too, can be a result of a damaged vestibular system.

3. Central Nervous System (CNS) Side Effects

Central auditory processing disorder: Sounds may enter our ears and be processed correctly, but these sound signals may be delayed or scrambled after they leave our inner ears. This scrambling can occur as the sound signals are processed by the neuronal networks that make up our auditory nerves, or in various parts of our brains. When this processed sound reaches the conscious levels in our brains where we "hear," we may hear a bunch of gibberish. This is known as a central auditory processing disorder. Several ototoxic drugs/chemicals have this effect.

4. Outer/Middle Ear Side Effects

Ceruminosis: Some drugs cause excessive ear wax production. This excess wax can block our ear canals and cause temporary hearing loss.

Ear pain: Medically called otalgia, ear pain is typically the result of middle ear infections. 154 drugs have ear pain associated with their use.4

Otitis externa; O. media: Otitis is typically an opportunistic infection of the outer (O. externa) or middle (O. media) ear. Many of the drugs listed as having otitis as an ototoxic side effect do not directly cause these conditions. Rather, these infections come in and take over when an opportunity presents itself—i.e. an ototoxic antibiotic killing off the "good bacteria" in the ear canal, leaving it wide open to an opportunistic invasion of "bad bacteria." 138 drugs are associated with otitis.4

Risk Factors

Some people take ototoxic drugs with seeming impunity. Others take one little dose, and wham—there goes their ears. Why?

The short answer is that we are all different. Each person (patients and professionals) is a unique biological case study! No two are exactly the same. Therefore, it should be no surprise that we vary in our sensitivity to ototoxic drugs.

Researchers have identified a number of factors that increase the risk of our having an ototoxic reaction when taking certain drugs. Here are 20 of the risk factors (in no particular order of importance).

You are very young—including unborn children.

You are a senior (over 60 years).

You have certain hereditary (genetic) factors that make you more susceptible than the general population. This is particularly true if you take AMINOGLYCOSIDE antibiotics.

You already have a sensorineural hearing loss, balance problems or some other form of pre-existing ear damage.12

You have had previous ear damage (hearing loss) from exposure to excessive noise.

You have problems with your kidneys. For some reason, people with kidney problems have an unusually high incidence of hearing loss, even without drug use.10

You are extremely sensitive to drugs or have a low tolerance for drugs.

You have had ototoxic reactions to drugs in the past. Not only does the risk increase, but the resulting ototoxic damage has a tendency to be more severe and is more likely to be permanent.7

You have previously used ototoxic drugs, or you have taken repeated courses of the same ototoxic drug.

You have taken certain drugs for a long time—especially if you have taken a drug for longer than the manufacturer recommended.

You can be at higher risk if an ototoxic drug is not administered properly—i.e. larger than recommended dose, higher that recommended cumulative dose, faster dose than recommended (injection or intravenous).7

You have been given an inappropriate dose—i.e. a child given an adult dose, or an overweight person given a dose based on total weight rather than on lean body weight (especially true if taking an AMINOGLYCOSIDE antibiotic).7

You are dehydrated.

You have taken ototoxic DIURETICS at the same time as other ototoxic drugs or if you have used or are using two or more ototoxic and/or nephrotoxic (toxic to the kidneys) drugs at the same time.

You have had previous ear infections.

You are generally in poor health.

You have abnormal laboratory values such as reductions in serum albumin, serum red blood cells, hematocrit, hemoglobin or you have rising serum creatinine levels.7

You have had radiation treatments on your head or ear.6

You have bacteremia (bacteria in the bloodstream).7

You have either eye or proprioceptive (balance) problems. This increases the chances that you will have a more serious result on your life-style if vestibular ototoxicity does occur.7

Reduce The Risk-Here's How

You cannot do anything about certain ototoxic risk factors such as your age or your genetic makeup. However, there are still some things you (and your doctor) can do to lessen your risk of having an ototoxic reaction from taking certain drugs.

Here are some things you and your doctor can do.

Be aware of the early warning signs of ototoxicity. They are (in order of frequency): you feel dizzy; your ears begin ringing (tinnitus); your existing tinnitus gets worse or you hear a new kind of tinnitus sound; you feel pressure in your ears (unless you have a head cold); your hearing gets worse or begins fluctuating; or you develop vertigo (spinning sensation).

Tell your doctor you are hard of hearing, especially if you have a sensorineural hearing loss and/or suffer from balance problems. Also, let him know if you have tinnitus.

Always discuss possible side effects with your doctor before you begin a new medication.

Follow your doctor's dosage instructions exactly. At the same time, make sure your doctor does not exceed the drug manufacturer's dosage instructions when he prescribes drugs for you.

Use the same pharmacy for all your prescriptions so they will know all the drugs you are taking. That way they can advise you of any known dangerous drug combinations.

Always read the labels on over-the-counter medications and particularly watch for ototoxic side effects.

Drink plenty of fluids so you don't get dehydrated. This is especially important if you have a fever or are taking loop diuretics.

If you have kidney problems, have your health care professionals carefully monitor your kidney function and report abnormalities immediately. Your doctor needs to know how well your kidneys are working before he prescribes various medications.

Avoid taking multiple ototoxic drugs at the same time.

Avoid noisy environments for at least 6 months after you have completed a course of an AMINOGLYCOSIDE antibiotic or platinum compound such as Cisplatin.8

If you are beginning treatment with an ototoxic drug such as any of the AMINOGLYCOSIDE antibiotics, LOOP DIURETICS or platinum compounds such as Cisplatin, it is important that you have a baseline high-frequency audiogram done before you begin treatment and then serial high-frequency audiograms (testing those frequencies above 8,000 Hz) during and after drug therapy.

If you have had vestibular (balance) problems from taking any drugs, be very careful not to damage your vestibular system further by taking drugs known to damage your vestibular system.

When you are aware of the many drugs that can damage your ears and the many risk factors that can make you even more susceptible to ototoxic side effects than the general population, you can take steps to protect your precious ears.

You will then be in the position to take control and make informed decisions about your health care. For example, "Joan" takes Celecoxib for her arthritis. When she takes it, her tinnitus gets louder, but her arthritis problems improve. She chooses the tinnitus over the arthritis pain. That is her choice and she is content to live with it.

"Harold," on the other hand, began taking Amitriptyline and soon noticed he had severe tinnitus. He didn't like this one bit and wrote to me for help. I suggested the Amitriptyline may be causing his tinnitus. With his doctor's permission, he stopped taking the drug. Twelve days later, he joyfully reported that his tinnitus went away. That was his choice. He is happy he made it.

When it comes to the health of your ears, you, too, have a choice. Don't let ototoxic drugs flip your world upside down!

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The information in this paper was taken from the second edition of the book Ototoxic Drugs Exposed by the same author. To learn more about ototoxicity in general, or to learn the specific ototoxic side effects of the 743 ototoxic drugs, 30 herbs and 148 chemicals mentioned in this book, get your own copy of Ototoxic Drugs Exposed.

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If you would like to join an information and support E-mail list for people who have damaged their ears from taking ototoxic drugs, type your E-mail address in the box and click on the Yahoo Groups button. (You can unsubscribe at any time.)

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Part I: Lives in Upheaval

"Lynn's" passion was flying. She loved her job as a flight attendant. One day she noticed an ingrown toenail. Within a few days it became infected. The Gentamicin1 her doctor prescribed killed the infection. It also killed the balance system in her ears. Ever since that fateful day in 1994, Lynn has not been able to work or fly. Without warning, an ototoxic drug turned her world upside down.

An ototoxic drug flipped "Ruby's" life upside down too. She explains: "I cannot drive any more. I had to quit my job as it was an hour's drive away. My mental status is now "foggy" at best. I cannot walk in the dark. My life has changed drastically."

"Bert" lost much of his hearing after taking Doxycycline for a urinary tract infection. "Eunice" told me that just taking the Amitriptyline her doctor prescribed for her resulted in "screaming tinnitus."

"Jonathan" described how he lost hearing in one ear after he took a course of Erythromycin. In addition, he experienced hyperacusis, balance problems and "horrific bilateral tinnitus." "Jonathan's" condition appears to be permanent—as this happened five years ago.

Peggy told me, "I was given Atenolol for some little irregular heart beats. Within a few days my perfectly normal ears started to give me all kinds of noise, roaring and muffledness. Within a week, I woke up one morning stone cold deaf in one ear."

In an email to me, "Sam" told how his doctor had prescribed an ointment containing Tobramycin for a sty on his left eyelid. He wrote, "I started using the cream on my left eyelid on Tuesday. At 8:30 the next morning, I lost the hearing in my left ear." In "Sam's" case, the Tobramycin apparently caused sudden hearing loss just 19 hours later—and this was only from using an ointment on his eyelid!

I wish I could say these are only a few isolated incidents, but I'd be lying if I did so. The truth is—side effects of ototoxic drugs are more common than people (doctor's included) imagine. Each year, the side effects of ototoxic drugs disrupt millions of people's lives and leave a trail of upheaval in their wake.

It is not just drugs taken for chemotherapy and life-threatening infections that cause ototoxic reactions, but the little unexpected everyday things too—an ingrown toenail, a sty on your eye, an irregular heartbeat, high blood pressure, and on and on it goes. Whether the ototoxic side effects result from taking an ototoxic drug for a life-threatening malady or for a relatively minor disorder, the results are the same—lives turned upside down.

Scary? You bet it is. Obviously, it's about time we became aware of what drugs are doing to our ears and learn to make wise decisions regarding them.

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Notes

1 In this paper, drug classes are in full capitals (ACE INHIBITORS), generic drug names are in bold (Enalapril) and brand names are in italics (Vasotec).

2 The brand names listed here are neither more or less ototoxic than any brands of this same generic drug that are not listed. I have simply chosen, more or less at random, one brand as a representative of all the brands available for that generic drug.

References

3 Bauman, Neil. 2002. When Your Ears Ring. Cope With Your Tinnitus. Here's How. Center for Hearing Loss Help. 49 Piston Court, Stewartstown, PA 17363. http://www.hearinglosshelp.com.

4 Bauman, Neil. 2003. Ototoxic Drugs Exposed, Second Edition. Center for Hearing Loss Help. 49 Piston Court, Stewartstown, PA 17363. http://www.hearinglosshelp.com.

5 Guidelines for the audiologic management of individuals receiving cochleotoxic drug therapy. 1994. American Speech-Language-Hearing Association. 36(3), Supplement No. 12.

6 Haybach, Patty J. 1998. Ototoxicity for nurses. http://www.geocities.com/otolithic/ototox.htm.

7 Haybach, Patty J. 1999. Balance and hearing: At risk from drugs. Course #170. http://nurse.cyberchalk.com/nurse/COURSES/NURSEWEEK/ NW170/menu.html.

8 Kalkanis, James. 2001. Inner ear—Ototoxicity. eMedicine. 2(7). http://www.emedicine.com/ent/topic699.htm.

9 Shlafer, Marshal. 2000. Ototoxic drugs. University of Michigan Medical School. http://www-personal.umich.edu/~mshlafer/ototox.html.

10 Staab, Dr. Wayne J. 1991. The Rexton guide to better hearing. 512 East Canterbury Lane, Phoenix, Arizona 85022.

11 Stedman's Medical Dictionary. 2000. 27th Edition. Lippincott Williams & Wilkins. Baltimore, Maryland.

12 Troost, B. Todd, and Melissa A. Walker. 1998. Drug induced vestibulocochlear toxicity. In: Iatrogenic Neurology. Butterworth-Heinman. Boston. http://ivertigo.net/ototoxicity/otvestibular.html.

Part II: Ototoxicity and the Practice of Audiology

Part I of this series presented an overview of the hundreds of ototoxic drugs currently available and how their potential side effects relating to hearing and balance turn countless lives upside down. Part I also detailed risk factors that predispose people to ototoxic effects and concluded with what individuals can do to reduce their risk.

In Part II, we'll examine things you, as an audiologist, can do to help your patients when their ears "butt heads" with ototoxic substances.

Think "Drugs" When Assessing Hearing Loss

As you know, when patients present for hearing evaluations, it is important to ask what medications they're taking. However, the importance of this questioning is not limited to a thorough and complete history. Rather, this knowledge may indeed impact their current status and future-based medical decision making.

If you look up their medications in Ototoxic Drugs Exposed,1 you'll quickly get an idea as to what may be happening to their ears. If ototoxic side effects started (or increased) around the time they began taking certain drugs, the ototoxic "index of suspicion" is elevated, and indeed, their current medications may be damaging their ears.

Given an elevated index of suspicion, and armed with objective data, you might contact the physician and suggest that perhaps alternative, non-ototoxic alternative medications might be an option.

For example, suppose a patient comes to you with severe hyperacusis which is disrupting her life. What do you do? Do you immediately think of something like Hyperacusis Retraining Therapy, or do you think "drugs?"

I suggest as a first step-think "drugs."

When patients ask me what they can do about their hyperacusis, among the first questions I ask is, "What happened in your life just before the hyperacusis began? Did you start taking new medications or was there a change in the dose of existing medications?" I ask for a complete list of their medications and I look them up in Ototoxic Drugs Exposed to see if any of them are known to cause hyperacusis. If any of them are known to cause hyperacusis, I suggest to the patient that he/she contact the doctor to investigate alternative drugs with the same benefits, but without hyperacusis as a known side effect. In certain situations, I may communicate directly with the physician on these issues.

Case 1:

A psychiatrist explained that a patient of hers had several psychiatric problems, but the one thing bothering the patient above all else was severe hyperacusis. The patient had tried hyperacusis remedies without improvement. The psychiatrist asked me if there was anything that might help her patient.

My first reaction was to "think drugs." I asked what medications the patient was on and what medications she had been on at the time the hyperacusis began. When I received the list of medications, I discovered that this patient was taking not just one, but three drugs known to cause hyperacusis! Of all the thousands of drugs on the market, only 38 are known to cause hyperacusis, yet this poor patient was taking three of them at the same time!

I suggested the psychiatrist consider taking the patient off those three particular medications (if medically possible) and then see whether the patient's hyperacusis was reduced or eliminated.

Case 2:

A man contacted me telling me had severe tinnitus and he wanted to know if there was anything he could do about it. Instead of suggesting a tinnitus masker or Tinnitus Retraining Therapy (TRT) or other treatments, I immediately thought "drugs." I asked if he had started any new medications about the time his tinnitus began.

He told me his doctor had recently put him on Amitriptyline. I suggested he ask his doctor to change his medication, if possible, as Amitriptyline is known to cause tinnitus. A couple of weeks later, he wrote me again, saying that 12 days after he stopped taking the Amitriptyline, his tinnitus went away. Again, the solution was simple and effective. Think "drugs."

Case 3:

A woman contacted me as she was experiencing annoying tinnitus and increasing hearing loss. As is my custom, I thought "drugs." I discovered she had been self-medicating-taking large doses of Aspirin each day for the nearly-constant headaches she often suffered.

I suggested to her that her hearing problems and her tinnitus were very likely a direct result of taking all that Aspirin. She stopped taking Aspirin. Six days later she wrote, "I have noticed that I am hearing better now. I have the TV volume set at level 18 instead of the usual 24. The ringing in my ears is still there but it is not as bad." Three days later she added, "Today when someone was talking behind me, I heard every word he said. My hearing still isn't perfect, but it is better than it was."

The people in the above examples didn't need expensive or extensive therapy or hearing aids. What they really needed was someone to help them see that they were damaging their ears due to medications they were taking. In many cases, you'll be able to help your patients more when you first think "drugs."

While You Are Thinking "Drugs," Think "Chemicals" Too

It is not only ototoxic drugs that damage our ears, there are at least 148 ototoxic chemicals that also give us grief.1

Two of the more ototoxic classes of chemicals are the organic solvents and the heavy metals.

There are a number of organic solvents. Some of them are benzene, benzyl alcohol, butyl alcohol, carbon disulfide, carbon tetrachloride, heptane, hexane, styrene, toluene, trichloroethylene and xylene. Ototoxic heavy metals include arsenic, cobalt, lead, manganese, mercury and trimethyltin.

Most people likely have a number of ototoxic chemicals in or around their homes. Some of these ototoxic chemicals include adhesives, auto emissions, fungicides, glues, grease and spot removers, insecticides, insulation, lacquers, liquid correction fluid, organic solvents, paint, paint thinners, resins, room deodorizers, rug cleaners, spray paint, varnishes and wood preservatives to name a few.13, 14

In addition, people may be exposed to ototoxic chemicals if they work in one of the many manufacturing plants and factories that use organic solvents or heavy metals. Such processes as electroplating, shoe manufacturing, dry cleaning, cold vulcanization, electronic battery manufacture and polyvinyl chloride manufacturing all use various ototoxic chemicals.14

Further, the pollutants in the air can also hurt peoples' ears. Depending on the type and severity of the air pollution, people can end up with hearing loss, balance problems or other damage to their ears.2

Most people probably think of air pollution as occurring outside. However, dangerous air pollution also resides within homes, offices and factories. Many of the indoor pollutants are organic solvents. When people inhale fumes from these solvents, they slowly but surely damage their ears.

One study of workers in a rubber factory revealed 47% had subclinical abnormalities in the auditory pathways and in their brainstems, due to solvents used in manufacturing rubber.16 One patient lost her hearing resulting from several years of using spray varnish in her garage without adequate ventilation. Toluene in the varnish was the culprit.

Sometimes, ototoxic damage from organic solvents is obvious—such as when it results in massive hearing loss or roaring tinnitus. However, in other cases (see above study) results can be insidious and subtle, presenting as impaired central auditory processing. Even though the chemical hasn't caused reduced "hearing" as might be expected on an audiogram, the person affected can't understand everything they hear.

A bit of probing may reveal that hearing loss is the result of exposure to an ototoxic chemical where you least expect to find it. Therefore, in addition to thinking "drugs," also think "chemicals."

Drug Interactions and Ears

Little is known about how ototoxic drugs adversely affect our ears. Dramatically less is known about ototoxic side effects when two or more ototoxic drugs are consumed at the same time. However, some interesting (and important) things have come to light in recent years.

Be Careful When Concurrently Taking Ototoxic Drugs

When a person takes two or more ototoxic drugs at the same time, or one immediately following the other, there are two likely outcomes. The ototoxic effects of each drug can either be additive, or the ototoxic effects can be synergistic.

In the first case, the total effect on the ears will be the sum of the effects of each drug as if they were taken separately. For example, if one ototoxic drug causes 2 "units" of damage and the second drug causes 3 "units" of damage, the resulting damage on the ear would be 5 "units" (2 + 3 = 5). This is the additive effect.

However, with some drug combinations, using the same example above, the result is not 5 "units" of damage as you might expect, but a larger number—say 10 "units" of damage. This represents a synergistic effect. With synergistic effects, the resulting damage is always greater than the sum of the damage of each individual drug.

To protect ears as much as possible, people should not take multiple ototoxic drugs at the same time, especially if they are known to have synergistic ototoxic effects.

The Order of Multiple Ototoxic Drugs Can Be Important

Researchers have discovered that the order a person takes certain ototoxic drugs can make an enormous difference as to whether they have much of a resulting hearing loss or not. With some drug combinations, if you take the drugs sequentially, and not simultaneously, you can avoid the synergistic effect.

For example, in one medical treatment, doctors put their patients on two drugs, a LOOP DIURETIC (e.g., Furosemide) and an AMINOGLYCOSIDE antibiotic (e.g., Tobramycin). If the patient completes the course of the LOOP DIURETIC before he begins the AMINOGLYCOSIDE antibiotic, the resulting hearing loss from these two drugs is additive. However, if the patient takes both drugs simultaneously or if the AMINOGLYCOSIDE antibiotic is administered first, followed by the LOOP DIURETIC—the two drugs act synergistically to significantly damage the patient's ears.25

The Synergistic Relationship Between Certain Drugs/Chemicals and Noise

Not only do certain ototoxic drugs react synergistically with each other, but they have another nefarious characteristic. Their ototoxic side effects can react synergistically with noise.

Certain ototoxic drugs when taken "normally" can result in a certain degree of hearing loss. However, if they are being taken while the patient is exposed to loud noise, the noise combines synergistically with the ototoxic side effects of the drug to cause even greater hearing loss than might otherwise be expected.

Some of the drugs that have this vicious effect include Aspirin,20 the anti-cancer drug Cisplatin,22 the microbial antibiotic Chloramphenicol3 and AMINOGLYCOSIDE antibiotics such as Gentamicin12 and Kanamycin.23

This same synergistic effect on hearing loss between the ototoxic side effects of certain drugs and noise also occurs between certain chemicals and noise. Chemicals that make our ears more prone to hearing loss as a result of noise include organic solvents such as carbon disulfide, dinitrobenzene, styrene, trichloroethylene, toluene and xylene as well as the asphyxiant carbon monoxide and the heavy metal lead.4, 10, 17, 26

Other chemicals with this same nefarious characteristic include arsenic, butyl alcohol, butyl nitrite, heptane, hexane, manganese, mercury and trimethyltin.19 This apparently is just the tip of the iceberg. Suspicion is already cast on carbon tetrachloride, various other metals and asphyxiants.17, 20

Just how pronounced is this synergistic effect? Sometimes the results can be dramatic! In a study of Brazilian workers, those exposed to both noise and toluene had a 53% incidence of hearing loss. In contrast, those exposed to noise alone had a 26% incidence rate while the control group had an incidence rate of only 8%. When these results were adjusted for age, they showed that noise exposure increases the risk of hearing loss by 4.6 times. When the noise was combined with exposure to toluene, the risk jumped a whopping 27.5 times!21

In another study, workers were grouped into one of four groups—those exposed to both noise and toluene, those exposed to toluene alone, those exposed to noise alone, and those not exposed to either toluene or noise (the control group). The hearing loss of those exposed to noise alone was 4 times greater than the control group; the hearing loss of those exposed to toluene alone was 5 times greater; and the hearing loss of those exposed to both noise and toluene was 11 times greater!17

Noise and Time Are Critical

One treacherous result of certain ototoxic drugs combined with noise is something you'd probably never suspect—the length of time a person's ears are still susceptible to the synergistic effects of ototoxic drugs and noise—after the drug has been discontinued.

If you tell a person not to take certain drugs while he is exposed to noise, he might think you are referring to the days he is actually taking the drug therapy. Surprise! Not true! A person has to avoid noise for much, much longer.

When a person takes AMINOGLYCOSIDE antibiotics or platinum anti-cancer drugs, such as Cisplatin, they are quickly transported to his inner ears. The problem is that, once there, these drugs persist in the inner-ear fluids long after they have disappeared from the bloodstream,11 not just for a few days, but for several weeks to several months,15 and up to a year later!

During the time these drugs are present in peoples' inner ear fluids, they can be damaging their ears. More importantly, during this time, their ears are especially susceptible to the synergistic effects of loud noise.15 This means that if people have taken AMINOGLYCOSIDE antibiotics or Cisplatin and are now finished with this drug therapy, their ears are still in danger of even more hearing loss if they expose them to loud noise any time in the next few months or more, depending on their specific body chemistry.

This has important implications for the audiologist treating hearing aid patients with hearing aids and other amplification systems. Dr. James Kalkanis, M.D., recommends setting the gain and maximum power output (MPO) as low as possible in order to protect your patients' ears while their ears are very sensitive to the effects of noise, secondary to ototoxic medications. If a patient already wears hearing aids, you should instruct him to keep the volume down during this time also.15 The same is true for people exposed to ototoxic chemicals in the workplace. Workers exposed to ototoxic chemicals should be advised that it is in their best health interest to keep the volume down on their hearing aids, and to keep the work environment as quiet as is possible.

What is a safe level in such situations? The only thing known for sure is that current standards are not stringent enough. Researchers were surprised to discover that when noise and ototoxic agents team up to damage ears, this damage can occur even though exposure to both noise and chemicals are within currently acceptable limits!10

High Frequency Hearing Testing is Important

Many ototoxic drugs and chemicals begin destroying hearing at the highest frequencies first, and as exposure continues, lower frequencies become involved. Since hearing is traditionally only tested up to 8 kHz, most initial cases of hearing loss from ototoxic drugs and chemicals are never revealed by standard audiometric testing.

However, high-frequency audiometry is important if hearing loss from ototoxic drugs is to be minimized or prevented. High-frequency audiometry can reveal the early effects of ototoxic drugs before tinnitus appears or hearing damage is visible on a conventional audiogram (250 and 8,000 Hz).

In studies involving Cisplatin, the first indications of hearing loss always appeared between 10,000 and 16,000 Hz.24 Of course, standard audiometric testing would not have revealed this hearing loss, as it impacts higher than typically tested frequencies.

Several ototoxic chemicals cause initial hearing loss in the high frequencies. For example, high-frequency hearing testing revealed that workers exposed to low concentrations of styrene fumes for 5 years had hearing losses in the high frequencies even though their hearing tests in the conventional frequencies were normal. If high-frequency hearing testing hadn't been done, styrene could have been given a clean bill of health—even though it is ototoxic.

Inhaling styrene fumes is known to cause a reduction in the upper limit of hearing. Researchers concluded that the upper limit of hearing is a sensitive indicator for early detection of ototoxicity in workers exposed to styrene18 and indeed, probably for many or most ototoxic drugs and chemicals.

One study demonstrated that audiometric testing across the conventional hearing range is the least effective method to determine initial hearing loss.5 Therefore, if you want to know whether drugs or chemicals are insidiously stealing your patients' hearing, you need to test their hearing up to the highest frequency possible.

Since ototoxic hearing loss typically begins at the highest frequencies and progresses through lower ones, audiologists should monitor the highest measurable frequencies in people with pre-existing hearing loss, to provide the earliest possible warning of further drug-related hearing loss.

Early detection does not, by itself, prevent further damage to a person's ears. However, it does give doctors time to adjust the dose or stop the medication altogether before hearing loss spreads to the conventional frequencies.6 If monitoring is restricted to frequencies below 8000 Hz, by the time audiologists detect new/additional hearing loss, hearing loss will have already affected those frequencies necessary for speech.

How good is high-frequency testing? When researchers compared testing high frequencies versus testing conventional frequencies, one study revealed that 52% of hearing losses were first detected in the high-frequency range only. That study revealed that more than half the people with drug-induced hearing loss have hearing loss that was not detected by conventional means. If only high-frequency hearing testing had been done, 67% of all the ears demonstrating initial hearing loss due to ototoxicity would have been found.7

Another study revealed that only 13.5% of the people (ears) studied had initial drug-related hearing loss in the conventional frequencies. An additional 24% had initial detectable hearing loss in the conventional frequencies as well as the high frequencies. Thus, a whopping 62.5% of drug-induced hearing loss likely goes undetected because it initially only occurs in the traditionally not-tested high frequencies!8 If only the high frequencies had been tested, 86% of all cases of drug-induced hearing loss would have been detected.

The Five-frequency Hearing Testing Process

Testing all frequencies between 125 Hz and 20,000 Hz is time consuming and of course, adds additional expense to the evaluation. Fortunately, researchers have recently discovered a five-frequency slope that is very sensitive to the ravages of ototoxic drugs. The beauty of this five-frequency slope testing is that it is highly sensitive to initial ototoxic hearing loss.

This five-frequency range varies depending on each person's pre-existing hearing loss and thus is unique to each person. These five frequencies are generally separated by 1/6 octave.

For example, a person with pre-existing hearing loss might have a five-frequency slope consisting of 8, 9, 10, 11.2 and 12.5 kHz.9 Since each person's hearing loss is unique, the testing process is tailored for each person and this can be easily and accurately accomplished.

Using an audiometer calibrated to accurately test up to 20,000 Hz, determine the highest frequency your patient can hear. (Note: the hearing loss at this frequency must be 100 dB or less.) Second, test this frequency and the next four lower consecutive audiometric test frequencies. This becomes the individual patient's five-frequency slope range.6

Depending on the patient's particular hearing loss, this five-frequency slope may all lie within the extended high-frequency range, it may straddle the 8,000 Hz boundary, or it may reside completely within the conventional frequencies.

Just how effective is this five-frequency slope in detecting hearing loss from ototoxic drugs? The results may surprise you!

In one study of the ototoxic effects of Cisplatin, if only the five frequencies in the five-frequency slope had been tested, 93% of the people with ototoxic drug-induced hearing loss would have been detected.6 This is in sharp contrast to the 39% detected in this same study using only the conventional frequencies.

Other studies have yielded similar results. For example, another study reported that if only the five-frequency slope values were tested, hearing loss due to AMINOGLYCOSIDE antibiotics would be detected 84% of the time, and for Cisplatin, the results would been 94%.9 Another study revealed that initial hearing loss would have been detected in 89% of the people with hearing loss if only the five-frequency slope had been tested. Testing only conventional frequencies caught just 37%.8

Based on results such as these, the routine use of high-frequency audiometry is not just "nice," it is essential.15

For hospital in-patients who must undergo drug therapy with ototoxic drugs, having complete audiometric testing can be a problem, especially if they are unconscious, semi-conscious or very sick. In such cases, using a conventional audiometer and test protocols is difficult, if not impossible. In these situations, auditory brainstem response (ABR) techniques modified to work in the higher frequencies can be effective tools. In one such study, high-frequency tone-burst-evoked ABRs identified 93% of the initial changes in hearing loss.7

The five-frequency slope protocol is fast and efficient and has been proven effective in providing early warning of hearing loss.

I recommend that the five-frequency slope protocol become the accepted standard practice in audiometric testing to help patients save precious hearing that otherwise might be lost to the ravages of ototoxic drugs.

First published in Audiology Online December 15, 2003.

____________________

The information in this paper was taken from the second edition of the book Ototoxic Drugs Exposed by the same author. To learn more about ototoxicity in general, or to learn the specific ototoxic side effects of the 743 ototoxic drugs, 30 herbs and 148 chemicals mentioned in this book, get your own copy of Ototoxic Drugs Exposed.

____________________

If you would like to join an information and support E-mail list for people who have damaged their ears from taking ototoxic drugs, type your E-mail address in the box and click on the Yahoo Groups button. (You can unsubscribe at any time.)

Subscribe to the Ototoxic-Drug list

____________________

Notes

In this paper, drug classes are in full capitals (LOOP DIURETICS), generic drug names and ototoxic chemicals are in bold (Enalapril, toluene) with generic drug names being capitalized and chemical names all in lower case.

References

1 Bauman, Neil. 2003. Ototoxic Drugs Exposed, Second Edition. Center for Hearing Loss Help. 49 Piston Court, Stewartstown, PA 17363. http://www.hearinglosshelp.com.

2 Bisesi, Michael, and Allan Rubin. 1994. Chemical air pollutants and otorhinolaryngeal toxicity. Journal of Environmental Health. 56(7):24.

3 Carmen, Richard. 1999. Chemicals & hearing-Danger ahead. Hearing Health Magazine (March/April).

4 Cary, R., S. Clarke, and J. Delic. 1997. Effects of combined exposure to noise and toxic substances-Critical review of the literature. Ann. Occup. Hyg. 41(4):455-465.

5 Fausti, S. A., et al. 1992. High-frequency audiometric monitoring for early detection of aminoglycoside ototoxicity. Journal of Infectious Diseases. 165(6):1026-32.

6 Fausti, S. A., et al. 1993. High-frequency monitoring for early detection of cisplatin ototoxicity. Arch Otolaryngol Head Neck Surg. 119 (6):661-6.

7 Fausti, S. A., et al. 1993. High-frequency testing techniques and instrumentation for early detection of ototoxicity. J. Rehabil. Res. Dev. 30(3):333-41.

8 Fausti, S. A., et al. 1994. High-frequency audiometric monitoring strategies for early detection of ototoxicity. Ear Hear. 15(3):232-9.

9 Fausti, S. A., et al. 1999. An individualized sensitive frequency range for early detection of ototoxicity. Ear Hear. 20(6):497-505.

10 Forge, Andrew. 1999. Industrial chemicals are hazardous to hearing. Lancet. 353(9160):1250.

11 Guidelines for the audiologic management of individuals receiving cochleotoxic drug therapy. 1994. American Speech-Language-Hearing Association. 36(3), Supplement No. 12.

12 Hain, Timothy. 2001. Gentamicin toxicity. http://www.tchain.com/otoneurology/disorders/bilat/gentamicin%20toxicity.htm.

13 Haybach, Patty J. 1998. Ototoxicity for nurses. http://www.geocities.com/otolithic/ototox.htm.

14 Haybach, Patty J. 1999. Balance and hearing: At risk from drugs. Course #170. http://nurse.cyberchalk.com/nurse/COURSES/NURSEWEEK/NW170/menu.html.

15 Kalkanis, James. 2001. Inner ear-Ototoxicity. eMedicine. 2(7). >http://www.emedicine.com/ent/topic699.htm>.

16 Kumar, V. and O. Tandon. 1997. Neurotoxic effects of rubber factory environment. An auditory evoked potential study. Department of Physiology, University of Medical Sciences, Delhi, India. Electromyogr. Clin. Neurophysiol. 37(8):469-73.

17 Morata, Thais C., and Derek E. Dunn. 1994. Occupational exposure to noise and ototoxic organic solvents. Archives of Environmental Health. 49(5):359.

18 Morioka, Ikuharu and Mototsugu Kuroda. 1999. Evaluation of organic solvent ototoxicity by the upper limit of hearing. Archives of Environmental Health. 54(5):341.

19 Niall, Paul. 1998. The effects of industrial ototoxic agents and noise on hearing. University College, London, England. http://www.racp.edu.au/afom/nlii9907.htm.

20 Rosen, Elizabeth. 2001. Noise Inducted Hearing Loss. Grand Rounds Presentation, UTMB, Dept. of Otolaryngology. January 10, 2001. http://www.utmb.edu/otoref/Grnds/Hear-Loss-Noise-000110/Hear-Loss-Noise.htm.

21 Rybak, Leonard. 1992. Hearing: The effects of chemicals. Otolaryngology-Head and Neck Surgery. 106(6):677-686.

22 Soh, K. 1999. Noise is a public health and social problem in Singapore. Singapore Med. J. 40(9). http://www.sma.org.sg/smj/4009/articles/4009e2.html.

23 Suter, Alice. 1991. Noise and its effects. Administrative Conference of the United States. November. http://www.nonoise.org/library/suter/suter.htm.

24 Tange, R. A., W. A. Dreschler, and R. J. van der Hulst. 1985. The Importance of high-tone audiometry in monitoring for ototoxicity. Arch. Otorhinolaryngol. 242(1).

25 Troost, B. Todd, and Melissa A. Walker. 1998. Drug induced vestibulocochlear toxicity. In: Iatrogenic Neurology. Butterworth-Heinman. Boston. http://ivertigo.net/ototoxicity/otcochlear.html.

26 WorkPro. 1999. Southeastern Ohio Regional Medical Center. http://www.seormc.org/workpro/newsletters/august_99.htm.

Edited June 8, 2020 by ChessieCat
Added info about link not working and provided new link

May 6, 2011

Hi Pun,

I feel that Remeron caused my hearing loss which unfortunately, is not irreversible.

I also have Tinnitus from Wellbutrin XL and Doxepin that I feel is permanent. Just a gut feeling.

Unfortunately, when I saw ENTs, I was misdiagnosed as having cochlear meniere's disease. Even though I was adamant that the tinnitus was from the drugs and nothing else, these doctors did what I call diagnosis anchoring since tinnitus is also part of meneire's. They heard that and it didn't matter what my version of the story was.

Anyway, if you have suffered any type of ototoxic reaction, you have to be very careful about taking any drug that has ototoxic properties. Common drugs like aspirin and benedryl are ototoxic.

CS

May 6, 2011

Hi Pun,

I feel that Remeron caused my hearing loss which unfortunately, is not irreversible.

I also have Tinnitus from Wellbutrin XL and Doxepin that I feel is permanent. Just a gut feeling.

Unfortunately, when I saw ENTs, I was misdiagnosed as having cochlear meniere's disease. Even though I was adamant that the tinnitus was from the drugs and nothing else, these doctors did what I call diagnosis anchoring since tinnitus is also part of meneire's. They heard that and it didn't matter what my version of the story was.

Anyway, if you have suffered any type of ototoxic reaction, you have to be very careful about taking any drug that has ototoxic properties. Common drugs like aspirin and benedryl are ototoxic.

CS

Hi CS.........

Yes, I'm very familiar with your story since, we have had a few past post exchanges. I'm so incredibly sorry for what has occurred to you. I remember in the past, I had mentioned that it may not have been the Remeron alone but rather, the drug combo effect, since, I believe there was another AD in the mix prior to the introduction of Remeron?

Could be the Remeron was the tipping point rather than the singular cause. You know what I mean? In any event, you certainly know your system and history better than I and thus, I don't mean to imply otherwise when sharing my thoughts.

I really feel for you on two accounts: first for the injury and loss you have incurred to these toxic drugs and, secondly for how you were brushed off by the doctors despite being adamant,aware and observant about your body and experiences.

I've had so many doctors do the same to me despite my own adamancies. It was like I may as well been screaming in the wind.

They pretty much sent the message, based on an assumption, that I didn't have the intellect and was not an authority on my own body nor capable of accurately assessing, analyzing and thus, drawing intelligent and educated conclusions about the cause of my condtion. Sound familiar CS?

Sounds like you've experienced the same. I so sorry, since I know how devastating it feels to be dismissed by the "all knowing" health experts/authorities (which BTW, they wish to viewed as), who don't believe in giving their patients a voice (not mention not willing to listen to).

CS, do you feel it's permanent or know that it is? Do you think perhaps you need to give things more time........allow your post-taper effects more time to heal? I realize the damage you speak of occurred while on the drugs, but as the article outlines, it could take 6 months to a year (I believe) for the post drug effects to wear off.

There was something in there that mentions that drug toxicity being trapped in the ear even though the drug has been eliminated from the blood stream. Can't remember if they were speaking about ototoxic drugs in general or specific ototoxic drugs. Don't know if you saw this and if not, give it a re-read.

I'd recheck myself but my computer sensitivities are really getting to me ATM and I'm going to have to sign off soon due to this fact. Besides, I'm better off printing out the article. I can't read anything lengthy on screen.

Oh, yes, I'm very much aware of your warning but I thank you for sharing this so others can be informed. The article mentions what you have relayed if I remember correctly.

Also, to my shock PPI's (Proton Pump Inhibitors) are on the list! I've been exposed to SO, SO MANY of the drugs on that list (t's not even funny) and REPEATEDLY I might add. Consequently, I wish to refrain from being exposed to anything that may pose a present or future risk.

BTW, at one point during my severe tolerance WD taper, I could feel the fluid in my middle ear moving/flowing. It was very intense and TBH I was very disturbed about it but was too violently ill to get it checked out. I decided to wait it out and it went away in a few days but the severe vestibular disturbances were long lasting and intense.

My hope is that you will see some improvements in your hearing as you recover, more fully, from psyche drugs exposure. I don't believe you've been off your last AD for a year yet right?

Much More Healing to You CS!

Pun

May 6, 2011

Hi Pun

""Yes, I'm very familiar with your story since, we have had a few past post exchanges. I'm so incredibly sorry for what has occurred to you. I remember in the past, I had mentioned that it may not have been the Remeron alone but rather, the drug combo effect, since, I believe there was another AD in the mix prior to the introduction of Remeron?""

Sorry, my memory impaired brain has forgotten:)

Yeah, I definitely had other drugs so what you're saying is possible. I think I blame Remeron because I was initially diagnosed with a hearing loss about 6 months after starting Remeron.

I didn't follow up for several reasons. But even if I had, I don't think at that point, I would have realized the drug was at fault.

Also, hearing loss is listed as a Remeron side effect. I don't think think it is listed for SSRIs but I could be wrong.

""I really feel for you on two accounts: first for the injury and loss you have incurred to these toxic drugs and, secondly for how you were brushed off by the doctors despite being adamant,aware and observant about your body and experiences.""

Thanks!

What really is mind blowing is I was sent for two tests to confirm Meneires that came back negative. When I went back to the ENT, I could tell she was like, "Oh sh-t, this is not what I expected" but of course, she had to stick to the party line that this is what I had.

""I've had so many doctors do the same to me despite my own adamancies. It was like I may as well been screaming in the wind.""

Frustrating, isn't it? I am sorry you have experienced that.

""They pretty much sent the message, based on an assumption, that I didn't have the intellect and was not an authority on my own body nor capable of accurately assessing, analyzing and thus, drawing intelligent and educated conclusions about the cause of my condtion. Sound familiar CS? ""

Unfortunately yes. Again, I am sorry you went through that.

""CS, do you feel it's permanent or know that it is? Do you think perhaps you need to give things more time........allow your post-taper effects more time to heal? I realize the damage you speak of occurred while on the drugs, but as the article outlines, it could take 6 months to a year (I believe) for the post drug effects to wear off.""

I think the hearing loss is permanent.

The tinnitus is what is in question. A primary care doctor I was considering seeing said he has seen many cases where the tinnitus is permanent.

I just feel that after being on meds for 15 years, it may be too late for it to reverse. But perhaps with time, it will. I have been off drugs almost a year.

""There was something in there that mentions that drug toxicity being trapped in the ear even though the drug has been eliminated from the blood stream. Can't remember if they were speaking about ototoxic drugs in general or specific ototoxic drugs. Don't know if you saw this and if not, give it a re-read.""

No, I didn't see that. I will see if I can go back and find that.

""I'd recheck myself but my computer sensitivities are really getting to me ATM and I'm going to have to sign off soon due to this fact. Besides, I'm better off printing out the article. I can't read anything lengthy on screen.""

I am so sorry for your suffering and I hope you feel better. I totally understand.

""Oh, yes, I'm very much aware of your warning but I thank you for sharing this so others can be informed. The article mentions what you have relayed if I remember correctly.""

It did. Sorry, I didn't read through everything.

""Also, to my shock PPI's (Proton Pump Inhibitors) are on the list! I've been exposed to SO, SO MANY of the drugs on that list (t's not even funny) and REPEATEDLY I might add. Consequently, I wish to refrain from being exposed to anything that may pose a present or future risk.""

Wow, I had no idea. Yeah, you definitely want to avoid them.

""BTW, at one point during my severe tolerance WD taper, I could feel the fluid in my middle ear moving/flowing. It was very intense and TBH I was very disturbed about it but was too violently ill to get it checked out. I decided to wait it out and it went away in a few days but the severe vestibular disturbances were long lasting and intense.""

Oh my god, I am so sorry. I know if I had stayed on these meds, that would have been my fate with the hearing loss and the tinnitus.

""My hope is that you will see some improvements in your hearing as you recover, more fully, from psyche drugs exposure. I don't believe you've been off your last AD for a year yet right?""

It will be a year on June 10. I have been considering getting hearing aids so the next audiogram will be interesting.

"Much More Healing to You CS!""

Same to you Pun.

CS

May 6, 2011

Hi again CS.

First off, thank you for your expressed sympathies and validation throughout your previous post.

Just wanted to share a couple of points after taking a second scan at the article in this thread.

BTW, I placed your words in bold text.

Also, hearing loss is listed as a Remeron side effect. I don't think think it is listed for SSRIs but I could be wrong.

Actually, the article above, lists bicyclics, tricyclics and SSRI's having ototoxic potential.

Surprisingly, this particular article does not mention antihistamines, as I stated in did, in response to your previous post. So, I was wrong about THIS article containing that info, although I had posted two other articles in another thread that definitely mention antihistamines. I should find the thread and copy and paste that info. in this thread as to create more organization on this particular subject.

Suprisingly, this article also doesn't mention neuroleptics which are, in realtiy, powerful antihistamines which also have ototoxic potential. Again, will copy and paste the other articles into this thread.

What really is mind blowing is I was sent for two tests to confirm Meneires that came back negative. When I went back to the ENT, I could tell she was like, "Oh sh-t, this is not what I expected" but of course, she had to stick to the party line that this is what I had.

Oh yes, sorry I forgot about this part of your story. Geez...some doctors just refuse to think outside the box and will stick to "standard" assumptions and/or the analysis of colleagues etc. It makes me so angry!

So much can be written about this topic but I better stifle myself for my own health ATM (lol).

I think the hearing loss is permanent.

The tinnitus is what is in question. A primary care doctor I was considering seeing said he has seen many cases where the tinnitus is permanent.

True what your doctor states but it is also true that many people can have psyche drug induced tinnitus that is severe and long lasting only to fully recover. I'm only one of thousands of cases to prove that tinnitus is a temporary condition for many people, despite being exposed to many ototoxic drugs.

Although the article posted in this thread talks about 6 months to one year for ototoxic drug effects to reverse themselves (heal), I also wish to mention that, medical opinions and forecasts, as we know, are often far off the mark. So, I prefer to believe that ototoxic effects can take more than a year to reverse since, psyche drug recovery can take 2 years or longer. My opinion of course but I don't believe it can be discounted as a possibility.

I just feel that after being on meds for 15 years, it may be too late for it to reverse. But perhaps with time, it will. I have been off drugs almost a year.

I hear what you are saying but I believe that more time must past, in my humble opinion (lol) before one can write off the possibility of things improving.

You know, the 10 plus years I was on Doxepin, my hearing was not right and I noted this early on and mention this to the doctor and of course, all I got were blank faces or some other look or a dumb comment. Anyway, I had the opposite effect that you had. I had precision hearing ....too acute for comfort as well as having difficulty distinguishing which direction a sound/noise was coming from.

Usually I would interpret the sound coming from the opposite direction than what it was actully coming from.

Anyway, this has continued since being off the meds (23 months now) however, I'm seeing significant signs of improvement, providing I don't get hit with a wave or stress induced setback where extreme noise sensitivity can become temporarily heightened. I expect things to improve even further over the next six months to year.

Even the tinnitis is laughable now compared to what it was.

I know if I had stayed on these meds, that would have been my fate with the hearing loss and the tinnitus.

For certain, you were wise to get off the meds for this reason alone.

It will be a year on June 10. I have been considering getting hearing aids so the next audiogram will be interesting.

I hope the next audiogram shows improvements CS. As I mentioned, I don't think one year off the last med is long enough to conclude that one's condition is not reversible IMHO, despite the fact that I'm no doctor. No doubt time will tell but I sincerely wish you all the best!

BTW, major congrats on being close to 1 year drug-free!!

BTW, no pressure to respond. I just thought I'd clarify a couple of points and share a few other thoughts.

Punar

May 6, 2011

Ototoxicity

Ototoxicity ("ear poisoning") is due to drugs or chemicals that damage the inner ear or the vestibulo-cochlear nerve, which sends balance and hearing information from the inner ear to the brain.

______________

“What you should know about ototoxic medications,” published in Tinnitus Today, September 1996, Stephen Epstein, MD, lists the six categories of medications that can be ototoxic and the signs of ototoxicity:

"1 – Salicylates – Aspirin and aspirin containing products

Toxic effects usually appear after consuming an average of 6-8 pills per day. Toxic effects are almost always reversible once medications are discontinued.

2 – Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) – Advil, Aleve, Anaprox, Clinoril, Feldene, Indocin, Lodine, Motrin, Nalfon, Naprosyn, Nuprin, Poradol, Voltarin. Toxic effects usually appear after consuming an average of 6-8 pills per day. Toxic effects are usually reversible once medications are discontinued.

3 – Antibiotics – Aminoglycosides, Erythromycin, Vancomycin

a. Aminoglycosides – Streptomycin, Kanamycin, Neomycin, Gantamycin, Tobramysin, Amikacin, Netilmicin. These medications are ototoxic when used intravenously in serious life-threatening situations. The blood levels of these medications are usually monitored to prevent ototoxicity. Topical preparations and eardrops containing Neomycin and Gentamycin have not been demonstrated to be ototoxic in humans.

b. Erythromycin – EES, Eryc, E-mycin, Ilosone, Pediazole and new derivatives of Erythromycin, Biaxin, Zithromax. Erythromycin is usually ototoxic when given intravenously in dosages of 2-4 grams per 24 hours, especially if there is underlying kidney insufficiency. The usual oral dosage of Erythromycin averaging one gram per 24 hours is not ototoxic. There are no significant reports of ototoxicity with the new Erythromycin derivatives since they are given orally and in lower dosages.

c. Vancomycin – Vincocin. This antibiotic is used in a similar manner as the aminoglycosides; when given intravenously in serious life-threatening infections, it is potentially ototoxic. It is usually used in conjunction with the aminoglycosides, which enhances the possibility of ototoxicity.

4 – Loop Diuretics – Lasix, Endecrin, Bumex

These medications are usually ototoxic when given intravenously for acute kidney failure or acute hypertension. Rare cases of ototoxicity have been reported when these medications are taken orally in high doses in people with chronic kidney disease.

5 – Chemotherapy Agents – Cisplatin, Nitrogen Mustard, Vincristine

These medications are ototoxic when given for treatment of cancer. Maintaining blood levels of the medications and performing serial audiograms can minimize their toxic effects. The ototoxic effects of these medications are enhanced in patients who are already taking other ototoxic medications such as the aminoglycoside antibiotics or loop diuretics.

6 – Quinine – Aralen, Atabrine (for treatment of malaria), Legatrin, Q-Vel Muscle Relaxant (for treatment of night cramps)

The ototoxic effects of quinine are very similar to aspirin and the toxic effects are usually reversible once medication is discontinued.

The signs of ototoxicity, in order of frequency, are:

1 – Development of tinnitus in one or both ears.

2 – Intensification of existing tinnitus or the appearance of a new sound.

3 – Fullness or pressure in the ears other than being caused by infection.

4 – Awareness of hearing loss in an unaffected ear or the progression of an existing loss.

5 – Development of vertigo or a spinning sensation usually aggravated by motion which may or may not be accompanied by nausea."4

Possible Symptoms of Vestibular Disorders

The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. If the system is damaged by disease, aging, or injury, vestibular disorders can result. Symptoms may include vertigo, dizziness, and imbalance, among others listed here. Not all symptoms will be experienced by every person with an inner ear disorder, and other symptoms are possible. An inner ear disorder may be present even in the absence of obvious or severe symptoms. It is important to note that most of these individual symptoms can also be caused by other conditions unrelated to the ear.

The type and severity of symptoms can vary considerably, and be frightening and difficult to describe. People affected by certain symptoms of vestibular disorders may be perceived as inattentive, lazy, overly anxious, or seeking attention. They may have trouble reading or doing simple arithmetic. Functioning in the workplace, going to school, performing routine daily tasks, or just getting out of bed in the morning may be difficult for some people.

Vertigo and dizziness

Spinning or whirling sensation; an illusion of movement of self or the world (vertigo)

Lightheaded, floating, or rocking sensation (dizziness)

Sensation of being heavily weighted or pulled in one direction

Balance and spatial orientation

Imbalance, stumbling, difficulty walking straight or turning a corner

Clumsiness or difficulty with coordination

Difficulty maintaining straight posture; tendency to look downward to confirm the location of the ground

Head may be held in a tilted position

Tendency to touch or hold onto something when standing, or to touch or hold the head while seated

Sensitivity to changes in walking surfaces or footwear

Muscle and joint pain (due to difficulty balancing)

Vision

Trouble focusing or tracking objects with the eyes; objects or words on a page seem to jump, bounce, float, or blur or may appear doubled

Discomfort from busy visual environments such as traffic, crowds, stores, and patterns.

Sensitivity to light, glare, and moving or flickering lights; fluorescent lights may be especially troublesome

Tendency to focus on nearby objects; increased discomfort when focusing at a distance

Increased night blindness; difficulty walking in the dark

Poor depth perception

Hearing

Hearing loss; distorted or fluctuating hearing

Tinnitus

Sensitivity to loud noises or environments

Sudden loud sounds may increase symptoms of vertigo, dizziness, or imbalance

Cognitive and psychological

Difficulty concentrating and paying attention; easily distracted

Forgetfulness and short-term memory lapses

Confusion, disorientation, difficulty comprehending directions or instructions

Difficulty following speakers in conversations, meetings, etc., especially when there is background noise or movement

Mental and/or physical fatigue out of proportion to activity

Loss of self-reliance, self-confidence, self-esteem

Anxiety, panic

Depression

Other

Nausea or vomiting

"Hangover" or "seasick" feeling in the head

Motion sickness

Ear pain

Sensation of fullness in the ears

Headaches

Slurred speech

Sensitivity to pressure or temperature changes and wind currents

___________

BTW, the medications, listed below, are ones you need to avoid, despite the fact that they are regularly prescribed for such disorders. These are all drugs having the potential to cause ototoxic effects, not to mention WD syndromes upon cessation. Punar

__________________________

Medication for Vestibular Disorders

http://www.vestibula.../medication.php

The use of medication in treating vestibular disorders depends on whether the vestibular system dysfunction is in an initial or acute phase (lasting up to 5 days) or chronic phase (ongoing). During the acute phase, and when other illnesses have been ruled out, medications that may be prescribed include vestibular suppressants to reduce motion sickness or anti-emetics to reduce nausea.

Vestibular suppressants include three general drug classes: anticholinergics, antihistamines, and benzodiazepines. Examples of vestibular suppressants are meclizine and dimenhydinate (antihistamine-anticholinergics) and lorazepam and diazepam (benzodiazepines).

Other medications that may be prescribed are steroids (e.g., prednisone), antiviral drugs (e.g., acyclovir), or antibiotics (e.g., amoxicillin) if a middle ear infection is present. If nausea has been severe enough to cause excessive dehydration, intravenous fluids may be given.

Symptoms must be actively experienced without interference in order for the brain to adjust, a process called vestibular compensation. Any medication that makes the brain sleepy, including all vestibular suppressants, can slow down or stop the process of compensation. Therefore, they are often not appropriate for long-term use. Physicians generally find that most patients who fail to compensate are either strictly avoiding certain movements, using vestibular suppressants daily, or both.

VEDA medical advisor Timothy C. Hain, MD, has detailed information about the most commonly prescribed medications that can be a helpful starting point for talking to a physician about the available options.

May 18, 2011

Finding the Pathways to a Cause of Tinnitus

The Wall Street Journal

by Ann Lukits

17 May 11

Researchers say they have found a biological explanation for tinnitus, a phantom ringing sound in the ears that affects up to 20% of the general population but isn't well understood.

The underlying cause of tinnitus may be the suppression, or inhibition, of key neural pathways in the brain, according to a report in the Proceedings of the National Academy of Sciences. Past research has shown that tinnitus sufferers have hyperactive auditory circuits but it isn't clear why.

In this study, U.S. researchers subjected normal-hearing mice and mice with induced tinnitus to a sudden loud sound, called a startle test, and measured their response to an unexpected gap in the noise frequency. A technique called flavoprotein autofluorescence was used to image a part of their brain called the dorsal cochlear nucleus (DCN), which is associated with tinnitus. The tinnitus mice showed less inhibition of their startle response than the control mice, causing a hypersensitivity to noise, researchers said. This suggests the DCN is blocked or inhibited in tinnitus, they said. The findings add to scientific understanding of the auditory circuit and cellular changes associated with chronic tinnitus, they said.

Caveat: The experiments were carried out in mice and have yet to be tested in humans. Tinnitus was induced in mice and didn't occur naturally.

http://online.wsj.com/article/SB10001424052748704681904576319603527660560.html

July 19, 2011

Following on from Alto's post about how serotonin can affect the inner ear.I would like to share this info from a uk support site for people with Labyrinthitus.Some symptoms are remarkably similar to those many of us have.

A 'different kind' of dizziness...

As discussed, Inner ear dizziness is different to the “normal” dizziness most people have experienced at some point in their lives. With Uncompensated Labyrinthitis, there are generally a host of symptoms rather than a couple. Not only does the patient feel dizzy but the world looks very different to how it did. Ear symptoms are commonly noted as are others such as problems with memory and fatigue.

Labyrinthitis most commonly starts with an acute bout of spinning vertigo which is very frightening – and then slowly turns into a sense of imbalance and dizziness. This is not the only way Labyrinthitis can start though. Another way is for the patient to feel a somewhat insiduous feeling of dizziness which then escalates over about one week – the spinning attack is never experienced (although sometimes it is whilst the patient is asleep and therefore does not notice) but instead severe dizziness in the head as well as disequilibrium and a feeling that the world is hugely surreal.

Our Labyrinthitis started in different ways but we have the same symptoms. Below are the symptoms that both of us have/are experiencing as a result of Uncompensated Labyrinthitis. The symptoms are experienced 24/7, not in spells, from the moment we wake up, they are there CONSTANTLY. Isla however, has now reached a point where she feels ok for much of the time - due to compensation - but for a long time they were there all the time.

Dizziness...

• Spinning in head - like marbles. This sensation is like one of those "snow domes" being violently shaken! If very intense, this dizziness can lead to a feeling of extreme faintness.

• Imbalance.

• Feeling of being constantly drunk.

Inner ear dizziness can make you feel drunk all the time - but without the fun!

• World is “warped” and very surreal. As if looking through the world through odd lenses. This feeling is always there. Particularly prominent in the dark. We liken this feeling to constantly looking through a video camera lens or a fish tank. World feels like a dream also.

• “Stiff” out of focus eyes.

• Lightheaded, faint, woozy.

• Constant internal movement (feels like a pendulum) and external (can see things shifting slightly and the room often looks like it is a swing).

• Shifting of objects - can be subtle or severe - for example: when turning a corner or looking down, the environment or objects can significantly move.

• Feeling of being pushed forwards/backwards/side to side. If back is not against a chair when sitting, body “does not know where it is in space”.

• Bouncing when walking – “Marshmallow feet”. This can be quite severe.

• Motion intolerance. When disembarking from a car, train, plane, you feel as if you are still moving and the ground bounces. This can even happen after going on an escalator.

• Can often visibly see the ground “breathing” – moving slightly.

• Buzzing in the head – feels like vibrations or a short circuit.

• Every movement feels "off" and not clear at all - a bit like you are moving through "thick air".

• Movement of the floor - as well as "bouncing" - when standing still there is also a feeling that the floor is moving - like being in a lift.

• Increased night blindness.

• True spinning vertigo - during illness or sometimes during the night.

Patients with inner ear dizziness feel like they are on a ferry - but without the life jacket!

Things that worsen our dizziness...

• Head movements – particularly up – this is v uncomfortable.

• Colds/illness including headaches.

• Computers.

• The dark.

• Small rooms and crowds.

• Tiredness.

• Menstruation (for girls!).

• Focusing on people or sitting for periods of time.

• Walking.

• Shops.

• Supermarkets.

Ear Symptoms...

• Feeling of fluid in both ears.

• Tinnitus – worse when dizziness is bad. Can be quite a strong ‘buzzing’.

• Popping.

• Momentary deafness.

• Blocked feeling – “full” ears.

• Catarrh.

• Sensitivity to sounds.

Other Symptoms...

• Nausea.

• Low stamina.

• Fatigue. This is common with inner ear problems as the brain is putting all of its energy into keeping you balanced - where as in normal people balance is an automatic process.

• Low immunity.

• Cognitive symptoms such as: Memory/Thinking problems – due to mental processing overload; Clumsiness; Feeling spaced out/vacant; Brain fog – worse when dizziness bad. Is like having a head packed full of cotton wool and then trying to think through it! These symptoms can be quite disturbing at times.

• Vivid dreams, frequent waking.

• Depression and anxiety (due to having to deal with the disorder plus it is believed that the vestibular system controls our anxiety/depression levels so an increase in these in vestibular sufferers may also be due to this fact as well as having to cope with the disorder).

• Loss of self-reliance, self confidence, self esteem.

The vestibular system filters and fine tunes all sensory information entering the brain - light, sound, motion, gravitational energy, chemical information, air pressure, temperature. It is responsible for controlling and fine tuning our vision, hearing, balance, sense of motion, altitude and depth, sense of smell, sense of time, sense of direction and anxiety/depression levels as mentioned above. Therefore any of these processes may be affected when suffering from inner ear dysfunction.

July 19, 2011

Thanks, squirrel. What is the link for that article? This will help people who want to read more.

(You can copy the link from the Web address box at the top of your browser window and paste it here.)

July 19, 2011

www.labyrinthitis.org.uk

April 1, 2012

I was looking for info on vision problems and stumbled across this thread on ototoxicity. Thought it might be of interest to others, too.

I didn't read in entirety, but the involvement of the vestibular-ocular system is new to me. I hadn't thought of the connectedness of the eyes-ears-vestibular system before.

"Vague feeling of unease" - that describes my life even before 'depression' or drugs

I wore glasses for myopia/nearsightedness from age 6 and the majority of my childhood friends wore glasses by junior high. It was attributed to alot of reading/close work as a kid.

I was baffled when I moved to Southern CA (from Pennsylvania) and noticed that VERY FEW people - especially native Southern Californians - required corrective lenses for nearsightedness (I accounted for any who had LASIX or other vision correction).

I have some theories involving sunshine.

April 1, 2012

Very helpful information. Thank you! I keep getting tinnitus, audio hallucinations and vertigo. Every time it happens I get scared that it will be permanent. I've found that the best Homeopathic remedy for the tinnitus is Sulpher 30C and Calcarea Carbonica 30C. I'm starting to get a little more relaxed now, as I'm having it less often and less intense. I'm feeling now like I'm not going to have permanent damage. I pray!

April 1, 2012

Thank you for posting these articles. I had trouble with tinnitus before I took antidepressants and they made it so much worse. The ringing in my ears after I tapered from and got off of Lexapro was one of the worst withdrawal symptoms. It's getting better now, thank God.

about me · April 2, 2012

Very humbling for someone to read who is struggling with a hearing issue. Wow... does not leave much leeway. Sounds like stay away, if I can use a malevolent pun. This is the sort of info I was looking for, and hoping not to find.

Schuyler

April 2, 2012

Dizziness has been a biggie for me since I stopped Paxil in 2005, That and tinnitus.In 2006 an ent doc said it was a vestibular occular reflex problem ( i had a horzontal nystagmus) in 2010 they said it was Labyrinthitus. in my heart i know its the Paxil withdrawl that caused it.I still have problems with my balance and have bad tinnitus everyday. I never had either before i stopped paxil.

April 12, 2012

Of course my doctor told me that zoloft could never have given me tinnitus. I NEVER had tinnitus before zoloft. So, I showed her how prescription drugs can indeed cause tinnitus. Her response: Don't believe everything you read on the internet. Wow. Really?

July 8, 2014

Is lexapro ototoxic? Is it only specific antidepressants or are they all ototoxic?

Can ototoxicity cause dizziness on its own or is it usually accompanied with tinnitus?

How do you know if this is the problem or withdrawal?

Thanks

May 3, 2015

Bump - fascinating stuff. I wonder how many people in SA have hearing impairment?

I do - and started antihistamines as a child - listed as "other" in this list: http://www.hlaabq.com/ototoxicdrugs.html

Then there's all the throat infections and Erythromyacin, every year, sometimes twice a year.

Then there's tricyclics (the antidepressants used most on me), SNRI's (which my antihistamines served that function as well), SSRI's (less so in me, but others here, too).

Speak up! We can hardly hear you for all the chemicals we've been given!

May 5, 2015

Help. Thank you for bumping this topic.

I've had ringing for all 6+ months I've been off meds.

Within past 48 hours developed bad ear pain, both ears.

Has anybody recovered from ear pain? Please help.

May 6, 2015

Thanks for bumping this topic!

I started my Paroxetine taper just over 8 months ago and unilateral tinnitus (right ear only) and a slight crackling when I yawn/swallow has been an issue for me throughout that time. Ditto the last time I tapered off the drug. Fortunately, it's very mild. I didn't realise that some of the other symptoms listed were so closely related to the ototoxic reaction, though. It never occurred to me that visual problems and muscular twinges were in any way related to it, even though it makes perfect sense when you consider that our visual and auditory senses work in harmony and sight and hearing impairments - however slight - lead to subtle musculoskeletal changes. I've experienced a bit of light sensitivity and muscular pain, particularly in my legs, so it's good in a way to have a scientific explanation for its causes.

June 14, 2015

Hi squirrel I have so much of these symptoms. Do you know if they heal themselves like our nervous systems do

September 25, 2015

Im dealing with blocked ears (Ears full of pressure) and have to unpop my ears a billion times a day. Mostly it stays blocked i cannot unblock them. It is a constant struggle and am unable to drive in a car because it causes me more suffering.

ENT cleaned out wax but said my pressure reading is normal and no fluid in middle ear usually associated with ETD

I think i might have ETD due to inflammation maybe. My ENT wont be able to see inflammation only via CT.

Anyone have this problem? Its been driving me insane and the only treatment seems to be nasal sprays which im not able to take.

I also have loud tinnitus dizziness and throat discomfort thats been going on for a very long time (Over a year)

I know i shouldnt be chalking it up to withdrawal, but ive never had problems like this before. Its as if my whole body mind and soul has just shut down since stopping and im getting worse instead of better. This surely cant be normal??

November 4, 2015

Im dealing with blocked ears (Ears full of pressure) and have to unpop my ears a billion times a day. Mostly it stays blocked i cannot unblock them. It is a constant struggle and am unable to drive in a car because it causes me more suffering.

ENT cleaned out wax but said my pressure reading is normal and no fluid in middle ear usually associated with ETD

I think i might have ETD due to inflammation maybe. My ENT wont be able to see inflammation only via CT.

Anyone have this problem? Its been driving me insane and the only treatment seems to be nasal sprays which im not able to take.

I also have loud tinnitus dizziness and throat discomfort thats been going on for a very long time (Over a year)

I know i shouldnt be chalking it up to withdrawal, but ive never had problems like this before. Its as if my whole body mind and soul has just shut down since stopping and im getting worse instead of better. This surely cant be normal??

I have the blocked ear feeling too in my right ear (initially in both) as well as the pressure change sensation. I was prescribed Doxycline (antibiotic) and a nasal spray for a right side sinus headache which lasted a weekend and went away. The right ear has not unblocked.

March 9, 2022

20 days ago I had a micropulsed yellow laser surgery on my eye to treat a central serous chorioretinopathy. At the end of the surgery I was installed with drops of the extreme ototoxic antibiotic Tobramycin of the Aminoglycoside class, because I am allergic to fluoroquinolones. Now is 5 days I have had severe tinnitus in my right ear and hyperacusis, I can't sleep and listen to music, my great passion.

Any advice I'm desperate? I have read that tinnitus caused by Aminoglycosides is often permanent, I have to go to my doctor tomorrow. But the ENT audiologist gave me the appointment in a week.

Some advice? Please Help

March 9, 2022

6 hours ago, Chuck83 said:

20 days ago I had a micropulsed yellow laser surgery on my eye to treat a central serous chorioretinopathy. At the end of the surgery I was installed with drops of the extreme ototoxic antibiotic Tobramycin of the Aminoglycoside class, because I am allergic to fluoroquinolones. Now is 5 days I have had severe tinnitus in my right ear and hyperacusis, I can't sleep and listen to music, my great passion.

Any advice I'm desperate? I have read that tinnitus caused by Aminoglycosides is often permanent, I have to go to my doctor tomorrow. But the ENT audiologist gave me the appointment in a week.

Some advice? Please Help

tinnitus-what-does-all-that-noise-mean

I suggest that you advise the prescriber.

March 10, 2022

I spoke to the prescribing eye doctor, he says eye drops are impossible such a reaction, but online I found hundreds of stories. My doctor says that Tobramycin is highly ototoxic only when taken orally or intravenously not in eye drops. But I have found hundreds of online stories of people who have had ears ruined by Tobramycin eye drops. I have to do the audiomentric tests with the otolaryngologist next Thursday, I have to see if it caused functional and structural damage.

March 24, 2022

Has anybody experienced sound and vision distortion? When i look at the tv or the iPad/iPhone it’s like the image is either to small, too far away or too close, like not normal. Sometimes i have issues focusing my eyes on the screen and the image is weird. My vision is also blurry.

I also struggle to focus on sounds. Its either to loud, to far away or i just cant detect where its coming from. Sound can also sound weird, more sharp and static.

When i put my earbuds in to listen to music, i cant hear the music properly. Its like its trapped in the back of my head and muffled. I find this very distressing, because i literally cant listen to music anymore. I also have a giant cotton ball (sometimes feels like a brick) in the back of my head where i hear the distorted music! Literally feels this inside my brain!

Anybody experience something similar? Or should i go to the doctor?

I also have dp/dr and loud tinnitus in my ears and head!

March 24, 2022

I don't know what is causing this, The screen issue I am familiar with. Mirtazapine also gave me slight hearing loss in one ear, so I had to stop taking it quickly, I avoided losing my hearing, but more withdrawal problems came. The hearing loss has come back on two separate occasions.

Dpdr can get bad. It can affect your vision and distort things. For me sounds felt far away, but the sounds felt dull most the time. There are those on here very familiar with DPDR and how it can twist, distort, and make things seem strange in distance.

The brick and cotton ball comment is familiar to WD. But usually refers to cognitive problems or headaches.

The way you are hearing music sounds like a brain problem and not an ear one. I don't know for sure of course and this is just speculation. But to a non-doctor, internet lurker that is what it looks like. I

This is just my opinion I have no medical knowledge and you know more about you than anyone. I do not know what is best, just here to present my thoughts.

dpdr can explain:

3 hours ago, Sofa said:

When i look at the tv or the iPad/iPhone it’s like the image is either to small, too far away or too close, like not normal.

I am assuming that screens are not the only thing your dpdr effects. If so, then I h

ave not yet heard of selective dpdr.

This is very common in withdrawal:

3 hours ago, Sofa said:

Sometimes i have issues focusing my eyes on the screen and the image is weird. My vision is also blurry.

Blurry eyes are a complaint I have heard before. I can not focus on screens, it is hard for me to look at the screen of my laptop. I have to take quick glances, or writ in spurts. The image being weird could also be dpdr. Dpdr can distort our vision up to very terrible, and uncomfortable things. At the lesser end of dpdr, things just look off.

3 hours ago, Sofa said:

When i put my earbuds in to listen to music, i cant hear the music properly. Its like its trapped in the back of my head and muffled. I find this very distressing, because i literally cant listen to music anymore. I also have a giant cotton ball (sometimes feels like a brick) in the back of my head where i hear the distorted music! Literally feels this inside my brain!

Tinnitus and muffled hearing are common in withdrawal. The brick and cotton ball comment is familiar to WD. But usually people associate them to cognitive problems or headaches. I have heard dpdr to distort sound, for me dpdr just makes sound sound farther away. (Not really but its close and the best way I can to describe it.)

Quote

i cant hear the music properly. Its like its trapped in the back of my head and muffled

I have not heard this described but it could just be a different way to perceive something. I have my thoughts feel as though they were in the back of my head but not sounds. Is it just with music?

This doesn't mean its not withdrawal. I had a reaction to water for a short period and no one seemed to know what I was talking about, or reply to it. So I assumed it was a very weird/rare symptom or it was all in my head. I much later I found someone else would had the same thing. At any rate seems more like a brain problem to me (not a doctor) and not an ear one.

If this is a brain problem instead of an ear problem, then it is probably best to chalk it up to withdrawal. The only other brain problem I can think of is a tumor that can cause changes, but withdrawal causes all the same symptoms as a tumor can. There is a saying that if you didn't have it before withdrawal then it came from withdrawal.

This is usually the cause but if you are worried you can get a scan for a tumor. I would avoid scans that use contrast dye as the dye has caused more withdrawal symptoms or more reactions to appear

I am sorry i don't have the answers. I just can say what I have seen. And based on that it is only my opinion that it is withdrawal caused. If it puts your mind at ease to check that there is not another problem you have to worry about then it would not hurt you to check. This is assuming you can leave the house, and the doctors only do a scan and not pump anything into you. I've had them put medication in the water of my Iv bag. I think they just thought it wasn't worth mentioning as it was a "light" medication.

All I can tell you is that in probability it is withdrawal. But it is ok to get checked.

I do not know if you can request a scan in your country, my urgent care offers them and if I walked into the ER I could get one I think. But the bill would be ridiculous.

March 25, 2022

@ThatOneGirlStitch

Thank you for your reply.

I hope its just dp/dr and not my brain.

What’s weird is that i when i look at s video on the phone or the tv, the sound and the video does not connect. I can see lips moving, but it does not sound the the audio is coming from the video still. Its distressing.

when i try to listen to music, my brain cannot focus on it! I know its coming from my phone, but i just cant focus on it and i just sounds like its coming from the wrong place.

March 25, 2022

@Sofa

I hope it clears up for you soon, though it may take it's time. I can tell this is distressing. I would find that so. I hope you are able to find more information on it.

March 25, 2022

I came across this:

Quote

Although sight is a much different sense than sound, Georgetown University Medical Center neuroscientists have found that the human brain learns to make sense of these stimuli in the same way.

They were really looking into how we perceive language I think, but here is the articale. I had a hard time reading it and it my not be related at all in the least. Here is the link:

https://www.sciencedaily.com/releases/2018/04/180418144725.htm

It may be related to Auditory processing disorder (APD)

There is also a visual processing disorder but I haven't read about that much.

Here is a link to APD

Warning: Do not be scared. They state there is no cure. But that does not seem to apply to withdrawal as people have healed from it. And I'm sure our situation in withdrawal is something they are not aware of.

https://www.webmd.com/brain/auditory-processing-disorder

I went to look for information and the first story I found was someone getting better

Here is the link. You will find it labeled under Temporal Lobe in the top post.

http://www.benzobuddies.org/forum/index.php?topic=232042.msg2977793#msg2977793

Here you will find in Tatertots91 response post their experience with sensory problems. It is the second to last post near the bottom of the page:

http://www.benzobuddies.org/forum/index.php?topic=228139.msg2940932#msg2940932

I don't know if this is close to what you mean, but I thought I'd post it. If not maybe something else will pop up.

March 26, 2022

I have had ear fullness/clogged ears and muffled hearing for 16 months as of today since reducing my zoloft by almost half. I am also taking remeron and risperidone, so it could be from both zoloft withdrawal and ongoing use of those latter 2 drugs. All the stories on this site point to it being a result of discontinuing serotonergic drugs e.g. SSRIs like zoloft. My research on this site and off it also suggests it can happen from discontinuing antipsychotics and other drugs like remeron (both indirectly increase serotonin but are also serotonin antagonists). There was one case of clogged ears from beginning an SSRI, and none directly from taking remeron or risperidone. Hearing loss (without mention of clogged ears) on this site was also mainly due to serotonergic drug withdrawal, with some reports of it stemming from taking remeron (which occurred within 3-12 months of taking it or instantly, plus one case where existing hearing loss was worsened by tapering it). There were also some reports of hearing loss, clogged ears, tinnitus, etc. from taking drugs after having taken and discontinued them before...which may be due to the kindling effect of repeated use and withdrawal.

I made the mistake of reducing my remeron dose for 3 days and reinstating, which has worsened my ear fullness considerably and may have made the remeron suddenly become damaging (ototoxic) due to the kindling effect. I may have to return to my reduced dose or risk further damage.

I am wondering if anyone has had similar experiences and whether they have found a solution or witnessed improvement and for what reasons...I am at my wits end and cannot take any more of this.

@Altostrata @Shep @ChessieCat Can you help get this topic started because it's a niche topic within the general auditory symptoms topic distinct from tinnitus, hearing loss, and hyperacusis and I haven't seen a specific enough thread. Thanks.

March 26, 2022

Hello

I do believe there is a forum on here that addressed this:

But any way.

I had your exact problem on Remeron. It happened to me in 3 weeks of taking the drug. They lowered my dose on the last week. In fact I had to quit suddenly because I started losing hearing in my left ear. It was all muffled. I saved most of my hearing, but the sudden stopping was worse than acute. It will mess up your ability to eat and in some cases sleep. (I was already in withdrawal at that point) Remeron is a known drug that causes impaired hearing for some. Be careful, remeron is a rough drug to be on and get off of. It's name that people recognize it by is Mirtazapine. This is because there is different names it is sold under depending on where you live. Because of this unique nature of the drug, the benzobuddies website has a forum dedicated to it: http://www.benzobuddies.org/forum/index.php?topic=80102.0 This forum seems to be relativly active compared to a lot of others on benzobuddies. I did not experience hearing loss on or after I got off zoloft, but I heard people tapering from it to be affected.

I only was on Mirtazapine for a short time. My hearing was able to get better, but it comes and goes.

For doing the best for your hearing it is best not to increase ototoxic drugs of any kind. Some over the counter drugs my fall under this (though probably won't affect people who are not at risk or in withdrawal) so it is best to look them up.

Can it improve? That is the big question. I have to rack my brain to see what I remember. I have heard someone getting better after 2 years, but I do not know the extent of their hearing problems. I have heard through the grapevine that someone read an article that it can get better but not back to the way it was. Someone else mentioned that they were going to try hearing aids.

As you can see none of this has a source. It is just a jumbled mess of things I remembered.

I am not a doctor, but from my own experience, reinstating remeron will only make things worse. If you had hearing loss on it or got anhedonia than go back on it is risking more of the same

Bottom line is stay away from ototoxic drugs. It's the best solution I know. Once off, you have a chance to heal. If someone thinks jumping will save their hearing and they would risk hell for that, it is up to the individual. If you put me back in time I still don't know what I'd do. Time will tell if it was worth it. But God, do my insides feel gutted now.

As for tapering, I do not know. I just jumped of mine (that had a different set of problems)

If you are looking for the best way to taper I would ask around. Ask the mods on the personal forum you created, go to the Mirtazapine support group and see what they say. You seem to have educated yourself on the topic pretty well.

Welp thats my personal experience.

March 26, 2022

@Remeron88 please use search in the Symptoms and Self-Care forum about ear problems.

The peer support staff doesn't know much about otolaryngology and cannot answer your questions about how to fix your specific problem, which probably needs examination by a medical specialist to rule out usual causes of ear problems.

May 4, 2022

Has anyone had these symptoms cured? I feel almost all these symptoms, there are so many that I don't know what else to do. I'm desperate and also because of a wave I just entered. In the ears the main thing is the sensitivity to sounds, everything is very loud. Is anyone healing from this?

May 5, 2022

18 hours ago, Warrior said:

Has anyone had these symptoms cured? I feel almost all these symptoms, there are so many that I don't know what else to do. I'm desperate and also because of a wave I just entered. In the ears the main thing is the sensitivity to sounds, everything is very loud. Is anyone healing from this?

Same. I want answers too.

Inner ear problems and drugs that can damage ears

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