With cochleotoxicity, hearing loss or the start or worsening of tinnitus (ringing in the ears) can occur through damage to the cochlea (the hearing apparatus) or the cochlear branch of the vestibulo-cochlear nerve. This was the case with aspirin and quinine centuries ago, with the antibiotic streptomycin in the 1940s, and more recently with some anti-cancer drugs. They may also reduce hearing, particularly when given at high doses. This can result in sensorineural hearing loss, dysequilibrium, or both. At high doses, aspirin and other salicylates may also cause high-pitch tinnitus and hearing loss in both ears, typically reversible upon discontinuation of the drug. Symptoms of ototoxicity include tinnitus (ringing in the ears), hearing loss (bi- or unilateral), dizziness, lack of movement coordination, unsteady gait, and oscillating or bouncing vision (vertigo). Additionally, fall risk can increase for patients who experience dizziness, poor coordination, unsteady gait, or vertigo. Whereas typical hearing tests involve frequencies only as high as 6,000 to 8,000 Hz, audiologists can perform testing that evaluates hearing in very high frequencies such as 9,000 to 20,000 Hz, possibly allowing for earlier detection of ototoxic effects.
Menieres disease, ototoxic medications (such as high-dose aspirin or certain strong diuretics), immune disorders, and noise exposure (see following section). Otoacoustic emission testing is very sensitive to noise induced hearing loss. Hearing loss and tinnitus (usually temporary), can also be associated with high doses of aspirin or other ototoxic drugs such as the nonsteroidal anti-inflammatory drugs. You may feel dizzy if you are depressed, or if you are breathing really hard and fast (hyperventilating). Ototoxicity may also come from receiving high doses an ototoxic drug at one time, which may damage certain cells in your inner ear. Nausea, ringing in the ears, and vomiting may be associated with dizziness. This is a very disabling symptom as it occurs without warning and can result in severe injury. In most cases, a progressive hearing loss occurs in the affected ear(s). Migraines occur more frequently in patients with Meniere’s disease (Ibekwe, 2008). While some people have hearing that fluctuates like this without any further symptoms of dizziness or tinnitus, in most cases, this does not progress to Meniere’s disease (Schaaf et al, 2001).
In humans, auditory perception changes following salicylate or aspirin, including decreased word discrimination and temporal integration ability. Since high doses of salicylate can reliably induce hearing loss and tinnitus, it is commonly used to study its behavioural, anatomical, physiological and perceptual effects on the auditory system 2 10 11. After a high dose of salicylate, neurons in the central auditory system tuned to low characteristic frequencies (CF) in the auditory cortex (AC) shift upward and neurons tuned to very high frequencies shift downward resulting in an over representation at the mid frequencies 12. Tinnitus is often associated with hearing loss. Aspirin is more likely to cause tinnitus at the higher daily doses often taken for chronic pain (for instance, the 8 to 12 tablets a day that some people take for arthritis), though there have been reports that occasional use may also cause it. Those who are very old, suffer from kidney problems, have a family history of hearing loss or are regularly exposed to loud noises may be at higher risk. The vertigo is milder and you may not lose any hearing, though you’ll probably have tinnitus, a ringing in the ear.
Sensorineural Hearing Loss
Coadministration with other drugs having ototoxic potential. Although vertigo and difficulty maintaining balance tend to be temporary, severe loss of vestibular sensitivity may persist, sometimes permanently. Vancomycin can cause hearing loss, especially in the presence of renal insufficiency. It’s possible that you are getting too high a dose or something. My husband has been on atenolol,50mg for over 14 years he is almost deaf in his left ear could this be the effects of this drug he was on statins took himself of them because of bad side effects he is also on Amlodipine 10mg,Ramipril 10mg,Aspirin 75mg. I have had the Tinnitus in my right ear, with high frequency hearing loss as well, for about two years. Years ago I suffered vestibular neuritis, very severe, and vertigo in the same ear (left), likely due to herpes zoster reactivation. Methotrexate in high doses is used to treat various types of cancer. Treating the inner ear with very small, strategically-placed doses of gentamicin takes advantage of this effect by inactivating the sensory cells that cause episodes of vertigo. The administration of high doses of NSAIDs to such patients has produced acute renal failure in rare instances. Other side effects have included Reye’s syndrome with aspirin use in children with an acute viral illness. Rare cases of ototoxicity have been reported when these medications are taken orally in high doses in people with chronic kidney disease. The ototoxic effects of quinine are very similar to aspirin and the toxic effects are usually reversible once medication is discontinued. Symptoms may include vertigo, dizziness, and imbalance, among others listed here. If you experience a sudden hearing loss in one ear, this is considered a medical emergency. If dizziness or vertigo is associated with your hearing loss, you may have a condition called Meniere’s disease. High doses of prednisone is the treatment of choice, typically tapered over a 2 week course (start at 20mg 3X per day for 5 days than taper the dose slowly every 3 days). I have my hearing back and very low residual tinnitus.
Review Of Salicylate-induced Hearing Loss, Neurotoxicity, Tinnitus And Neuropathophysiology
To many doctors, ototoxicity just means hearing loss or tinnitus. For extremely ototoxic drugs such as Cisplatin (used in the treatment of cancer), virtually everyone that takes this drug ends up with hearing loss. 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). I discovered she had been self-medicating-taking large doses of Aspirin each day for the nearly-constant headaches she often suffered.