Article Summary: Ototoxicity is damage to the inner ear caused by certain medications, chemicals, or substances. It can affect hearing, balance, or both, and early symptoms may include tinnitus, muffled hearing, dizziness, or balance problems. Ototoxic drugs may include certain antibiotics, chemotherapy medications, loop diuretics, high-dose aspirin, NSAIDs, quinine-based drugs, and some over-the-counter pain relievers. Patients should not stop prescribed medication on their own, but anyone taking a known ototoxic medication should talk with their doctor and consider a baseline hearing test.
Last Updated: June 11,2026
Ototoxicity: Quick Answers
| Question | Short Answer | What It Means |
|---|---|---|
| What does ototoxic mean? | Ototoxic means toxic to the ear. | An ototoxic substance can damage hearing, balance, or inner ear function. |
| What is ototoxicity? | Ototoxicity is ear damage caused by certain drugs, chemicals, or substances. | It may cause tinnitus, hearing loss, dizziness, or balance problems. |
| What are ototoxic drugs? | Ototoxic drugs are medications that may harm the ear. | Examples may include some antibiotics, chemotherapy drugs, loop diuretics, NSAIDs, aspirin, and quinine-based medications. |
| Is Tylenol ototoxic? | Frequent or long-term acetaminophen use has been studied for possible links to hearing changes. | Occasional use is different from repeated use. Talk with your doctor before changing any medication routine. |
| What are ototoxicity symptoms? | Symptoms may include ringing, muffled hearing, hearing loss, dizziness, or balance problems. | Symptoms can appear gradually, so baseline and follow-up hearing tests may be helpful. |
| Can ototoxicity be prevented? | Risk can sometimes be reduced with monitoring and medical guidance. | Do not stop prescribed medication without talking to your doctor. Ask about hearing monitoring if you take a known ototoxic drug. |
When you take a TYLENOL the last thing you’re thinking about is your ears.
They’re off hiding on the sides of your head while you’re focused on shaking that throbbing ache in your neck, but few people realize that ingesting something as basic as acetaminophen can put your ears at risk for ototoxicity. It’s an obnoxious yet unavoidable reality when it comes to protecting your hearing health, but acknowledging the oft overlooked ramifications of your medications is an important first step when deciding how to best address a health issue.
So, today, we’re going to look at one of the most overlooked side effects and one of the most common causes of hearing loss: ototoxicity. What it is and how you can prevent it.
Ototoxicity and Hearing Loss
According to the American Academy of Audiology, “Ototoxicity refers to damage to the hearing and/or balance organs that occurs after exposure to medications or chemicals that affect the inner ear.” These medications and chemicals are what’s known as ototoxic, and they can adversely impact a person’s ability to hear, maintain their balance or both.
It’s a pretty severe designation that a medication can receive, but what medications do you have to watch out for?
Surprisingly, the list is pretty long. In fact, the American Speech-Language-Hearing Association (ASHA) states that “There are more than 200 known ototoxic medications (prescription and over-the-counter) on the market today.” These include medications from aspirin to some anticancer drugs.
This unfortunate matter puts many patients in a compromised position where they must decide what parts of their body they must sacrifice in order to attain their health goals, but regardless of the decision these patients make, they must be aware of the impacts that ototoxic medications will have on their quality of life.
Ototoxicity is a slow affliction that often begins when the patient’s ears start to ring. Over time, hearing loss may start to occur, but as with all hearing loss, it may go unnoticed until the patient’s communication begins to be affected. Balance may also be affected, but sometimes the human body will learn to adapt to these changes, making the impact of ototoxicity on balance temporary.
Unfortunately, there are no approved protective strategies that are approved by the necessary governing bodies, but you can still educate yourself on the types of ototoxic drugs and chemicals that may put you at risk.
According to the Sound Relief Hearing Center, the most common medications that cause ototoxicity are non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics including aminoglycosides, certain cancer medications, water pills and loop diuretics, long-term hormone therapy and quinine-based medications. Understanding that keeping track of all these medications is a fool’s errand, they compiled a fairly comprehensive list of ototoxic drugs that anyone can reference here.
With a list this long, consuming an ototoxic medication is unavoidable if not inevitable, but there are things that you can do before and while being treated with one of these drugs.
To begin, ASHA recommends visiting an audiologist to record a baseline evaluation of all your hearing and balance faculties. “The baseline record should include an audiologic hearing test that uses high-pitched testing, word recognition, and other tests when possible. This information can help you and your doctor make any important decisions to stop or change the drug therapy before your hearing is damaged.”
There may be cases in which your medication cannot be changed, but if you find yourself in that situation, consult with your audiologist to manage the effects that come as a result.
A baseline hearing evaluation is highly recommended for anyone who thinks they may be taking an ototoxic medication. This can include diagnosing balance issues, exploring the need for professional ear cleaning, and hearing tests.
Call Big Sky Audiology Clinic at 406-656-2003 to schedule your appointment today!
Ototoxic FAQs
What Are Ototoxic Drugs?
Ototoxic drugs are medications that can damage the structures of the inner ear. This may affect hearing, balance, or both.
Common medication categories associated with ototoxicity include certain antibiotics, chemotherapy drugs, loop diuretics, aspirin, NSAIDs, quinine-based medications, and some other prescription or over-the-counter drugs.
Not everyone who takes these medications will experience hearing or balance problems. Risk depends on the medication, dose, treatment length, other medications, kidney function, age, and overall health.
Is Tylenol Ototoxic?
Tylenol is a brand name for acetaminophen. Some research has examined possible links between frequent acetaminophen use and hearing changes, especially with long-term or repeated use.
This does not mean someone should panic after occasional use. It does mean patients should tell their doctor about all medications they take, including over-the-counter pain relievers, and report new tinnitus, muffled hearing, dizziness, or hearing changes.
Never stop or change a medication routine without speaking with your doctor first.
What Are the Symptoms of Ototoxicity?
Ototoxicity symptoms may include ringing in the ears, buzzing, muffled hearing, hearing loss, dizziness, vertigo, or balance problems.
These symptoms may appear suddenly or gradually. Some people first notice trouble understanding speech, especially in background noise. Others notice tinnitus before they notice measurable hearing loss.
If you are taking a medication known to be ototoxic and notice new hearing or balance symptoms, contact your prescribing doctor and schedule a hearing evaluation.
How Can You Reduce the Risk of Ototoxicity?
The first step is to talk with your doctor before starting, stopping, or changing any medication. Some ototoxic medications are medically necessary and should not be stopped without professional guidance.
A baseline hearing test can document your hearing before treatment begins. Follow-up testing during or after treatment can help identify hearing changes earlier.
Other helpful steps include taking medications only as directed, avoiding unnecessary loud noise exposure, reporting tinnitus or hearing changes quickly, and keeping your audiologist informed about medication changes.
When Should You Schedule a Hearing Test?
You should consider a hearing test if you are taking a known ototoxic medication, starting chemotherapy, using certain IV antibiotics, taking high-dose or long-term pain relievers, or noticing new tinnitus, muffled hearing, dizziness, or balance changes.
A hearing test gives you and your healthcare team a baseline. If your hearing changes later, the results can help your doctor and audiologist understand what changed and what support may be needed.
References
- American Academy of Audiology: Ototoxicity
- American Speech-Language-Hearing Association: Ototoxic Medications
- Sound Relief Hearing Center: List of Ototoxic Drugs
- National Library of Medicine: Aminoglycoside Toxicity
- National Library of Medicine: Ototoxicity Research Review
About the Author: Dr. Tracy Hayden
Dr. Tracy Hayden is the Audiologist and Owner of Big Sky Audiology in Billings, Montana. She has practiced audiology for 30 years and has served the Billings area for 27 years. Dr. Hayden holds her doctoral degree from the Arizona School of Health Sciences and is a member of the Academy of Doctors of Audiology and a Fellow of the American Academy of Audiology. She focuses on helping adults and children improve communication through hearing aids, listening strategies, assistive devices, and counseling, with a patient-first approach built around better hearing and easier listening.
