Ototoxicity

Related: Dizziness, hearing loss, ototoxicity, tinnitus (ringing in the ears)

What Is Ototoxicity?

• Ototoxicity occurs most often, after you have received medications that have caused you to lose your hearing, or feel dizzy.
• Ototoxic medications are drugs that can cause damage to the inner ear, and result in temporary or permanent loss of hearing. It may also cause your loss of hearing to become worse.
• Some common medications that cause ototoxicity, if given in high doses may include:
• Cisplatin, and other types of chemotherapy
• High doses of salicylates, such as aspirin
• Non-steroidal anti-inflammatory medications (NSAIDs), such as naproxen sodium
• Diuretics or "water pills," such as furosemide (Lasix^®)
• Antibiotics, such as Erythromycin, Gentamycin, Tobramycin or Streptomycin.
• Ototoxicity following medications may be due to a long-term exposure to these drugs. Your risk for developing ototoxicity increases as the drug accumulates in your body.
• It may also come from giving high doses of the drug at a time, which may damage certain cells in your inner ear. The hearing loss you may experience as a result of medications may be irreversible.
• When people experience dizziness as a result of ototoxicity from medications, it may be a sign that the balance mechanism in your inner ear is not working properly, or has been damaged.
• The first sign of ototoxicity may be dizziness. Some other causes of dizziness may include:
• You may feel dizzy when you are dehydrated, and you change positions. This is a result of low blood pressure. Your healthcare provider may check your vital signs while lying down, sitting up, and standing, if you are dizzy, and seek medical care.
• Stress, tiredness, fever, fatigue, anemia, heart problems, or stroke may cause dizziness.
• You may feel dizzy if you are depressed, or if you are breathing really hard and fast (hyperventilating).
• Inflammation of your inner ear, caused by infection.
• Infections in your brain and central nervous system.
• Meniere's disease, an inner ear disease. Meniere's disease is a disorder where patients experience dizziness, tinnitus, and hearing loss.
• Certain tumors may cause dizziness, such as brain tumors, and a tumor found in the auditory (hearing) canal of the ear, called a vestibular schwannoma. A schwannoma is a benign tumor. (The word "benign" refers to a medical condition that is not immediately life threatening, and is not likely to become worse).

Ototoxicity Symptoms:

• Ototoxicity may be accompanied by a tinnitus. Tinnitus is a word used to describe any ringing, or abnormal sound in your ear or head. Some people may hear roaring, hissing, or humming sounds. This may interfere with your ability to rest, or concentrate. You may be unable to sleep at night. As your ototoxicity becomes worse, the sounds become louder.
• You may feel a pressure or fullness in your head or ears, like you have a cold.
• You may notice a loss of hearing, or your existing hearing loss may become worse.
• You might feel like the room is spinning around you, or that you are spinning. Some people describe dizziness, as feeling a bit "woozy." Severe dizziness is the fear that you may fall down when you stand up.
• Nausea and vomiting may be associated with ototoxicity.
• Even if you have been diagnosed with ototoxicity, dizziness may be a symptom or sign of a serious problem. Notify your doctor if you experience any of the symptoms mentioned here.

How Is Ototoxicity Diagnosed?

• Your healthcare will usually, at first, take a complete health history from you. They will then examine your neurologic system by conducting a physical exam in their office. This may include looking in your eyes, watching you stand or walk, and testing your strength. They will also look inside your inner ear, to see if there is an infection.
• If you are dizzy, it is important to distinguish vertigo from dizziness. Your healthcare provider may turn your head in different positions, usually from a sitting position, to a lying position, and back again, as they try to elicit the same symptoms that you are describing.
• Your healthcare provider may suggest that you have x-rays, an MRI, or a CAT scan of your head.
• You may also be referred to a specialist, such as an audiologist, otolaryngologist, or a Neurologist; depending on the type of symptoms you are experiencing.
• An otolaryngologist or neurologist will usually perform the complete physical examination, and order all the tests. Your healthcare provider may also do this.
• A Neurologist specializes in dizziness disorders, and tinnitus.
• You may also be referred to an audiologist, a professional who diagnoses, treats, and manages individuals with hearing loss or balance problems.
• Your healthcare provider may order some blood work to be drawn. The blood work will show many things, including if you have anemia, low electrolytes, or it may suggest that you are dehydrated, as a cause of your dizziness.

Things You Can Do To Minimize Ototoxicity:

• It is important to notify your healthcare provider if you notice any dizziness, or any change in the pattern of dizziness, or the ringing in your ears that you are experiencing. Also, notify your healthcare provider if you have any loss of vision, hearing, or if your symptoms become more severe, and do not improve.
• Drink 2-3 liters of fluid per day to prevent dehydration. This may include fruit juices, water, non-caffeinated sodas and coffee, and non-alcoholic beverages. Alcohol and caffeine may cause dehydration, which can lead to dizziness, so these should be avoided. Always carry a "sipper" cup with you, filled with your favorite drinks.
• Change positions slowly. Allow your body a chance to adapt to the position change. For some individuals, lying down until the dizzy episode passes may be the best.
• With moderate dizziness, walk slowly and often. Walk with assistance if the dizziness is severe.
• If you have vertigo, your doctor or a trained therapist may teach you exercises, called "vestibular exercises" to try to get rid of your dizziness. These exercises involve you sitting down, and changing into different positions. This may cause you to be dizzier at first, while you are performing these movements, but should help to correct the vertigo. You may see some improvement in 2-6 months.
• You may have tinnitus (ringing, humming or any abnormal sound in your ear or head) as a result of your ototoxicity. Stress, anxiety and tiredness may cause your tinnitus to become worse. If stress and anxiety causes your tinnitus to become worse, relaxations techniques may help. You may also be prescribed an anti-anxiety drug.
• Using a quiet radio, television, or any low levels of sound when you are trying to rest may help you to ignore the tinnitus, and make it easier to sleep or relax.
• If you have Meniere's disease, your doctor or healthcare provider may tell you to limit the amount of salt you eat in a day, and prescribe anti-nausea or anti-vertigo medications, along with a medication to help your body rid itself of salt and fluids. The goal is to decrease the pressure of your inner ear, and to control the vertigo.
• Depending on the cause of dizziness, it may last a few days to a few months. It is important to follow all the instructions your healthcare provides.
• If your hearing loss is a result of drugs or medicines that you have received in the past, it is important to avoid these in the future, if possible. Be sure that you tell all of your health care providers about all of the medicines you are taking, including over-the-counter medications, vitamins, and herbal remedies. It is important to avoid the use of drugs that may cause further damage the cells in your ear.
• Always ask your healthcare provider if they know of your hearing loss, especially if it is sensory.
• Make sure to keep all appointments.
• Do not share your medications with anyone.

Drugs That May Be Prescribed By Your Doctor:

• There are no drugs to specifically treat ototoxicity. The treatment is aimed at controlling the symptoms.
• Dizziness is a major symptom, and there are many drugs that can be used to treat dizziness. These may include:
• Meclizine (Antivert^®, dimenhydrinate (Dramamine^®), or the scopolamine patch (Transderm-Scop^®). These medications may help to decrease the feelings of unsteadiness or imbalance that you may be feeling.
• Prochlorperazine (Compazine^®), and promethazine (Phenergan^®), may work by preventing the feelings of dizziness, or by preventing nausea and vomiting that may cause dizziness.
• These are just some of the most commonly used drugs. Your healthcare provider may prescribe others.

When to Contact Your Doctor or Health Care Provider:

• If you develop any sudden severe ear pain
• If you have a temperature greater than 100.5 F (38 C).
• If you have nausea that interferes with your ability to eat, or experience vomiting more than 4-5 times in a 24 hour period.
• If you have a sudden loss of vision, or if you lose your hearing.
• If you fall down, or lose consciousness as a result of your dizziness.
• Severe, uncontrolled nausea and vomiting, unrelieved by anti-nausea medications.
• If your symptoms worsen within 3 days of treatment.
• As always, notify your doctor or healthcare provider if you are concerned about any of the symptoms you are experiencing.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Additional resources for hearing problems:

Better Hearing Institute

515 King Street, Suite 420

Alexandria, VA 22314

800-EAR-WELL(327-9355)

http://www.betterhearing.org

The National Association of the Deaf

814 Thayer Ave.

Silver Spring, MD 20910-4500

Voice: 301-587-1788

TTY: 301-587-1789

http://www.nad.org

Self Help for Hard of Hearing People

7910 Woodmont Ave., Suite 1200

Bethesda, MD 20814

Voice: 301-657-2248

TTY: 301-657-2249

http://www.shhh.org