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Ototoxins. A reminder.

frascati

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Didn't see any mention of this in a search. Maybe missed it. But it's an often overlooked bit of awareness. When your doc prescribes to you, given that you are a serious enough audiophile to be active here, you should appraise her/him of your concerns and take care to select those pharmaceuticals that pose the least ototoxic risk to you while still being effective.

Just a quick overview..

Brief Overview – Scroll down for a complete list.​

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Certain antibiotics, including aminoglycosides
  • Certain cancer medications
  • Water pills and loop diuretics
  • Long-Term Hormone Therapy
  • Quinine-based medications

Other common medications that can cause ototoxicity include the following:​

  • Certain anticonvulsants
  • Tricyclic antidepressants
  • Anti-anxiety medications
  • Antimalarial medications
  • Blood pressure controlling medications
  • Allergy medications
  • Chemotherapy drugs, including cisplatin
Even alcohol consumption is a mild ototoxin (inasmuch as it's a bit toxic to every part of your physiology it comes into contact with, internally, externally, and sometimes socially... but who am I to judge, with beer at my side as I type:).

Not to be alarmist, at all really, but it's a subject that is surprisingly not discussed much among audiophiles.
 
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sejarzo

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Our former neighbors' son has cystic fibrosis--father a pharmacist, mother a nurse. We filled in for them one weekend around 25 years ago to visit their son when he was in the hospital for extended tobramycin inhalation therapy so they could attend functions with their other kids. The dad had told me quite a bit about tobramycin and why it was so effective for CF patients; he said it was in the class of antibiotics that were used only when truly indicated.

That's why I was surprised that I was prescribed tobramycin drops before cataract surgery, but my eye doc said that was the standard prophylactic drop used before almost any eye surgery and frequently used for any other ocular infection.

The little kid with CF eventually graduated from college with a degree in criminal science and at age 33 or so is a patrol officer in a nearby town, so perhaps it's a good thing that his hearing wasn't severely impacted by repeat rounds of extended tobramycin therapy.
 

Keith_W

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Didn't see any mention of this in a search. Maybe missed it. But it's an often overlooked bit of awareness. When your doc prescribes to you, given that you are a serious enough audiophile to be active here, you should appraise her/him of your concerns and take care to select those pharmaceuticals that pose the least ototoxic risk to you while still being effective.

Just a quick overview..

Brief Overview – Scroll down for a complete list.​

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Certain antibiotics, including aminoglycosides
  • Certain cancer medications
  • Water pills and loop diuretics
  • Long-Term Hormone Therapy
  • Quinine-based medications

Other common medications that can cause ototoxicity include the following:​

  • Certain anticonvulsants
  • Tricyclic antidepressants
  • Anti-anxiety medications
  • Antimalarial medications
  • Blood pressure controlling medications
  • Allergy medications
  • Chemotherapy drugs, including cisplatin
Even alcohol consumption is a mild ototoxin (inasmuch as it's a bit toxic to every part of your physiology it comes into contact with, internally, externally, and sometimes socially... but who am I to judge, with beer at my side as I type:).

Not to be alarmist, at all really, but it's a subject that is surprisingly not discussed much among audiophiles.

This list is true. I will comment on each drug class from a medical perspective.

- NSAID's: not ototoxic unless consumed in high doses regularly. Even then it is reversible if consumption is ceased.
- Aminoglycosides: causes permanent hearing loss if regularly overdosed. Many years ago I had a patient who was negligently treated by his doctor - gave high dose Gentamicin and did not check drug levels. We became aware of it when the patient started complaining of dizziness.
- "Certain cancer medications": well, a few of them actually (anything with Platinum, also Methotrexate, Vincristine, Bleomycin). Causes permanent hearing loss. Or even loss of all your neurons (i.e death) if not dosed correctly.
- Diuretics: cause hearing loss by interfering with electrolytes. Reversible with cessation of the drug.
- Hormone replacement (mostly Estrogens). I have a peripheral awareness of this only given it is not my specialty. Not sure of the mechanism, have to look it up.
- Quinine based medications: a classic cause.
 

BlackH20

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Don't skip your Chemo or many of these medications if prescribed by your physician! May have more problems that not hearing your audio system.
 
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theREALdotnet

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Keith_W

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In low doses, too? Like in gin&tonic?

I actually half typed out a case report that I read many years ago about quinine toxicity from Tonic water, but decided to delete it because I did not want to spread FUD (and also because I could not find the case report when I did a quick medline search). It was only ONE case report, and that guy consumed massive quantities of Tonic water. From memory, he also had liver failure and consumed other drugs which reduced the excretion of Quinine. Even then I was skeptical because the dose of Quinine in Tonic water is pretty low, but I suppose it is possible. I thought it was more likely due to the NSAID's he was consuming concurrently - NSAID's acidify the urine and slow down urinary excretion.
 

theREALdotnet

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Sounds like the role of the gin in gin&tonic is to keep you from overdosing on quinine, by making you pass out before you do :D
 
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