Aminoglycosides
In China, deafness due to misuse or abuse of aminoglycoside antibiotics is at the top of the list of drug-induced deafness in China, and is the most important and common cause of drug-induced deafness, and is gradually developing into the top of the list of various deafness-causing factors leading to congenital and acquired deafness in newborns and deafness in adults.
Injections of aminoglycosides in pregnant and lactating women can cause hearing impairment in newborns and should be contraindicated.
Ototoxicity is more likely to occur with renal impairment, concomitant use of other ototoxic drugs, long-term use (>10 days), and doses >3 mg/kg per day, so blood levels should be monitored when available.
β-lactams
It has been shown that penicillins such as ampicillin, cloxacillin, phenelzine penicillin and cephalosporins such as cephalexin, cefazolin and cefradine also have adverse effects of tinnitus or hearing loss, especially in patients with poor renal function, and the symptoms can usually be relieved after discontinuation.
Tetracyclines
These include tetracycline, chlortetracycline, oxytetracycline and semi-synthetic tetracyclines (doxycycline, metacycline and minocycline, etc.). Studies have shown that tetracyclines produce ototoxicity in a very dose dependent manner. For example, high doses of minocycline can cause vestibular dysfunction in a dose-dependent manner, which is more common in women than in men, and in the elderly than in young people. The symptoms are vertigo, tinnitus, ataxia, nausea, vomiting, etc., which can be recovered after 24-48 hours of drug withdrawal.
Macrolides
Macrolide antibiotics can cause tinnitus and hearing impairment, especially when administered intravenously, and can be recovered by stopping or reducing the dose. Erythromycin, for example, can produce dose-dependent, reversible bilateral hearing impairment, usually accompanied by tinnitus. Some patients taking azithromycin have experienced hearing impairment, including hearing loss, tinnitus, and/or deafness, associated with high doses of the drug, but it is mostly reversible.
Glycopeptides
Such as vancomycin, desmethylvancomycin, and teicoplanin have some nephro- and ototoxicity, which is especially likely to occur with high doses and prolonged application, and can produce dose-dependent tinnitus and irreversible hearing damage. For example, vancomycin can cause tinnitus or a feeling of fullness in the ear, hearing loss or even absence, and damage to the auditory nerve. It is particularly likely to occur at high doses (usually blood levels >60 mg/L), for prolonged periods of time, in the elderly, or in people with renal insufficiency.
Fluoroquinolones
Fluoroquinolones are synthetic antimicrobial drugs widely used in clinical practice in recent years, and ototoxicity has been reported in both oral and sedative administration. After discontinuation of the drug, the symptoms are mostly relieved or disappeared.
Anti-mycobacterial drugs
For example, ashwagandha can cause tinnitus and deafness when used in large doses for a long time, but the symptoms can mostly disappear after stopping the drug.
Other ototoxic antibacterial drugs
Polymyxin, chloramphenicol, isoniazid, metronidazole, etc. have been reported to produce ototoxicity when applied clinically. For example, chloramphenicol has ototoxic effects when applied systemically, and local ear drops can cause hearing loss. Polymyxin can cause vestibular damage, sometimes with tinnitus but no auditory damage, and such neurological symptoms can easily appear at higher doses of intrathecal injections and resolve after discontinuation of the drug.
Drug deafness is difficult to treat once it develops
The key to treating drug-related deafness is early detection and early treatment. Before hearing loss and deafness occur, there are usually symptoms such as headache, dizziness and tinnitus. During the application of ototoxic drugs, once such symptoms are detected, it is important to stop the drug and give appropriate treatment as early as possible.
In terms of western medicine, vasodilator drugs can be used to improve microcirculation; vitamin drugs and trace elements can be used to enhance the nutrition of the auditory nerve and promote the detoxification and discharge of ototoxic drugs in the body. In response to the characteristic that ototoxic antibiotics make the hair cells in the inner ear metabolically impaired, treatment mostly uses drugs that improve cell metabolism, supply energy and promote cellular redox, such as ATP, coenzyme A, vitamin C, cytochrome C, etc. In addition, vitamin A, vitamin B, compound salvia, etc. can be applied to save part of the degenerated hair cells and restore their activity in the early stage. Hyperbaric oxygen therapy can also be used if available.
In traditional Chinese medicine, many scholars report that honeysuckle, yellow essence, bone marrow, licorice, etc. have detoxifying effects on drugs. According to the principle of diagnosis and treatment, using the formula of detoxifying and clearing orifices, nourishing blood and calming liver, clearing liver and fire, tonifying kidney and benefiting qi, tonifying spleen and activating blood, tonifying kidney and strengthening spleen, strengthening spleen and calming liver, promoting lung and benefiting qi, etc. can receive good therapeutic effect for some patients.
Moderate to severe hearing loss can be treated with hearing aids and speech rehabilitation training, and for patients with very severe or total deafness early implantation of cochlear implants.