Tinnitus and Ringing in the Ears from Medications: What You Need to Know

Many people notice a ringing, buzzing, or hissing in their ears and assume it’s just stress, aging, or loud music. But sometimes, the cause is something you’re taking every day - a pill, a shot, or even an over-the-counter painkiller. Medications can trigger or worsen tinnitus, and it’s more common than most people realize. In fact, more than 600 prescription and over-the-counter drugs are linked to this symptom. The good news? In many cases, it’s reversible. The key is knowing which drugs to watch for - and what to do if you start hearing things that aren’t there.

What Exactly Is Medication-Induced Tinnitus?

Tinnitus isn’t a disease. It’s a symptom - the perception of sound when no external noise is present. For some, it’s a faint ring. For others, it’s a loud buzz that won’t quit. When it’s caused by a medication, doctors call it ototoxicity. That means the drug is damaging parts of your inner ear or the nerve that sends sound signals to your brain.

It doesn’t always mean permanent damage. About 60% of cases go away once you stop the drug. But some medications - like certain antibiotics or chemotherapy drugs - can cause lasting harm, even after you’ve stopped taking them. That’s why it’s critical to pay attention to when the ringing started. If it began shortly after you began a new medication, there’s a strong chance it’s connected.

Which Medications Are Most Likely to Cause Ringing in the Ears?

Not all drugs carry the same risk. Some are far more likely to cause tinnitus than others. Here are the main culprits, ranked by risk level:

• Aminoglycoside antibiotics - Drugs like gentamicin and tobramycin are among the most dangerous. Used for serious infections, they can cause permanent hearing loss in up to 25% of patients on long-term IV treatment. Topical versions (eye drops, creams) are much safer.
• Chemotherapy drugs - Cisplatin, used for lung, ovarian, and testicular cancers, causes tinnitus or hearing loss in 30% to 70% of patients. The damage often starts with high-frequency hearing loss - you might miss birdsong or alarms before noticing speech problems.
• Loop diuretics - Furosemide (Lasix) and bumetanide, used for heart failure and fluid retention, can cause temporary ringing, especially at high doses or in people with kidney issues.
• High-dose aspirin and NSAIDs - Taking more than 4,000 mg of aspirin daily (far above typical headache doses) can cause tinnitus in about 15% of users. But here’s the catch: modern pain relief uses 325-650 mg. At those levels, tinnitus is very unlikely. The same goes for ibuprofen - high doses (like 800 mg three times a day) can trigger ringing, but it usually fades within days of stopping.
• Quinine - Found in some malaria treatments and, historically, in tonic water. Tinnitus from quinine typically starts within 1-3 days and clears up in 1-2 weeks after stopping.
• Isotretinoin (Accutane) - Used for severe acne, it’s linked to tinnitus in about 5% of users, though the manufacturer reports less than 1% in clinical trials. The discrepancy suggests some people are unusually sensitive.

On the lower-risk side: antidepressants like sertraline or fluoxetine cause tinnitus in less than 1% of users. Benzodiazepines (like Xanax) may trigger it after months of use. Beta blockers? Carvedilol has been linked to ringing, but atenolol hasn’t. It’s not about the class - it’s about the specific drug and your body’s reaction.

Why Do Some Drugs Hurt Your Ears?

The exact reason isn’t fully understood. But scientists believe ototoxic drugs interfere with the delicate balance of fluids and chemicals in the inner ear. They may disrupt the hair cells that convert sound waves into electrical signals, or they may mess with the nerve that carries those signals to your brain.

Some drugs build up in your system over time. Others hit hard and fast. That’s why timing matters. About 70% of people notice tinnitus within two weeks of starting the drug. But with some antibiotics and chemo drugs, symptoms can creep in after 60 or even 90 days.

Genetics may also play a role. New research is looking at whether certain DNA markers make some people more vulnerable. In the future, a simple blood test might tell your doctor if you’re at higher risk before you even start a risky medication.

What Should You Do If You Notice Ringing After Starting a New Drug?

Don’t panic. But don’t ignore it either.

First, check the medication’s side effects list. If tinnitus is listed, that’s a red flag. Then, ask yourself: When did it start? Did it get worse after increasing the dose? Did it begin after switching brands or generics?

Next - and this is critical - do not stop your medication on your own. Many of these drugs treat life-threatening conditions. Stopping antibiotics too soon can lead to resistant infections. Stopping chemo can let cancer spread. Even antidepressants need to be tapered carefully to avoid withdrawal symptoms, which can include tinnitus.

Instead, call your doctor. Say: “I started [drug name] on [date], and since then, I’ve had ringing in my ears. Could this be related?” Your doctor may:

• Check your dosage - sometimes lowering it helps
• Switch you to a different drug in the same class
• Order a hearing test to see if there’s actual damage
• Monitor your kidney function - since many ototoxic drugs are cleared by the kidneys, poor kidney health can make side effects worse

For high-risk drugs like cisplatin or gentamicin, many hospitals now do baseline hearing tests before treatment and repeat them weekly. If your doctor doesn’t offer this, ask. It’s a simple, non-invasive test that can catch early damage.

Can Tinnitus from Medications Be Permanent?

Yes - but it’s not the norm. For most people, the ringing fades after stopping the drug. Aminoglycosides and cisplatin are the big exceptions. With these, damage can be permanent, especially if the drug was given for a long time or at high doses.

That’s why early detection is everything. If you catch the ringing within days or weeks, your chances of full recovery are high. If you wait months, the damage may already be done.

Even if the tinnitus doesn’t go away, it doesn’t mean you’re stuck with it. Sound therapy - using background noise like white noise machines or fans - helps many people tune it out. Cognitive behavioral therapy (CBT) has been shown to reduce the distress caused by tinnitus in 60-70% of patients. These don’t cure the ringing, but they make it bearable.

What About Aspirin? I Heard It Causes Tinnitus.

Yes - but only at very high doses. Back in the 1970s, people took 6-8 aspirin a day for arthritis. That’s 3,000-5,000 mg. At that level, tinnitus was common. Today, most people take one or two 325 mg tablets for headaches or heart health. At that dose, tinnitus is extremely rare.

There’s one exception: a very small number of people are unusually sensitive. They report ringing after just one tablet. If that’s you, your doctor can recommend alternatives like acetaminophen or low-dose naproxen.

How Common Is This Problem?

Over 50 million Americans have tinnitus. Experts estimate that 5-10% of those cases are tied to medications. That’s 2.5 to 5 million people. In Australia, with a population of 26 million, that translates to roughly 1.3 to 2.6 million people.

Yet, most doctors don’t screen for it. A 2022 survey found only 35% of primary care doctors routinely ask about hearing changes before prescribing high-risk drugs. That’s a gap. You have to be your own advocate.

What’s Being Done to Fix This?

Researchers are working on solutions. The NIH has invested $12.5 million since 2024 into drugs that protect the ear from ototoxic damage without reducing the medicine’s effectiveness. These “otoprotective agents” are in early trials.

Hospitals are also improving monitoring. In 2018, only 45% of hospitals used regular hearing tests for patients on cisplatin or gentamicin. By 2023, that number jumped to 68%. More clinics are now involving audiologists in treatment planning - not just after damage occurs, but before it starts.

Pharmaceutical companies are also under pressure. The FDA now requires stronger warnings on labels for ototoxic drugs. Some manufacturers are developing new versions of old drugs with lower ear toxicity.

But until these advances become standard, your best defense is awareness - and speaking up.

Final Advice: What to Remember

• Don’t assume ringing in your ears is normal. It’s a signal.
• Timing matters. If it started after a new drug, connect the dots.
• Never stop a prescription drug without talking to your doctor.
• Ask for a hearing test if you’re on a high-risk medication - even if you feel fine.
• Keep a symptom journal: note when the ringing started, how loud it is, and whether it changes with your dose.
• There are ways to manage persistent tinnitus - even if the drug can’t be stopped.

Medications save lives. But they can also quietly damage your hearing. The goal isn’t to avoid all drugs - it’s to use them wisely. If you’re on one that could cause tinnitus, stay alert, stay informed, and don’t hesitate to ask your doctor: Could this be affecting my ears?