by Neil Bauman, Ph.D.
© November, 2018
A man read my article, “The Ototoxicity of Drugs Ending in-mycin”. In it, I said that all of the drugs listed there (which included Clindamycin) are ototoxic to some extent or other.
He then referred me to Dr. Tim Hain’s article “Ototoxic Medications” where Dr. Hain had written, “Clindamycin has not been reported to cause ototoxicity, by itself, and is probably safe.”
Confused, this man then lamented,
This article says that there is no reported hearing loss from Clindamycin and you say differently. I don’t know what to believe anymore.
I can sure understand your confusion. There is a lot of misinformation posted on the Internet, as well as a lot of good stuff. You need to exercise a measure of wisdom to discern the one from the other.
Furthermore, even on the good sites like Dr. Hain’s, there are differences in opinion. For example, some define the term “ototoxicity” more broadly or narrowly than others—thus some are more inclusive and others more exclusive in the drugs they accept as being ototoxic. Some authorities define ototoxicity as damage to the inner ear only, while others define it as damage to any part of the ear—inner, middle or outer.
Furthermore, in regards to ototoxicity, some doctors and other experts are ultra-conservative when it comes to drug ototoxicity. Others are far more broadminded.
Ultra-conservative doctors, which includes Dr. Tim Hain, don’t believe a drug is ototoxic unless it has been written up by another doctor as being ototoxic, and/or there are formal studies to prove it. Thus, they discount anecdotal reports of ototoxicity by members of the public that have actually experienced ototoxic side effects from a given drug.
The result is that untold millions of people suffer drug side effects, report them to their doctors, and instead of taking their complaints seriously, these doctors often ignore them and write it off as a “coincidence” or another condition, or categorically declare that “that drug doesn’t/can’t cause that side effect” and send the patients on their (not so) merry way.
Other experts take a much more all-encompassing view and accept anecdotal reports as having validity even if no formal studies have been done. After all, a drug that is ototoxic is still ototoxic whether a study has been done to prove it or not. I am one of those who fall into this category.
Therefore, I typically accept a person’s report of experiencing drug side effects at face value. If only one person ever reports a certain side effect for a certain drug, then I tend to write it off as a coincidence or an anomaly. However, when numbers of people all tell me essentially the same thing, I see this as strong evidence that this is indeed a valid ototoxic side effect and needs to be taken seriously. Such evidence is accepted in a court of law as “circumstantial” evidence so why shouldn’t it be accepted by medical doctors in relation to ototoxicity?
Unlike Dr. Hain who is a respected otologist (and I certainly have respect for him), I am not a medical doctor and don’t pretend to be. Nor am I a pharmacist. So what are my credentials for taking the stand I take?
For the past 25 years, I have been collecting and compiling all the ototoxic information I can find for any drugs I come across. For example, I have scoured tens of thousands of pages of drug books I have access to looking for ototoxic side effects. These books have included a number of editions of the Physicians’ Desk Reference (PDR) (USA), the Compendium of Pharmaceuticals and Specialties (CPS) (Canada), the British National Formulary (BNF) (UK), the Nursing Drug Handbook (NDH), the American Society of Health-System Pharmacists Drug Information (AHFS), Drug Facts and Comparisons, etc.
Furthermore, I have searched drug databases such as the FDAs database and drug databases from around the world whenever I come across them, whether in South Africa and Singapore, for example. In addition, I have collected the stories of thousands of people who have told me of their ototoxic experiences with various drugs. This has given me better insight into what is likely a much more realistic view of ototoxicity than doctors get in medical school and from their medical journals.
Now, let’s look at the evidence in favor that Clindamycin is ototoxic, as opposed to Dr. Hain’s terse “Clindamycin has not been reported to cause ototoxicity”. First, the PDR and CPS both have reported two ototoxic side effects—dizziness and vertigo. They are reported to occur in less than 1% of the people taking them.
Next, the FDA’s database contains thousands of reports of ototoxic side effects for Clindamycin. In fact, they received 2,556 reports of ototoxicity (spread over 21 different ototoxic side effects) from taking Clindamycin in the 9-year period between January, 2004 and October, 2012.
Here’s something else to consider. Fewer than 1% of serious side effects are ever reported to the FDA (as reported by former FDA commissioner David Kessler). Thus, very conservatively, you could multiply this number by 100 which would then be more than a quarter million (255,600) ototoxic side effects experienced. That’s a lot of people’s ears being affected by this one drug. Even so, you’d still likely still be way off. This is because ear side effects are typically not considered “serious” (but we know better) so considerably fewer ototoxic side effects are reported than the more “serious” side effects such as heart or liver or kidney problems. Consequently, a more realistic multiplier could be 1,000 or more. That could mean maybe somewhere around 2,556,000 ototoxic side effects for this one “non-ototoxic” drug have occurred in the USA in just one 9-year period!
Add to these reports, anecdotal reports like this one I received from a lady. She wrote, “Several years ago I woke up one morning and my hearing was partially gone. I went immediately to my ENT and he said it was probably caused by the Clindamycin he had me on for a sinus infection. I asked if it would be permanent, and he said probably. My doctor was right. My hearing did not come back. Recently I was given Clindamycin for a tooth problem. I explained that I had taken it before and experienced hearing loss. He told me this was the best drug for my problem and that my hearing loss was not connected to the Clindamycin I was taking at the time. I reluctantly took it—a 10 day course. About 2-3 days after finishing it, I woke up with the hearing in my left ear gone. I went immediately to my current ENT. He was doubtful that Clindamycin had caused the additional hearing loss. But I’m convinced that I know my body better than he does, and I don’t think it’s coincidental that it happened twice.”
In the face of all this above evidence, I can’t see how any informed doctor can conclude that Clindamycin is not ototoxic.
Thus, when you read various websites, it is up to you to make up your own mind which ones you believe contain the most realistic/reliable data. You can choose to go with the ultra-conservative data posted by certain doctors (and when they say a drug is ototoxic, I’m sure it is), or you can choose to open your mind and believe the preponderance of available evidence that seems to be so conveniently ignored.
My data is definitely not complete and thus is not particularly accurate—I know that (and call it “hairy” data)—but it is still the best evidence I’ve been able to glean over the past 25 years. Thus, it represents a more realistic view of just how common drug ototoxicity really is.
What you do with this information is up to you. I provide it as an information service to help you and your doctor make better-informed decisions on whether you want to risk getting any ototoxic side effects from taking a given drug or not.
The chances are that you typically won’t have any ototoxic reactions, but millions of people have found out to their sorrow that a drug their doctor said wasn’t ototoxic damaged their ears. You don’t want that to happen to you. Thus I urge you to err on the side of caution and be safe rather than sorry.
My doctor gave a liquid Clindamycin solution for a skin problem, 5 days after applying it to one site, had severe dizziness and vertigo, it has been 4 weeks since I stopped it and I still have the effects. Also had a severe intestinal infection for 6 days.
Hi Loreto:
You want to be careful when taking Clindamycin as it can do exactly what you experienced–give you dizziness, balance problems and vertigo. You’re lucky it didn’t also affect your hearing and give you tinnitus.
Cordially,
Neil
So what do l take for this pneumonia ?
Hi Mike:
That’s up to you and your doctor. I’m not a medical doctor so I don’t deal with prescribing anything.
Cordially,
Neil
I had a a biopsy on a nodule on my thyroid. 2 days later the side i had my biopsy done on became hot and swollen. I got in to see a doctor and he prescribed Clindamycin. I took it for 10 days. It caused havoc on my Hiatal Hernia but 2 days after I stopped taking it my ears started rining. I seen my doctor and she said it should stop in a week if not give them a call. Now after researching and finding this article I’m very disappointed and sad by all this.
Hi Kekoa:
I sure wouldn’t be surprised that the Clindamycin caused your tinnitus. This drug doesn’t seem to show up side effects immediately. They show up a few days later or even in the few days after you stop taking the drug. Unfortunately, I think this is what happened to you.
Cordially,
Neil
I am so glad to have found this site. I have been struggling with unexplained dizziness, rocking in a boat, vertigo, imbalance, visual issues, all which started after taking clindamycin. I am working with a great doctor at John’s Hopkins university but have always felt the antibiotic kicked this all off. I am still not under control and wish there was some way to go back to “normal”. If there is any advice you can offer at all I would really appreciate it!
Hi Smriti:
In case you are interested, vestibular (balance) side effects of taking Clindamycin such as ataxia, balance disorders, dizziness, vertigo, etc., occur almost 4 times as often as cochlear side effects of Clindamycin (hearing loss, tinnitus, etc).
If this happened just a day or so ago, you might be able to take certain drugs and supplements to recover from these side effects, but if more than a few days have gone by, and certainly after 30 days, I don’t know of anything that will fix it. The only thing that works after that as far as I know is vestibular therapy–doing various balance exercises in order to strengthen the remaining balance function. Some people have remarkable results, but they are determined to get their balance back and do whatever is necessary to achieve that after drugs wreck their vestibular system.
Cordially,
Neil
What drugs and suplements can i take for thinnitus and dizzines?
Hi Davor:
That question is much to nebulous to answer with any accuracy. I need to know much more about your history of what caused your tinnitus and balance problems, etc. before any answer would make sense.
Cordially,
Neil
I have a tooth infection and my endodontist has given me a choice between three antibiotics: Clindamycin, Azithromycin, or Cephalexin. I have had tinnitus in both ears since 2013 which started after taking a dose of Amoxicillin. I’m very nervous about taking any of these antibiotics. Which of these three do you feel might be the best option?
Hi Janet:
Of those three choices, Cephalexin would be the least ototoxic, then Azithromycin followed closely by Clindamycin.
Cordially,
Neil
Hey Sir, I’ve been taking BenzaClin, which is a topical acne treatment of (1% Clindamycin and 5% Benzoyl Peroxide) and ever since I’ve been experiencing Tinnitus and don’t know if the Clindamycin in my topical treatment is causing my tinnitus.
Thanks
Hi Ali:
From the little you’ve told me I can’t say whether the Clindamycin is causing your tinnitus or not, but it is a definite possibility.
Cordially,
Neil
Clindamycin is not ototoxic. Do not confuse this drug with Gentamycin or Tobramycin (aminoglycosides).
Dizziness, vertigo and imbalance are text book side effects of clindamycin. And even 2 months after the last dose.
Hi Oscar:
I’m well aware of the difference between Clindamycin and the aminoglycosides.
I don’t know how you can say that Clindamycin is not ototoxic and then say that it causes dizziness, vertigo and imbalance which are 3 ototoxic side effects of Clindamycin.
I don’t know how you define ototoxicity, but Stedman’s Medical Dictionary defines ototoxicity as the property of being injurious to the ears and those side effects meet that criterion.
Besides, hundreds upon hundreds of people have reported to the FDA database getting hearing loss and tinnitus. So Clindamycin is most definitely ototoxic.
Cordially,
Neil
Sir,
I have taken clindamycin for 7 days and then a few days after i started having tinnitus. It affected my mental health. I can’t sleep anymore.
Will this ringing in my head stop? I have been suffering from this tinnitus for 3 weeks
Hi Angel:
The tinnitus from Clindamycin can be permanent at least in some people. Since it is bothering you, you need to take action to bring it under your control.
Since it is bothering your sleep, you should have soft background sounds on all night long. It could be a fan, or pink noise, fractal music, or even better, water sounds–waves lapping on the beach, babbling brook sounds, rainfall, waterfall sounds, etc.
And to keep yourself emotionally neutral towards your tinnitus, you should read chapter 16 in my book, “Take Control of your Tinnitus”. You can get it at https://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/
Cordially,
Neil
Hello All. I had to take clindamycin during quite a long time. First of all take it with probiotics and caution as it can generate clostridium difficile. Due to clindamycin i suffered from clostridium and it is a scary bacteria. If you have to take it, regarding the ears, i would say it has a more vestibular risk than hearing risks. I suffered from dizziness a bit but my hearing and tinnitus did not change. This is only my experience. Thank you Neil for your amazin work! Best regards
Hi AM:
Taking Clindamycin doesn’t “generate” Clostridium difficle (C. Dif). Rather the C. Dif. is already in your body and taking antibiotics such as Clindamycin kills off all the “good guys”, thus allowing the “bad guys” such as C. Dif. to multiply unimpeded. This is one very good reason not to take antibiotics unnecessarily and to take them for the shortest time possible.
You are right that you want to take probiotics whenever you take an antibiotic and for some weeks AFTER you stop taking the antibiotic to be sure you have built up the “good guys” population again. An even better way is to eat lots of live culture fermented foods such as yogurt, kimchi, sauerkraut, natto, etc.
You are also correct that Clindamycin has more reports of vestibular side effects than cochlear side effects the most common being dizziness, ataxia, vertigo and balance disorders. On the cochlear side hearing loss is about 3 times as common as tinnitus.
Cordially,
Neil
I’ve been experience tinnitus recently, and it started after I started using topical clindamycin about 2 weeks ago. I didn’t realize that may have been the cause, but I had stopped using it. The tinnitus stopped, and I started using it again yesterday, and the tinnitus came back. I’ve never experienced tinnitus in my life, so I’m thinking it clindamycin has to be the cause.
Hi Lonnie:
Where were you using the topical Clindamycin–near your ears or face, or elsewhere on your body?
I’m with you that your tinnitus seems to be related to the Clindamycin. The good news is that your tinnitus goes away when you stop taking it. This is not true for everyone.
Cordially,
Neil
Thanks for the response doc.
I have folliculitis on the back of my neck, and so I was applying the topical cream there. It went away the first time. Now that I recognize that clindamycin may be the culprit I have stopped using it and I’m currently waiting to see if it goes away this time. Any tips? I will keep you posted, thanks!
Hi Lonnie:
If the infection doesn’t go away on its own, I’d try a different antibiotic as you know the Clindamycin messes with your ears.
Cordially,
Neil
Thanks doc! I appreciate the answers. The tinnitus has gone down but it’s still there unfortunately, mainly in the morning. I still haven’t used the clindamycin since. Hopefully it goes away but I’ve been learning to live with it. I will keep you posted.
I was just prescribed clindamyacin. Now I’m not taking it after reading all this. What other antibiotics to you advise instead. I have an infected cyst over my left eye. Thank you
Hi Rene:
All antibiotics are ototoxic to some degree so you want to choose the least ototoxic antibiotic that will do the job. I don’t know what “bug” you have nor which antibiotics will work on that bug. That is your doctor’s job.
What I can do, if you get a list of antibiotics that your doctor says will do the job, is put them in order of ototoxicity (in my opinion) so you can choose the least ototoxic one.
Cordially,
Neil
I would love a copy of this as well!
Hi Alyssa:
A copy of what?
Cordially,
Neil
I have been taking Clindamycin for 6 days after a small oral surgery. I started to experience aural fullness on Day 4. I googled it today and found your paper. I decided to stop taking Clindamycin to see if it helps. Hopefully I won’t experience more severe symptom and the aural fullness will go away soon. Thank you for this valuable paper.
Hi Bill:
Have you had your hearing checked? A feeling of aural fullness is often an indication you have suffered a hearing loss from the drug.
Cordially,
Neil
I had a 5 week course of IV vancomycin followed by a 10 week course of clindamycin with a dosage of 450mg three times a day. Towards the end of I felt like my left ear had a raging inner ear infection. This subsided about a week and a half after the last dose. Now a month later I have dizziness/vertigo if I fully bend over at the waist while standing. My left inner ear still feels a bit off but not as bad as before. Mike Smith, Canberra, Australia
Hi Mike:
I’m not surprised that you have some hearing and balance issues after taking such a large course of these two antibiotics. Hopefully, most of the damage will be temporary, but that is not a given.
Cordially,
Neil
Hello Dr. Bauman, my son suffered from ear infections as a young child and he had ear tubes and his adenoids removed. Now he is 15. He recently started using topical Clindamycin for acne. After using it for approximately two months he started getting viral infections and now he has had two episodes of ear infections. We recently started taking probiotics and stopped using the clindamycin. I have just found your website. Do you have any suggestions on how we can help him get out of this ear infection cycle?
Hi Randie:
When you take antibiotics you kill off the good guys in your gut, so you have to replace them since they comprise most of the immune system in your body, believe it or not.
Thus taking probiotics is a good start. But even better is to eat live culture probiotic foods such as live culture yogurt, kimchi, sauerkraut, natto, etc. These give you far more good guys than probiotic tablets can ever give you.
He also wants to stay away from antibiotics in the future unless really necessary as taking them again will just undo all the good you have been doing in building up his gut microbiotia.
If he is having viral infections, I assume you mean they are attacking his inner ears and not his middle or outer ears–correct? One thing that few people seem to know is that taking vaccines such as the covid and flu-shots leave you more open to future viral infections due to the way they affect your immune system.
Make sure he has adequate levels of essential vitamins and minerals such as Vitamins C and D3 and magnesium and zinc. Many people are very low in vitamin D3. Doctors seem to think that levels of 20 to 30 ng/ml are adequate, but the optimal level for D3 is 70 ng/ml. These and other vitamins and minerals can really help improve resistance to viruses.
Cordially,
Neil
Dear Doctor Bauman ,
I got clyndamicin for 5 days , because of tooth infection . After 3 days my tinnitus started . I have no hearing loss , had no infection in my ear… but tinnitus is still there after one month . Its started sudden and i can hear it from my head in my both ears. Do you thing its typical for tinnitus caused by clyndamycin?
Thank you
Hi Alex:
I’d say you have a typical (if there is such a think as typical) experience with Clindamycin. Numbers of people find that their symptoms show up 3 co 5 days later.
How do you know you don’t have any hearing loss from this? Have you had your hearing checked up to 20,000 HZ and have it checked for other hidden hearing losses?
Hearing loss from Clindamycin can be permanent, and if the tinnitus was associated with that hearing loss, it too could prove to be permanent. If your tinnitus is not associated with a hearing loss, it may be temporary, but since a month has gone by, the chances of it being temporary and becoming slimmer by the day.
Cordially,
Neil
Hello Doctor Bauman,
Thank you for your answer. About my hearing loss. I visit ENT specialist , he did all tests and found everything is perfect. And me personally i dont feel any changes in my hearing , just tinnitus . Its very strange , but strange is very common word realated to tinnitus.) Do you think its any special hearing test i should do ?
Thank you for your respons. Means a lot
Hi Alex:
If you had “all” hearing tests, then there aren’t any more to do. So you need to learn how to successfully habituate to your tinnitus so it no longer bothers you. When you reach that state, it doesn’t matter whether you hear your tinnitus or not because it’s not an issue. It’s just an unimportant, useless background noise that you safely ignore, just like you do to all other unimportant background sounds.
Cordially,
Neil
It is possible to get used to tinnitus, eventhough it doesn’t seem like it, for the first year. I was suicidal for the first year. Doesn’t even bother me now, although it’s still always there. Tinnitus retraining therapy with the white noise ear pieces helped. The ear pieces are a relief at first, but after a year, you get sick of wearing them and the tinnitus doesn’t bother you anymore, when you stop wearing them.
I was prescribed 300 mg. clindamycin, twice daily, for gum infection. After the first dose, it was as if storm sirens were wailing in both ears. After three days, I could no longer hear certain bird songs. I discontinued the drug but my ability to discern bird calls has never returned.
Can clindamycin cause ear pain as well
Hi Kathryn:
Yes, Clindamycin is reported to cause ear pain. In fact, there are a few more reports of it causing ear pain than there are of it causing tinnitus.
Cordially,
Neil
I understand that I also became a victim of clindamycin. A single dose of 600 mg resulted in severe noise in both ears after 2 hours. It is after 2 hours that the maximum dose of the medicine is in the blood. After hip replacement, my doctor prescribed me to take clindamycin before visiting the dentist. It’s been 10 days and it hasn’t gone away. I understand that going to our American doctors is useless. My English is bad. I used a translator. What effect did this antibiotic have?
Hi Lena:
Clindamycin (like all other antibiotics) can damage your ears resulting in hearing loss, tinnitus and balance problems among other things. I don’t know the exactly how Clindamycin causes damage to the inner ear. Hopefully, your tinnitus will go away in time. In order to help this happen, don’t focus on your tinnitus. Rather, ignore it and focus on the loves of your life.
Cordially,
Neil