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.