by Neil Bauman, Ph.D.
June 16, 2021
The Center for Hearing Loss Help has just released the 2021 edition of what is probably the most comprehensive list ever compiled of the hundreds of drugs, herbs and chemicals that have been associated with tinnitus.
Neil Bauman, Ph.D., the author of the books, “Ototoxic Drugs Exposed” and “Take Control of Your Tinnitus—Here’s How” compiled this list. It contains 1009 drugs, herbs and chemicals that are associated with tinnitus. Of this total, 966 are drugs and medications spread over 1,535 brand names, 14 are herbals under 20 different common names, and 29 are chemicals known under 126 different chemical names.
This updated 44 page 2021 edition of the List of Prescription Medications, Over-the Counter Drugs, Herbals & Chemicals associated with Tinnitus 2021 is available free for download.
I am perscribed Cymbalta, Trazadone, Lisinopril and Neurontin. I have had a mastoidectomy and two surgeries for cholesteatoma. I have lost the hearing in my right ear as a result of these surgeries. The above medications are on the 2016 list of drugs associated with tinnitus. What should I do? The throbbing and noise really gets to me at times. One ENT told me to always have some form of music or TV playing at all times. It would be nice to have complete quiet. The only time that I notice silence was following my second surgery.
Hi Carol:
Let’s look at these four drugs and see which one is more likely the culprit.
In my opinion, the Cymbalta is probably the most likely for tinnitus, followed by Gabapentin (Neurontin). Lisinopril is further down yet and Trazodone brings up the rear.
If possible, you might want to get off the Cymbalta and Gabapentin and then see whether your tinnitus reduces to a lower volume after a couple of weeks or so.
Cordially,
Neil
Hi got a bit of ringing in right ear I work in a factory where so noise would it help if west ear plugs on meditation to for thyroid and heart burn tablets
Hi Shell:
If the factory is noisy–average sound levels above 70 to 80 dB–wearing ear protectors would be a good idea to bring the sound that reaches your ears down to 70 dB or a bit less. You don’t want to block all sound or that will just make tinnitus worse.
Incidentally, you want to wear ear protectors in both ears, not just in the one that is ringing.
How long have you been on the thyroid and heart burn drugs? Which ones are you taking and I can look them up and tell you whether they are likely affecting your tinnitus.
Cordially,
Neil
The list is extensive – looks like an abridged version of the PDR. My father had tinnitus that was debilitating to him and I’ve had it as long as I can remember (now 67 yrs. old). Mine is constant, but varies in loudness. Can it be hereditary?
Hi Tom:
Abridged? It’s more comprehensive that the PDR in scope–but doesn’t give any information about the associated drugs–just a listing.
I tend not to think that tinnitus is hereditary, but that factors common to both of you have caused your tinnitus. For example, if both of you had hereditary hearing losses from birth, you could both also have tinnitus–but the tinnitus would be a result of the hearing loss, not genetic in itself. However, the outcome would be the same. You could both have been exposed to the same environmental toxins that resulted in tinnitus. So I’d look more into these kinds of factors rather than thinking it was genetic.
Cordially,
Neil
I have Tinnitus and also think I suffer from MES. Being diabetic I take some of the drugs mentioned and a daily coated aspirin prescribed by my doctor. What makes me crazy more than ringing ears (I’ve learned to cope with that) is a constant rhythm kind of like a song but not really. The sounds of air conditioning fans and compressors really gets me going and seems to provide the rhythm and beat to my imaginary song. I’ve been concerned because I left construction to do something else before retiring and work in a memory care facility. I see folks every day that do a lot of imagining so I started to wonder about my self! Any thoughts on this?
Thanks
Hi Rick:
The air conditioner and fans can indeed give you this phantom “music” you are hearing. The solution is actually quite simple (if possible) turn them off when they begin to bother you, or move away from the source of the sound if you can.
I explain this kind of MES in my article, “Apophenia, Audio Pareidolia and Musical Ear Syndrome” which I suggest you read.
Cordially,
Neil
Good morning I have previously bought your ototoxic medication book and just seen the 2016 update. I suffer from severe tinnitus and have currently got either a sinus infection or an ear infection. My ears were blocked (he thought due to wax) and the doctor syringed them to clear them, but the eustian tube is now blocked and tinnitus is much worse. Doctor wants to think about putting me on antibiotics,but we are both scared to given that my tinnitus was caused by antibiotics in the first place 2 years ago. It appears amoycillin is now not safe. Can you recommend any antibiotic that is suitable for my condition and is a safe for tinnitus. Many thanks
Hi Tania:
As far as I know, all antibiotics are ototoxic to some degree. Thus, the trick is to find one that will do the job and yet has the smallest risk to your ears. I don’t know which classes of antibiotics your doctor thinks will do the job so I can’t suggest any. But if he gave you 3 or 4 choices, I could tell you which is the least ototoxic of the bunch.
You can also just take a wait and see approach. Eventually, your body will overcome the infection (especially if you build up your immune system) and the gunk will drain out of your Eustachian tubes. When that happens any hearing loss you have should return and your tinnitus should fade away (assuming your tinnitus is from this cause). So that’s another possibility. This could take 2 or 3 months–it won’t happen overnight.
Cordially,
Neil
Hi the two choices he has given me is Amoxicillin or Zinnat which in Australia is Cefuroxime.
Hi Tania:
If those are the two choices, I’d go with the Cefuroxime, but it is mildly ototoxic too and can cause hearing loss and tinnitus in some people.
Cordially,
Neil
Hi Neil,
I’ve recently been prescribed an ear spray called “Otomize” for an ear infection.
This however contains NeoMyosin to which I’ve heard is Otoxic.
I have become a little worried about using it to say the least reading up on forums.
However as this is a spray, it does not go right where the ear drum is.
Could I be right in thinking, if done in moderation if will not cause any issues?
Would love to hear your thoughts
Tom
Hi Tom:
It is possible it will not cause any problems, but then again, it could cause ear problems.
If it were me, I’d not use anything with neomycin in it unless it were life threatening.
Otomize contains a steroid (dexamethasone), neomycin and acetic acid. Why you need a steroid is beyond me. And acetic acid by itself could easily kill the infection so why bring out the big guns of antibiotics such as neomycin which is very ototoxic?
If it were me, I’d use either apple cider vinegar (which is basically acetic acid) or hydrogen peroxide 3% which is a common home remedy used to kill ear infections, or a combination of 3% hydrogen peroxide and an equal amount of apple cider vinegar. You could put it in a spray bottle and spray it in your ear canal, or soak a cotton swab and put it in your ear canal for a few minutes and then take it out. Do any of the above several times a day and see whether that takes care of the infection.
If nothing works, then maybe you might want to try the Otomize with the neomycin.
Those are my thoughts.
Cordially,
Neil
Hi Neil,
Thanks for your insight, I didn’t know about the Apple Cider Vinegar, I’ll consider taking that.
I actually forgot to mention I was also prescribed Amoxicillin in tablet form to which I have also been taking for the infection.
It was the Otomize that I have was weary about. So to sum up, do you think it would be better to carry on with the Amoxicillin and see how I go, and then consider Otomize as the ultimate last resort?
I’d appreciate any advice.
Tom
Hi Tom:
Where is this ear infection? I was assuming it was an infection in the ear canal based on your using a spray. If so, vinegar (acetic acid) and/or hydrogen peroxide can readily reach it and clear it up.
If the infection is more internal (middle ear for example), then I could see the Amoxicillin. Remember, Amoxicillin can also cause hearing loss and tinnitus, but it is not as ototoxic as Neomycin. I don’t see why you need to take both at the same time unless you have both a outer ear AND middle ear infection.
Cordially,
Neil
Hi Neil,
My infection was diagnosed as “otitis externa” , so the lining inside the ear is inflamed from bacteria : The outside of my ear is tender and my inside is swollen too (not pleasant!)
I don’t believe near the ear drum itself is affected.
I did read Amoxicillin is Ototoxic, but as you say, it is the lesser of two evils, but would rather take this over the spray for obvious reasons !
I am also on Ibuprofen too for inflammation reducing (again am aware of Ototoxicity and taking in moderation).
I guess at this point I am trying to find out if i can avoid the spray and get better with the Antibiotics.
Best,
Tom
HI Neil – I have noticed that Avamys is now on the 2016 list for tinnitus ( tinnitus was not mentioned in the last book) Can you please indicate to what extent it is ototoxic for tinnitus? I have eustian tube dysfunction and my GP has recommended this to try and get rid of the excess fluid. thanks
Hi Georgia:
Avamys (Fluticasone) is not listed as causing tinnitus in any of the drug books I consult. However, 59 cases of tinnitus from this drug were reported to the FDA. That’s why it is now in the tinnitus list. That being said, the chances of getting tinnitus from taking this drug are probably minimal (but possible).
More to the point, why don’t you work on getting rid of the Eustachian tube dysfunction–then you won’t have to take any drugs. That is what you doctor should be doing–not just treating some symptoms.
Do you know or suspect what caused your Eustachian tube dysfunction?
Cordially,
Neil
Hi Neil,
I have severe tinnitus along with often having a feeling of fullness in both ears. Thinking that it may have been caused by a prior sinus infection, my gp has me on both Mometasone Furoate and Apo-Amoxi. I noticed Mometasone on your list but didn’t see Apo-Amoxi. Any thoughts on this one? I no longer think it was triggered by the sinus infection but am not sure on the cause.
Thanks.
Hi neil
I was wondering what your view of Nystatin was in terms of ototoxicity and tinnitus. I have your book and I could only find one reference to it but it was linked to another drug. Thank you
My husband, Al, had a stroke 3 years ago at age 75 . He developed severe depression because of the results of the stroke (primarily aphasia and some dragging of the right foot) and “self-medicated” with alcohol which resulted in alchoholism. He also has other physical problems. I have looked at your list of questionable medications and find that he is taking many of them for such ailments such as alcohol cravings, depression, heart, burn, heart (a-fib). Any suggestions??
Hi Julia:
Is he having any ototoxic side effects. If not, then you probably don’t have to worry about his ears. But its all the other side effects of drugs that you have to worry about. So often, doctors prescribe a drug which causes a side effect so they prescribe another drug to deal with that side effect which causes still another side effect, etc., etc.
If that is his case, then getting him off the original drug that set this chain reaction in motion is a good idea–then he can stop the downstream drugs as well. And when you do that, you may see a big improvement in his health.
Cordially,
Neil
I’ve had tinnitus for many years. 5 years ago I acquired a massive increase in T. In my search to “cure” it I contacted you and you were the only one who recognized that I may have AIED. My rhem doc did a test and sure enough I have the marker for AIED. So thank you for your information. I”m lucky in that I have not lost hearing at all, just massive T. I’ve acclimated to it all with the use of good hearing aids and they come with a feature that plays ocean waves which I at times use for sleep. Now I’ve suddenly acquired yet MORE tinnitus or louder T. I have A-Fib and GERD. I take Famotadine, Flecainide, Digoxin and Coumadine. I have 2 glasses of wine in the evening. I guess it’s safe to say these meds have caused the uptick in noise? And vino isn’t helping either?? Thoughts?
Hi Peggy:
Of the four drugs you mention, Warfarin (Coumadin) is the most ototoxic and has the highest number of reports of tinnitus and hearing loss. The next most ototoxic is Digoxin with less than half the number of reports of tinnitus and hearing loss. Famotidine is a bit less again. And at the bottom being least ototoxic is Flecainide. I doubt it is causing you any problems with ototoxicity.
As for the wine, some people finds that it revs them up and makes their tinnitus worse, and for others it calms them down and doesn’t affect their tinnitus. So you can always stop the wine for a week or so and if there is no difference, then the wine is probably not affecting your tinnitus.
So it seems that the most likely culprit is the Coumadin. Can you correlate your increase in tinnitus with beginning to take this drug?
Cordially,
Neil
Thank you for the quick response. I’ve been taking the Coumadin for close to a year now and have had no side effect. Since this went well and my AFib has worsened I then added the Flecainide. I’ve been on Flec for 2 months now and not one side effect! My MD has urged me to get on the Digoxin so I don’t acquire atrial flutter. I took the first dose just a day ago and stopped as it made me incredibly tired. All meds are at the lowest dose you can possibly get. Since I need stroke prevention, perhaps then Eliquis is the ticket…or an ablation. Both have pros and cons.
Hi Peggy:
So it looks like the Digoxin is the culprit then. Apixaban (Eliquis) is probably a better choice as it has far fewer reports of ototoxicity (although it is a newer drug and thus hasn’t been prescribed as much which could account for the big difference in ototoxic reports between the two). But since the Digoxin has side effects that bother you, trying Eliquis sounds like a reasonable option.
Cordially,
Neil
I have been on several of the meds listed at one time or another…mainly heart meds (2003 – now) and stomach pills (about 14 years).
Out of the meds mentioned, I am currently only on Cardizem LA, which is on the list. How likely is it to cause or worsen tinnitus? I have been taking it since 2003.
Hi Lisa:
From anecdotal reports I’ve received, Diltiazem (Cardizem) side effects seem to be temporary–while you are taking this drug–and go away when you get off it.
Since you don’t seem to have had any changes in your tinnitus over the years, I rather doubt that this drug likely to make your tinnitus worse. If you quit taking it, there is the possibility that your tinnitus may go away–assuming that this drug caused your tinnitus back when you started taking it. But your tinnitus may be from other causes/other drugs and if so, quitting the Diltiazem likely won’t affect your tinnitus.
Cordially,
Neil
Thanks, Dr. Bauman. Your website is a gift to tinnitus sufferers! I plan to read your books. I am 65 and have suffered from tinnitus for about 6 months. I highly suspect Septra, which I took a couple of weeks before my tinnitus became loud and quite troubling. I also started sublingual allergy drops in the same time frame and wonder if you are aware of tinnitus symptoms related to that. Yet another suspect is the hormone replacement therapy I have used for 6 years and am now slowly stopping after reading this study: “Association of perceived tinnitus with duration of hormone replacement therapy” https://bmjopen.bmj.com/content/bmjopen/7/7/e013736.full.pdf. No change yet from backing off estrogen but hope springs eternal.
Meanwhile, every allergy/nasal congestion medication I’ve relied on for years (some even decades) is on your 2016 list (Mometasone, Loratadine, Benedryll, Pseudoephedrine, Oxymetazoline). I’ve stopped them all except Mometasone several times a week, because it’s hard to sleep without something to relieve congestion. My dr. has proposed surgery to correct a relatively minor deviated septum but the risks, including post op pain relievers, scare me.
Can you provide any guidance on the allergy meds in terms of which might be the riskiest? I’ve stopped the sublingual allergy drops as I sort this out, tho’ I am not convinced they were making a huge difference.
Thanks in advance!
Hi Ann:
Septra is a combination of Trimethoprim and Sulfamethoxazole. It can indeed cause tinnitus in some people, so it may be the cause of your tinnitus.
HRT drugs can also cause tinnitus. Although you’ll notice in the study you only have a 6.9% increase in risk.
The other drugs are all ototoxic to some degree too, but of the common ones, Loratadine has the lowest percentage of tinnitus reports. Mometasone has about three times the percentage and Diphenhydramine (Benadryl) is 6 times the percentage as Loratadine. I don’t have the data to put Oxymetazoline and Pseudoephedrine into percentages so can’t properly compare them. But of all these drugs, Oxymetazoline has the fewest number of reports.
So my choice for allergy meds based on the date available to me would be either Loratadine or Oxymetazoline.
Cordially,
Neil
Thanks, Dr. Neil. Good point about the relatively small risk of continued HRT. Still, I am hopeful. Meanwhile, how / where are you finding the percentages you provided for Loratadine etc.? I.e., are they in your book on ototoxic drugs and/or is there an online resource that provides the percentages?
I learned in December that I have mild to moderate hearing loss in one ear, mild in the other. Are similar percentages available for hearing loss? I noticed that my tinnitus got really loud for 2-3 days after my most recent course of Septra but then seemed to return to the volume I had been experiencing for the past several months. Now I am wondering if using Septra 2-3 times per year over the past 4-6 years could be responsible for my hearing loss.
Thanks in advance for your additional input on these questions.
Ann
Hi Ann:
All the percentages are calculated by myself based on thousands of pages of semi-compiled data I extracted from a website that has mysteriously disappeared and laboriously compiled by myself so I could make sense of the data.
Much of this information will be in the upcoming 4th edition of my drug book–when I finally get it all compiled.
I could calculate similar percentages for hearing loss or any other ototoxic side effect. Just takes time and effort.
The problem I have is finding the number of prescriptions written each year for each drug. I only have the information for the top 300 most popular drugs. Thus, for most drugs, I cannot convert incidence figures into percentages to accurately compare between drugs.
I can tell you right now that there are almost exactly 2 times as many reports of hearing loss from taking Trimethoprim (Septra) as there are reports of tinnitus for the same drug.
So it is certainly possible. I just don’t know how likely it might be in your case, but some people have to have hearing loss from this drug or else there would be no reports.
Cordially,
Neil
I am now reading your excellent book Take Control of Your Tinnitus and wonder if hearing aids will help my tinnitus. I have experienced moderate tinnitus for about 6 months and have minor to moderate hearing loss on the right, minor on the left. After a 10-minute trial of hearing aids with an audiologist, she suggested I didn’t need them for my particular loss since I am not often in noisy situations where my loss is troublesome. But now I am wondering if she is correct. The question will cost several thousand dollars to answer. Do you think it is worth a try?
Adding on a bit…my hearing loss is in the higher frequencies, and my tinnitus is often high pitched. I find it to be quite troublesome, though I can see how changing my attitude toward it and trying strategies you suggest in the book have potential to be very helpful.
Hi Ann:
Hearing aids MAY help your tinnitus–no guarantees though. They can do this by 1) reducing the contrast between silence and your tinnitus so you don’t notice your tinnitus as much, and 2) by giving your ears more real sounds (in the higher frequencies in your case) so the otherwise “unemployed” neurons for those high frequencies have something real to process so they don’t produce tinnitus.
It is true that you might not need hearing aids for your hearing loss, but they may help your tinnitus so you might want to look into trying out hearing aids.
What I’d do, if you want to save several thousand dollars is to go to CostCo and try out their new Kirkland Signature 10.0 hearing aids. They are only $1,400.00 a PAIR, not each.
Costco’s Kirkland brand (their house brand) are currently made by Phonak, so their Signature 10.0 hearing aids are basically the Phonak Audeo Paradise hearing aids, but for a much lower price. I think they are an excellent deal. I think I’m going to check them out for myself.
If you get hearing aids, you don’t have to wear them all the time but I’d wear them in situations where your tinnitus becomes bothersome.
Also, practice the various tinnitus reduction strategies I explain in my book. The key is to do what works for you.
Cordially,
Neil
Hi Dr. Neil,
I have extreme insomnia due to tinnitus related anxiety (I am new to this). Currently, I haven’t slept more than 2 hours in 3 days. I took .25 of Xanax over the course of 5 days that helped my sleep a small bit a couple of days ago, but I ran out and the Dr. prescribed Trazodone instead for sleep. My Tinnitus is mild compared to some people, but I fear taking Trazodone could make my Tinnitus worse or louder. Any medication recommendations for anxiety related insomnia caused by fear of hearing my Tinnitus?
Hi Bryanna:
What caused your tinnitus? Do you know?
Why are you so anxious over your tinnitus? This just makes it worse and worse. You need to calm down and instead of treating your tinnitus as a threat to your well-being, instead, treat it as a meaningless, useless background sound that it is safe to ignore, and then as much as is possible, just ignore it.
Drugs may help you sleep in the short term, but are not the long term answer as drugging tinnitus never gets rid of your tinnitus. It pops up again when you get off drugs. So it’s better to deal with your tinnitus properly from the get go.
Anyway, of the two drugs, as far as tinnitus ototoxicity goes, Trazodone is much less likely to cause or make worse your tinnitus than Alprazolam (Xanax), by a factor of at least 3 and it does not cause dependence like Xanax does.
Cordially,
Neil
Hello Dr. Bauman! Would you classify the main covid vaccines (Pzifer, Moderna, Astrazeneca, Janssen) as ototoxic? Any of them seem to be less ototoxic than the rest? Thanks sou much!
Hi Marc:
Yes, all the Covid “vaccines” are ototoxic. Many, many people have experienced tinnitus after getting the shots for example. At this point, I don’t have equal information on each of them, so it is hard to determine if one is less ototoxic than the others.
Personally, I think they are all too dangerous to take–they have so many serious side effects in addition to their ototoxic ones.
Cordially,
Neil
Hi, Neil. I previously bought your books after I developed severe tinnitus 24 hours after I received my third Pfizer Covid vaccine, the “booster” shot. The US government has still not accepted the link between the Covid vaccines and developing tinnitus. So there is no support available from the government that urged us to take the vaccines, and promised they were safe.
Hi James:
Many people do indeed get tinnitus after taking the various shots for Covid. And you are right, the gov’t and the drug manufacturers and the health system are not being supportive or honest about these shots causing tinnitus (and a lot of other even worse side effects). And they lie when they say they are safe as you now well know.
Cordially,
Neil
I suddenly developed moderately severe reverse slope hearing loss, tinnitus, concentration issues, and mild dizziness and nausea four days after my Moderna booster. 7 weeks later, except for the hearing loss, all symptoms have improved greatly. I am terrified, however, to get any more vaccines. I would love to hear your suggestions.
Hi Anne:
Since side effects tend to get worse and worse the more jabs you get, the better part of valor is to stop now and refuse future jabs. Personally, I would never take these jabs in the first place. The side effects are just too dangerous as hundreds of thousands of people have found out to their sorrow. It’s a case of the treatment being worse than the problem in many cases.
Cordially,
Neil
Hi Dr Neil
As a menopausal woman I take compounded hormones estrogen and progesterone along with vitamin D, K, C, zinc, but no other drugs. I have mild tinnitus, should I be concerned? I don’t understand how these supplements can be ototoxic, can you please explain.
Kind regards
Jane
Hi Jane:
When did you tinnitus begin in relation to taking the hormones–before or after? Ditto for the supplements.
Both estrogens and progestins can cause tinnitus in some women. So that could be the cause.
It’s also possible that the vitamins could cause the tinnitus–depending on the exact formulation and the dose. I take high doses of Vitamin D3, and relatively high doses of K2 and C, as well as zinc and I’ve never had any problems with my tinnitus changing due to taking those supplements.
If your tinnitus is only at a low level and doesn’t bother you, I wouldn’t be concerned unless you also notice a drop in your hearing which is more common in women using HRT than is tinnitus.
Cordially,
Neil
Hi Dr Neil
Thank you for your response. I’ve been on the hormones for over 5 yrs., so I don’t think they are harming me. The tinnitus started last year after a dental appointment I developed Eustachian Tube Dysfunction for 4 mths. The symptoms were horrendous, dizziness, raging tinnitus etc. I no longer have ETD but what remains is a clicking sound and mild tinnitus in my right ear months later. Can you tell me why my ear clicks throughout the day? What can I do about it? I also feel liquid/wax moving around in that ear. When I had ETD the doctor put me on antibiotics and prednisone. Then an ENT put me on Dymista spray and steroid drops. I also tried acupuncture to no avail, Have you ever heard of ETD coming on suddenly after being in the dental chair? I have no history of sinus/allergies.
My mother-in-law suicided 20 yrs ago because of Meniere’s, I never understood what she went through until I developed ETD, the symptoms were incredibly debilitating.
Thank you for your thoughtful posts.
Kind regards
Jane
Hi Jane:
I heard of numbers of people that have various ear problems after having dentistry done–especially if the work was on upper molars which are closest to the inner ear.
Explain the clicking sound you hear in more detail as there are at least three different causes for such sounds. Are the clicks more like a typewriter or morse code, are they regular, or irregular? How long do they last? And anything else about them.
I’m sorry to hear about your mother-in-law. Twenty years ago I didn’t know the treatment for Meniere’s, but I do now–and there is no reason for people to suffer from it as the cure is simple in most cases. Unfortunately, few doctors know much about it so they are of little or no help.
Cordially,
Neil
Hi Dr Neil
The clicks are crisp and sharp in sound. It’s more of a snapping sound, definately not Morse code but similar to the typewriter. The clicking sounds more like a finger/thumb clicking sound.It is short and quick and happens throughout the day. They occur all times of the day and night, though I notice it more when I turn my neck from side to side. The clicks are not continuous but occur in a single click, with a few hours in between each one. The ENT said I was at the tail end of the ETD and said the clicking was the sound of the Eustachian tube trying to open up and getting stuck. If this is the case why have I had it for 9 mths?
Thank you for your feedback, would like to know what you think is causing the clicks.
Kind regards
Jane
Hi Jane:
One likely cause is, as your ENT says, your Eustachian tube opening. The mechanism is much like making a kissing sound as your lips open letting the suction equalize. The same can occur with your Eustachian tube.
Another possible cause is your trigeminal nerve causing your eardrum to make a clicking/thumping sound as it goes into spasm. In your case, it is just a single spasm.
Since your trigeminal nerve enervates both your eardrum and your Eustachian tubes, it could be one or the other, but probably the former. Although since it happens often when you move your neck, the movements may cause your trigeminal nerve to activate and cause a spasm. If your neck is “out” or “tight” that can “pinch” the trigeminal nerve resulting in spurious signals that activate the eardrum or Eustachian tube.
Cordially,
Neir
Hi Dr. Neil
What do you think of the new device to treat tinnitus called Lenire ? It’s mild electric shocks to the tongue , sounds barbaric but could help millions.
Hi Jane:
The Lenire is an interesting solution for tinnitus, but it definitely doesn’t live up to the hype surrounding it. I went back to the original studies to see what the real facts were.
This product doesn’t work for the majority of people with tinnitus. How do I know this? For example, they eliminated 94.4% of the people with tinnitus that applied to be in the basic study. They only accepted 326 people of the 5,826 people that applied. Since they only accept people into a study that they think will be successful, by eliminating 94.4% of the applicants tells you that they didn’t think the vast majority of people with tinnitus would be successful.
Now let’s look at the results. They concluded that 81% of the people in the study got relief. Remember this was only 81% of the 5.6% of those that applied and were accepted. So based on all the people with tinnitus, this device would only help 4.5% of them.
Then, diving deeper into the study results, their average tinnitus improvement was guess what–only between 13.2% and 14.6%. If you only scored 14% on an exam, you wouldn’t call that a rousing success would you? Yet that is what they did. They set the bar for success so low that most people “passed” with a score around 14%. And note that the placebo effect in tinnitus studies can be up to 40% or more–so it is possible that all or most of this “success” is due to the placebo effect.
And to add insult to injury, you have an 18% chance of making your tinnitus worse. That’s what I got out of the study results.
Now, in order to get this 4.5% chance of a success of 14% reduction in your tinnitus while risking your tinnitus getting worse, you have to put out around $3,000.00. Is it worth the risk? That’s for you to decide.
Cordially,
Neil
Hi Dr Bauman,
Do you know what the least ototoxic antihistamine drugs are? I have fairly severe MCAS (Mast cell activation syndrome) and need to take them for a few months or possibly longer.
I tried loratadine which seemed to give me ear pain or a strange dizziness/ loss of balance feeling in my head.
I also have constant low level ear ringing due to a previous or long haul (not sure) covid infection which might make my ears sensitive to medications.
Also, are antihistamines likely to cause permanent ear damage?
Thank you so much!
Hi Daniel:
Loratadine, along with Diphenhydramine and Fexofenadine are by far the three worst antihistamines as far as ototoxic side effect reports go. I’d also stay away from Bromodiphenhydramine as it is a form of Diphenhydramine, and Desloratadine as it is a form of Loratadine, so you could expect them to have similar ototoxic side effects.
Azelastine and Chlorpheniramine do not have near as many ototoxic side effect reports, but are the next worst.
All the rest don’t have many ototoxic side effect reports so they are probably your best choices. There are at least 15 different drugs in this group–namely, Azatadine, Betahistine, Chlorphenoxamine, Clemastine, Cyproheptadine, Dimetindene, Diphenylhydrazine, Doxylamine, Emedastine, Methdilazine, Orphenadrine, Pheniramine, Pyrilamine, Trineprazine and Tripelennamine.
However, note, that since they are probably not prescribed near as much as the three leading ones, you naturally expect them to have fewer ototoxic reports. Thus, they may be just as ototoxic. As a result, you want to keep your eyes open for developing ototoxic side effects.
On the other hand, there is a good chance that they may be the least ototoxic of the bunch, so that is where I’d start.
Another caution–it may be that these antihistamines have other negative side effects and that is why they are not prescribed as much. So you need to talk this over with your doctor and come up with a short list of those antihistamines that seem to be the least ototoxic and will do the job without hurting the rest of your body.
Cordially,
Neil
Thanks so much for your detailed response!
What are your thoughts on cetirizine?
Hi Daniel:
Cetirizine is in a different class of antihistamines. In my opinion it is just as ototoxic as Loratadine, so I wouldn’t recommend it if you want to avoid ototoxic side effects.
Cordially,
Neil
On March 8, 2021 you mentioned in an answer the following” The other drugs are all ototoxic to some degree too, but of the common ones, Loratadine has the lowest percentage of tinnitus reports. ”
However, on October 3, 2022 you made this comment in an answer: “Loratadine, along with Diphenhydramine and Fexofenadine are by far the three worst antihistamines as far as ototoxic side effect reports go.”
Is your most recent comment based on new information you have gathered?
Hi Stephanie:
You have a sharp eye to notice this. The reason for the discrepancies is that I have two different data sets so to speak.
In the March 28, 2021 reply you’ll notice I said, “Loratadine has the lowest PERCENTAGE of tinnitus reports.” Whereas in my October 3, 2022 reply I said, “… as far as ototoxic side effect REPORTS go.”
So of all the side effects I have compiled, Loratadine has “lots” of reports, BUT when dividing the number of reports by the number of prescriptions for that drug per year, the PERCENTAGE may tell a different story.
For example, say I have 100 reports of a side effect–in this case tinnitus–for drug A and 1,000 reports of tinnitus for drug B, obviously drug B has 10 TIMES the number of tinnitus side effect reports as compared to drug A (That’s what I referred to in my October 3 reply).
Now let’s say that Drug A had 1,000,000 prescriptions filled in a given year giving a result of 1,000,000/1,00 = 10,000 (or 1 side effect per 10,000 prescriptions) and Drug B had 25,000,000 prescriptions filled in the same year, the result would be 25,000,000/1,000 = 25,000 (or 1 side effect per 25,000 prescriptions). Thus, percentagewise, Drug A is 2.5 times (or 250%) worse than Drug B, even though there are more reports than for Drug A.
My problem is that I don’t have the prescription figures for all drugs, so I cannot always make the percentage comparison, all I can give is the number of reports without reference to the number of prescriptions of each drug.
I’m the first to admit that my information is “hairy”, but it is the best I have so I have to run with it. The data is definitely NOT precise–but it should give a rough ballpark comparison between different drugs. So both answers are “correct” when you understand how they were derived.
Cordially,
Neil
Is there any drug, or herb or chemical that will help reduce the tinnitus?
Hi Lisa:
The FDA has not approved any drug for treating tinnitus. However, some doctors prescribe some drugs off label to calm you down so you don’t focus on your tinnitus as much, but they are not a good long-term solution as they often produce unwanted side effects and can ultimately make your tinnitus worse.
Since tinnitus is basically your system revved up, some people try dopamine or GABA to help calm their tinnitus down. This works for some people.
For some people taking Vitamin B3 (Nicotinic acid) works if their tinnitus is due to lack of adequate oxygen to their inner ears.
Getting your Vitamin D3 levels up to around 70 ng/ml can help your ears, and indeed your overall health.
For some people their tinnitus responds to magnesium or zinc if they are low on either of these two minerals
You might want to try the herbal Ginkgo biloba. When taken at the correct standardized dose of 480 mg/day it helps numbers of people, but not everyone. So much depends on the cause of your tinnitus and your psychological make-up.
Cordially,
Neil
Hello,
After already diagnosed with vestibular neuritis, I took Plan B (i.e. levonogestrel). Now, my dizziness is worse…I had no idea it was ototoxic. I took the single dose pill on October 2, 2022. It has now been 20 days. Will I recover from this?
Hi Erica:
Why do you think the Levonorgestrel caused your dizziness and not your vestibular neuritis? In actual fact, both can cause dizziness. To be sure, thousands of people have reported dizziness from taking Levonorgestrel, so it certainly could have been the culprit, but I think your vestibular neuritis could have played a part too.
I’d expect the dizziness to go away as your vestibular neuritis clears up.
Cordially,
Neil
Dr. Neil, I have recently been prescribed a new RX for unrelenting hot flashes which started when I had to get off of HRT after a double lumpectomy for Stage 1 breast cancer in 2017. Are you familiar with Viozah made by a Japanese Co named Astellas? It was supposedly approved by the FDA in May 2023, but I understand that it is still not approved in Europe where higher standards of testing are supposedly required. I took it about a month but stopped when I realized that not only my Tinnitus and Misophonia were worse, my dry eyes from Meibomian Gland Disorder were worse too. Your”Ototoxic Drugs Exposed” is my bible. Earlier this year, I went to a well-known otolaryngologist who shocked me by prescribing Gavapentin for my Tinnitus and Misophonia. I refused to take that Class 4 drug. I have been off the medicine, and so far, my Tinnitus, Misophonia and dry eyes are not any better. Any suggestions?
Hi Joan:
I have no ototoxic information on Fezolinetant (Veozah). It’s still to new of a drug for ototoxic side effects to be reported.
Misophonia (also known as annoyance hyperacusis) is where certain sounds immediately trigger feelings or anger or annoyance at the sound and person making that sound. What are your triggers? The treatment for misophonia is totally different from the treatment for tinnitus.
What caused your tinnitus in the first place? I need to know more about your tinnitus and what you have done for it so far before I can really help you.
Cordially,
Neil
B3 is mentioned to help tinnitus by getting more O2 to the inner ear. What strength do you recommend?
Hi Bonnie:
Vitamin B3 comes in two forms: The natural form of B3 is niacinamide or Nicotinic acid. Niacin is the synthetic form. Niacinamide is a vasodilator and causes flushing.
The older name of niacinamide was nicotinamide (Nicotinic acid) but it was switched because too many people confused it with nicotine. Although niacinamide and niacin are both classified as vitamin B3, it is best to use niacinamide. My sources suggest you take 50 mg 3x per day.
Cordially,
Neil
Can prednisone cause tinnitus?
I got labrynthitis and got on prednisone two weeks after and then tinnitus developed.
Could this just be a symptom of labrynthitis or the prednisone?
Thank you very much
Hi Ray:
The short answer is yes, Prednisone can cause tinnitus as thousands of people can attest in their reports to the FDA’s database.
Cordially,
Neil
I have tinnitus in my right ear only. I have no hearing loss. I have hearing aids to deliver sound therapy. Do I have to use the hearing aids on both ears or is it okay to just wear it on the tinnitus ear?
Hi Patricia:
The current wisdom is that you want to keep your ears balanced, so it is best to wear the hearing aids in both ears. (You don’t want the tinnitus to switch to the other ear, do you?”
Cordially,
Neil
I have had tinitus for so long that I don’t remember when it started. I had braces as a teen. When I was 23yrs old and fell down a step carring my baby and grocerys. I passed out at that time and had a concussion. Many years later I had a hearing test and the Dr. asked when I had a concussion. I never told him that I had so I don’t know how he knew, but he said that I had damage to nerves and would probably have hearing loss later in life, and I do. The thing that is most anoying is the tinitus though. It is hard to sleep with it so I got a sound machine wich helped for a while and I’ve tried the tv and music nothing seems to work. I am on many medicines for depression but I don’t think that is the cause. Can the nerves be repaired?
Hi Darlene:
How long ago did you have this concussion?
I’m curious as to what testing your doctor did and what the results were that led him to diagnose your previous concussion. Do you have a copy of your audiogram that you can send to me?
How long after your concussion did you notice that you had a hearing loss?
Tinnitus almost always accompanies significant hearing loss so your tinnitus may be a secondary side effect of the hearing loss.
One cause of your tinnitus could be the antidepressants and anti-anxiety drugs you are on. They all can cause tinnitus or make existing tinnitus worse. If you tell me which ones you are on, I can tell you the likelihood of them making your tinnitus loud.
Exactly which nerves did your doctor refer to as being damaged?
If you want to take this discussion private, you can email me rather than post it publicly. My email is at the bottom of every page on the Center’s website.
Cordially,
Neil