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

If you’ve started a new medication and suddenly hear a ringing, buzzing, or hissing in your ears-especially when no one else can hear it-you’re not imagining things. This isn’t just stress or fatigue. It could be your medicine. More than 600 prescription and over-the-counter drugs are known to trigger or worsen tinnitus, according to Dr. Julie Prutsman, Au.D., in her 2025 clinical guide. And while many people assume this is rare, it’s actually one of the most common yet underreported side effects of everyday medications.

How Medications Cause Ringing in the Ears

Tinnitus from medication isn’t a mystery-it’s called ototoxicity. That means the drug is damaging the inner ear, specifically the hair cells that send sound signals to your brain. These cells don’t regenerate, so if they’re destroyed, the damage can be permanent. But not all ototoxicity works the same way. Some drugs cause temporary ringing that fades when you stop taking them. Others, like certain antibiotics or chemotherapy drugs, can lead to lasting hearing loss.

The exact mechanism isn’t fully understood, but experts believe these drugs interfere with the electrical signals in the inner ear or disrupt blood flow to the cochlea. Some even affect the auditory nerve directly. The result? Your brain starts making up sounds because the real signals are scrambled or lost.

Drugs Most Likely to Cause Tinnitus

Not all medications carry the same risk. Some are high-risk, some are low, and most fall somewhere in between. Here’s what the data shows:

• Aminoglycoside antibiotics (like gentamicin and tobramycin): These are among the worst offenders. Used for serious infections, they can cause permanent hearing damage in up to 25% of patients on long-term IV therapy. Topical versions (ear drops, creams) are much safer.
• Chemotherapy drugs (especially cisplatin): Between 30% and 70% of patients on cisplatin develop hearing loss or tinnitus. It usually starts with high-pitched sounds you can’t hear anymore, then spreads to speech frequencies.
• Loop diuretics (like furosemide): Used for heart failure or kidney issues, these can cause ringing, especially at high doses or in people with kidney problems.
• High-dose aspirin: You need to take more than 4,000 mg daily for this to happen-far more than anyone takes for headaches today. Still, some people report ringing after just a few pills. A very small number are unusually sensitive.
• NSAIDs (ibuprofen, naproxen): At high doses (like 800 mg three times a day for pain), tinnitus can pop up within days. Most people stop taking it, and the ringing goes away within a week.
• Isotretinoin (Accutane): Used for severe acne, about 5% of users report tinnitus. The manufacturer says it’s less than 1%, but real-world reports suggest otherwise.
• Antidepressants (SSRIs like sertraline): Tinnitus is rare-under 1% of users. But some report it starting when they begin the drug, or even when they stop it. Case studies go back over 20 years.
• Benzodiazepines (like Xanax, Valium): Usually only after long-term use (6+ months). Stopping them can also trigger ringing.

Here’s the key: ototoxicity is dose-dependent. A low dose of ibuprofen for a headache? Almost never a problem. A high dose for chronic pain? That’s when risk spikes.

Is the Tinnitus Permanent?

This is the biggest fear-and the answer isn’t simple. About 60% of medication-induced tinnitus cases reverse once you stop the drug. But not all. Aminoglycosides and cisplatin often cause irreversible damage. That’s why monitoring matters.

Some people notice ringing within 24 hours of starting a new drug. Others take weeks or even months. Sound Relief’s 2025 data shows 70% of cases begin within two weeks. But delayed reactions up to 90 days have been documented, especially with antibiotics and chemo drugs.

Reversibility also depends on your health. If you already have hearing loss, kidney disease, or are older, your risk of permanent damage goes up. Your body can’t clear the drug as efficiently, so it builds up and causes more harm.

What to Do If You Notice Ringing After Starting a New Drug

First, don’t panic. Second, don’t stop the medication on your own. Third, tell your doctor right away.

Here’s what happens next:

1. Track the timing. When did the ringing start? Did it begin the same day you started the drug? Or after a week? Write it down.
2. Check the dose. Are you taking more than recommended? Sometimes people double up because they think it’ll work faster.
3. Ask your doctor. Say: “I started this medication on [date], and now I hear ringing in my ears. Could this be related?”
4. Request a hearing test. A simple audiogram can show if your hearing has changed. Baseline tests are standard before starting high-risk drugs like cisplatin or gentamicin.
5. Discuss alternatives. Can your doctor switch you to a different antibiotic? A different painkiller? A lower dose? Many options exist.

For example, if you’re on high-dose ibuprofen for back pain and developed tinnitus, your doctor might switch you to acetaminophen or a non-ototoxic muscle relaxant. If you’re on an SSRI and the ringing started after increasing the dose, they might adjust it or try a different antidepressant.

What Your Doctor Should Be Doing

Doctors aren’t always trained to think about tinnitus as a side effect. A 2022 survey found only 35% of primary care physicians routinely check for ototoxicity risk before prescribing high-risk drugs.

But they should. Best practice includes:

• Asking about existing hearing issues or tinnitus before prescribing
• Monitoring kidney function for drugs cleared by the kidneys (like gentamicin or furosemide)
• Checking serum drug levels when possible
• Ordering baseline and follow-up hearing tests for high-risk medications
• Informing patients about warning signs before they start the drug

Some hospitals now use automated alerts in electronic records to flag ototoxic drugs for patients with kidney disease or prior hearing loss. That’s progress.

Managing Tinnitus While Still Taking the Medication

What if you can’t stop the drug? Maybe it’s life-saving-like chemo or an antibiotic for a severe infection. You still need relief.

Sound therapy helps. White noise machines, fans, or apps that play gentle background sounds can mask the ringing and help your brain ignore it. Studies show 60-70% of people feel better with consistent use.

Cognitive behavioral therapy (CBT) for tinnitus also works. It doesn’t make the sound go away, but it changes how your brain reacts to it. Less stress, less focus on the noise, less suffering.

And don’t ignore your ears. Avoid loud music, use earplugs in noisy places, and don’t use cotton swabs. Anything that stresses your hearing further makes tinnitus worse.

What’s Changing in the Future

Researchers are working on otoprotective drugs-medications that shield the ear from damage without reducing the effectiveness of the main drug. The NIH funded $12.5 million in research in 2024, with several compounds in phase 2 trials.

Genetic testing is also emerging. Some people have a gene variant that makes them extra sensitive to ototoxic drugs. In the future, a simple blood test could tell you if you’re at higher risk before you even start a drug.

Regulators are paying attention too. The FDA updated labeling requirements for several aminoglycosides in 2023 to include stronger warnings about hearing loss. More drug companies are now required to test for ototoxicity during development.

But the biggest change needed? Better awareness. Patients need to know this can happen. Doctors need to ask about it. And no one should feel like they’re overreacting if they mention ringing in their ears after starting a new pill.

Bottom Line: You Have Power

Tinnitus from medication isn’t inevitable. It’s preventable-with the right questions, the right monitoring, and the right communication.

If you’re on a medication and notice ringing, buzzing, or muffled hearing:

• Don’t ignore it.
• Don’t stop the drug yourself.
• Do talk to your doctor.
• Do ask for a hearing test.
• Do ask if there’s a safer alternative.

Most of the time, the solution is simple: a dose change, a different drug, or a short break. But if you wait too long, you could lose hearing you can’t get back.

Your ears are listening. Make sure your doctor is too.