We provide here a list of known ototoxic drugs and herbs that have been known to cause or exacerbate tinnitus. This list is for educational purposes only and is available as a resource to you to use in your discussions with your health care professional. We thank doctor Neil Bauman, Ph.D., for his expertise in this area and for compiling this list for us.

There seems to be a two-way-street relationship between tinnitus and sleep problems. The symptoms of tinnitus can interfere with sleeping well—and poor sleep can make tinnitus more aggravating and difficult to manage effectively. In the same study that found a majority of people with tinnitus had a sleep disorder, the scientists also found that the presence of sleep disorders made tinnitus more disruptive.
Earwax (ear wax) is a natural substance secreted by special glands in the skin on the outer part of the ear canal. It repels water, and traps dust and sand particles. Usually a small amount of wax accumulates, dries up, and then falls out of the ear canal carrying with it unwanted particles. Under ideal circumstances, you should never have to clean your ear canals. The absence of ear wax may result in dry, itchy ears, and even infection. Ear wax may accumulate in the ear for a variety of reasons including; narrowing of the ear canal, production of less ear wax due to aging, or an overproduction of ear wax in response to trauma or blockage within the ear canal.

Some patients choose to get involved in “tinnitus retraining,” which involves wearing a device in the ears that provides soothing music or noise, along with undergoing counseling. The goal is to help your body and brain learn to get accustomed to tinnitus noise, which reduces your negative reactions to unwanted sounds. Support and counseling during the process can be helpful for reducing anxiety. Researchers are now learning more about the benefits of coherent cognitive behavioral therapy interventions to help treat distress associated with tinnitus. (3)
Most people should have a formal hearing test done by either the doctor or a hearing specialist (audiologist). People with tinnitus in only one ear and hearing loss should have gadolinium-enhanced magnetic resonance imaging (MRI). People with tinnitus in only one ear and normal hearing should have an MRI if tinnitus lasts more than 6 months. People with pulsatile tinnitus often require magnetic resonance angiography (MRA) and sometimes angiography.
It is possible that the most common cause of pulsatile tinnitus is sigmoid sinus diverticulum and dehiscence, which can be collectively referred to as sinus wall abnormalities or SSWA. The sigmoid sinus is a blood carrying channel on the side of the brain that receives blood from veins within the brain. The blood eventually exits through the internal jugular vein. Sigmoid sinus diverticulum refers to the formation of small sac-like pouches (diverticula) that protrude through the wall of the sigmoid sinus into the mastoid bone behind the ear. Dehiscence refers to absence of part of the bone that surrounds the sigmoid sinus in the mastoid. It is unknown whether these conditions represent different parts of one disease process or spectrum, or whether they are two distinct conditions. These abnormalities cause pressure, blood flow, and noise changes within the sigmoid sinus, which ultimately results in pulsatile tinnitus. Narrowing of the blood vessel that leads into the sigmoid sinus, known as the transverse sinus, has also been associated with pulsatile tinnitus.
Ototoxic drugs can also cause subjective tinnitus, as they may cause hearing loss, or increase the damage done by exposure to loud noise. Those damages can occur even at doses that are not considered ototoxic.[30] Over 260 medications have been reported to cause tinnitus as a side effect.[31] In many cases, however, no underlying cause could be identified.[2]
Your doctor will try to determine what is causing the condition. If it is not due to a medication side effect or a general medical condition (such as high blood pressure), he or she may refer you to an otolaryngologist (an ear, nose, and throat doctor) or an audiologist (hearing specialist). It is especially important to see an otolaryngologist if you experience tinnitus in only one ear, tinnitus that sounds like your heartbeat or pulse (pulsatile tinnitus), tinnitus with sudden or fluctuating hearing loss, pressure or fullness in one or both ears, and/or dizziness or balance problems. Unless the cause of the tinnitus is obvious on physical examination, a hearing test is usually required.
To keep the brain activated and aware, Kilgard’s therapy involves stimulating the vagus nerve, which is actually a pair of nerves that runs inside the neck and into the brain. “All the stuff you brains learns about your body — it all comes in through the vagus nerve,” he says. “We trick the brain into thinking it’s learning something important by stimulating this nerve in the neck.”
As with the first exercise, make sure you’re comfortable and unlikely to be disturbed. Now imagine yourself leaving this room. You walk out of the door and follow a path… at the end of the path is another door. You open that door and inside you see a beautiful garden – you can hear birds singing, children playing somewhere in the distance. You feel a cool breeze on your skin and hear the rustle of leaves through the trees. The colours of the leaves, green, gold, red, all dance across a beautiful pond in the middle… as you walk over to the pond, you feel the soft grass under your bare feet… you dip your toes into the calm, clear pond and stop for a moment – just experiencing the beauty of everything around you…
With respect to incidence (the table above is about prevalence), Martinez et al (2015) reported that there were 5.4 new cases of tinnitus per 10,000 person-years in England. We don't find this statistic much use as tinnitus is highly prevalent in otherwise normal persons. It seems to us that their study is more about how many persons with tinnitus were detected by the health care system -- and that it is more a study of England's health care system than of tinnitus.
A poor diet, sedentary lifestyle, lack of sleep and chronic stress are all capable of reducing immunity and making you susceptible to nerve damage, allergies and ear problems. If you frequently experience seasonal or food allergies that affect your ears, ear infections, swelling and other problems related to damage of the vestibular system, consider changing your diet, exercise routine and ways of dealing with stress, which in turn will aid your tinnitus treatment. Try natural stress relievers like exercising, yoga, meditation, taking warm baths, using essential oils and spending more time outdoors, and eat an anti-inflammatory diet.
Vascular issues. Some people have blood vessels near their ears that are capable of causing tinnitus. I have found that if the blood pressure is elevated, this increased pressure can cause that dreaded ringing in your ears or even a whooshing sound. Because pregnant women often have elevated blood pressure, they are easily susceptible to tinnitus. Tinnitus caused by pregnancy should go away with an over the counter tinnitus treatment and once the baby is born. An overactive thyroid has also been shown to causes vascular issues that bring on tinnitus.

Widex employs fractal tone technology, so that the sounds you hear are predictable but not repeating. Your audiologist can choose between an assortment of “musical tones” known as “Zen styles,” which are random and chime-like. Your audiologist can adjust the tones’ pitch, tempo, and volume. If employed correctly, Widex Zen Therapy can help re-wire your brain and make your tinnitus less noticeable.
Exposure to loud noise: Loud noise exposure is a very common cause of tinnitus today, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise from firearms, high intensity music, or other sources. Twenty-six million American adults have suffered noise-induced hearing loss, according to the NIDCD.
Limit use of earplugs. Earplugs are important to use to protect your hearing when you’re likely to be exposed to loud noises. (Remember, exposure to loud sounds, and noise-induced hearing loss, are common causes of tinnitus, and may make tinnitus worse if you already have the condition.) But otherwise, people with tinnitus are advised not to wear earplugs, including for sleep. Earplugs reduce your ability to hear external noise and can make tinnitus more noticeable.
Auditory-somatosensory stimulation is a similar treatment approach to Kilgard’s, in that its goal is to retune the faulty patterns of brain activity that can cause tinnitus. It involves pairing sounds played in the ear with specially timed electric impulses, which are administered to touch-sensitive nerves using a pad attached to the neck, Dr. Shore explains about the research she’s working on.

It can often be very helpful to talk to someone who understands how you are feeling, who can reassure you about any anxieties you may have, and answer your questions. We can provide details of self-help groups and contacts in the UK, and we also run a helpline on 0800 018 0527. Most of the people who run groups or are contacts have tinnitus themselves and have been helping people with the condition for a long time. Even if you don't want to take part in group activities, it can be a comfort to know there is someone you can contact.
Sound-masking devices provide a pleasant or benign external noise that partially drowns out the internal sound of tinnitus. The traditional sound-masking device is a tabletop sound machine, but there are also small electronic devices that fit in the ear. These devices can play white noise, pink noise, nature noises, music, or other ambient sounds. Most people prefer a level of external sound that is just slightly louder than their tinnitus, but others prefer a masking sound that completely drowns out the ringing.

Don’t ignore ear pain. Pain or discomfort in your ear can be a sign of conditions associated with tinnitus, including ear infections and earwax buildup. These conditions, and the discomfort they cause, can also interfere with sleep. Whether your ear pain is sharp or dull, constant or intermittent, accompanied by itching or not, take these symptoms to your doctor.
Antidepressants. Antidepressants, such as nortriptyline and amitriptyline, have been used as mood enhancers to help someone with tinnitus cope with the life changing implications and complications it brings. However, they are often only prescribed in the most severe of tinnitus cases as they carry some serious side effects that might not make them worth taking for everyone. These include blurred vision, heart problems, dry mouth and constipation.
Although mitochondrial DNA variants are thought to predispose to hearing loss, a study of polish individuals by Lechowicz et al, reported that "there are no statistically significant differences in the prevalence of tinnitus and its characteristic features between HL patients with known HL mtDNA variants and the general Polish population." This would argue against mitochondrial DNA variants as a cause of tinnitus, but the situation might be different in other ethnic groups.
Think about your breathing. Notice that it has a natural rhythm. Try to breathe in a steady, even rhythm. It helps to breathe in through your nose, hold your breath for a moment and then breathe out through your mouth. Wait a moment before breathing in again. Every time you breathe out, try to release a little bit of your tension. Do this for a few minutes, until you feel ready to move on to the next step.
This personalized solution offers a selection of tinnitus relief sounds to support common management approaches. The flexible programming provides sound stimulation through select auditory options that can ease the effects of tinnitus. The sounds offer a variety of customized options and are used in conjunction with tinnitus retraining therapy to provide instructional counseling.
Tinnitus is commonly thought of as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of tinnitus, even though they do not express the condition or its effect on their lives.[100] Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously.[101] Among those children who do complain of tinnitus, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere’s disease or chronic suppurative otitis media.[102] Its reported prevalence varies from 12% to 36% in children with normal hearing thresholds and up to 66% in children with a hearing loss and approximately 3–10% of children have been reported to be troubled by tinnitus.[103]
Some patients choose to get involved in “tinnitus retraining,” which involves wearing a device in the ears that provides soothing music or noise, along with undergoing counseling. The goal is to help your body and brain learn to get accustomed to tinnitus noise, which reduces your negative reactions to unwanted sounds. Support and counseling during the process can be helpful for reducing anxiety. Researchers are now learning more about the benefits of coherent cognitive behavioral therapy interventions to help treat distress associated with tinnitus. (3)

Muscle spasms: Tinnitus that is described as clicking may be due to abnormalities that cause the muscle in the roof of the mouth (palate) to go into spasm. This causes the Eustachian tube, which helps equalize pressure in the ears, to repeatedly open and close. Multiple sclerosis and other neurologic diseases that are associated with muscle spasms may also be a cause of tinnitus, as they may lead to spasms of certain muscles in the middle ear that can cause the repetitive clicking.

There is a growing body of evidence suggesting that some tinnitus is a consequence of neuroplastic alterations in the central auditory pathway. These alterations are assumed to result from a disturbed sensory input, caused by hearing loss.[28] Hearing loss could indeed cause a homeostatic response of neurons in the central auditory system, and therefore cause tinnitus.[29]

Some patients choose to get involved in “tinnitus retraining,” which involves wearing a device in the ears that provides soothing music or noise, along with undergoing counseling. The goal is to help your body and brain learn to get accustomed to tinnitus noise, which reduces your negative reactions to unwanted sounds. Support and counseling during the process can be helpful for reducing anxiety. Researchers are now learning more about the benefits of coherent cognitive behavioral therapy interventions to help treat distress associated with tinnitus. (3)

Lidocaine, a medication used for the treatment of certain types of abnormal heart rhythms, has been shown to relieve tinnitus for some people, but it must be given intravenously or into the middle ear to be effective. However, the benefits of lidocaine are almost always outweighed by the risks of the drug and it is therefore not recommended and not used for tinnitus.
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