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H91.0 – Ototoxic Hearing Loss: Causes & Treatment
H91.0 is the ICD-10 code for ototoxic hearing loss – hearing damage caused by certain medications or chemicals, typically affecting the inner ear or auditory nerve.
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H91.0 is the ICD-10 code for ototoxic hearing loss – hearing damage caused by certain medications or chemicals, typically affecting the inner ear or auditory nerve.
Definition
H91.0 is a diagnostic code from the International Classification of Diseases (ICD-10) referring to ototoxic hearing loss. This condition describes damage to the hearing system caused by exposure to certain substances – most commonly medications – that are toxic to the sensitive structures of the inner ear (cochlea) or the auditory nerve (cochlear nerve). The hearing loss may be temporary or permanent depending on the substance, dosage, and duration of exposure.
Causes
Ototoxic hearing loss is triggered by substances that damage the delicate hair cells or nerve fibers of the inner ear. The most common ototoxic substances include:
- Aminoglycoside antibiotics (e.g., gentamicin, tobramycin, amikacin): Used in serious bacterial infections; known to permanently damage cochlear hair cells.
- Platinum-based chemotherapy agents (e.g., cisplatin, carboplatin): Widely used in cancer treatment and associated with a high risk of irreversible hearing loss.
- Loop diuretics (e.g., furosemide, ethacrynic acid): At high doses or when given intravenously, these can disrupt the electrolyte balance of the inner ear.
- Salicylates (e.g., high-dose aspirin): Often cause reversible tinnitus and temporary hearing loss.
- Quinine and quinolone antibiotics: Also associated with ototoxic effects.
- Certain industrial chemicals and heavy metals (e.g., lead, mercury).
Risk Factors
Not everyone exposed to ototoxic substances will develop hearing loss. The following factors increase the risk:
- High doses and prolonged treatment duration
- Combination therapy with multiple ototoxic agents
- Pre-existing kidney disease (reduces drug elimination)
- Pre-existing hearing impairment
- Older age
- Genetic predisposition (e.g., mitochondrial mutations)
- Concurrent noise exposure
Symptoms
The symptoms of ototoxic hearing loss may develop gradually or suddenly:
- Hearing loss: often beginning with high-frequency sounds, later affecting lower frequencies
- Tinnitus: ringing, buzzing, or hissing sounds in the ears
- Dizziness and balance disturbances: particularly when the vestibular system is affected
- A feeling of fullness or pressure in the ears
- In advanced cases: profound or complete deafness (anacusis)
Diagnosis
The diagnosis H91.0 is established through a combination of medical history and audiological testing:
- Pure-tone audiometry: Measures hearing thresholds at various frequencies. A high-frequency notch is typical for ototoxic damage.
- Speech audiometry: Evaluates speech understanding ability.
- Otoacoustic emissions (OAE): A sensitive early-detection test for hair cell damage before hearing loss becomes subjectively noticeable.
- Auditory brainstem response (ABR): Electrophysiological measurement of auditory nerve activity.
- Medication history: Documenting all current and past medications is essential for attributing the cause.
Treatment
In most cases, there is no causal treatment for ototoxic hearing loss, as damaged hair cells cannot regenerate. Management focuses on rehabilitation and minimizing further harm:
- Discontinuation or dose reduction of the ototoxic agent (if medically feasible)
- Hearing aids for mild to severe hearing loss
- Cochlear implant for profound or total hearing loss
- Vestibular rehabilitation for balance problems
- Audiological monitoring during therapy: regular hearing tests during treatment with ototoxic medications
- Tinnitus management: sound therapy, cognitive behavioral therapy, or hearing aids with masking features
Prevention
Because ototoxic hearing loss is often unavoidable – for example, during life-saving chemotherapy – efforts focus on minimizing risk:
- Using the lowest effective dose of the ototoxic substance
- Choosing less ototoxic alternatives where available
- Regular audiological monitoring throughout treatment
- Avoiding additional noise exposure during therapy
- Genetic screening in high-risk patients (e.g., before aminoglycoside therapy)
References
- World Health Organization (WHO): International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), Code H91.0 – Ototoxic hearing loss.
- Rybak LP, Mukherjea D, Ramkumar V. Mechanisms of cisplatin-induced ototoxicity and prevention. Seminars in Hearing. 2019; 40(2): 197–204. PubMed PMID: 31036991.
- Schacht J, Talaska AE, Rybak LP. Cisplatin and aminoglycoside antibiotics: hearing loss and its prevention. Anatomical Record. 2012; 295(11): 1837–1850. PubMed PMID: 23027604.
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