Ototoxic Substances Risk Assessment

Mark Taylor

I’d be interested to know if anyone has undertaken a risk assessment on the dangers associated with the use of ototoxic substances in their organisation?

Substances such as aspirin, ibruprofen, pesticides, antiseptics, disinfectants, solvents and heavy metals I'm told can lead to deafness, vertigo and tinnitus.

Ototoxicity is the property of being toxic to the ear (oto-), specifically the cochlea or auditory nerve and sometimes the vestibular system, for example, as a side effect of a drug. The effects of ototoxicity can be reversible and temporary, or irreversible and permanent. It has been recognized since the 19th century.

Ototoxicity typically results when the inner ear is poisoned by medication that damages the cochlea, vestibule, semi-circular canals, or the auditory/ vestibulocochlear nerve. The damaged structure then produces the symptoms the patient presents with.

Ototoxicity in the cochlea may cause hearing loss of the high-frequency pitch ranges or complete deafness, or losses at points between. It may present with bilaterally symmetrical symptoms, or asymmetrically, with one ear developing the condition after the other or not at all. The time frames for progress of the disease vary greatly and symptoms of hearing loss may be temporary or permanent.

Research and tests have also proven that cytotoxic substances can effect balance by damaging the semi-circular canals filled with fluid in the inner ear and when the vestibule and/or semi-circular canals are affected by ototoxicity, the eye can also be affected.

Stuart Keer-Keer

Whenever we do workplace risk assessments we consider the ototoxic properties of the substances in the work place. It is part and parcel of assessing the risks to health and should be done on all risk assessments.

Volatile organic compounds, heavy metals (as found in welding fumes) are commonly encountered in our risk assessments. Lead and mercury have some severe health consequences and need to be managed. The ototoxic activity is one of the consequences.

Carbon monoxide is also considered to have ototoxic effects and this is more widely found in the workplace.

When doing a noise assessment if ototoxins are present then consideration to reducing the noise standard needs to be made.

Mark Taylor

Does anyone have a policy regarding administration of painkillers and the potential ototoxic side affects?

Alex P

↪Mark Taylor

I think you'd be best to seek on advice from Medsafe on that one. Administering medications in the workplace is a massive grey area, and one that has never been tested in court. Essentially it should be up to the individual to read the packet and make their own decision as to whether or not it is suitable for them.

I come from workplace that carries and administers a variety of different medications, including pain relief and NSAID's. The authorization to administer these medications comes for a doctor (medical advisor) who provides a standing order, training, and then assesses whether an individual should carry and administer these medications. From the doctor's perspective, as long as the patient doesn't have any contraindications that match that specific medication and the medication is indicated for use, then it is ok to administer.

With pain relief, like anything else, there are maximum safe dosages, and this is obviously noted on the packet. Still, it would take a very large dose of ibuprofen or paracetamol (pain killers) to put someone in hospital.

From the doctors I work under and after speaking to others in healthcare, the benefits from pain relief far out way the risk.

You can find an extensive list on Ototoxic Medications here.

Ototoxic Substances Risk Assessment

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