{"id":9078,"date":"2026-05-12T12:00:00","date_gmt":"2026-05-12T10:00:00","guid":{"rendered":"https:\/\/audiotek.es\/medicamentos-ototoxicos-que-farmacos-pueden-danar-tu-audicion\/"},"modified":"2026-07-31T12:05:42","modified_gmt":"2026-07-31T10:05:42","slug":"medicaments-ototoxics-audicio","status":"publish","type":"post","link":"https:\/\/audiotek.es\/ca\/medicamentos-ototoxicos-audicion\/","title":{"rendered":"Medicaments otot\u00f2xics: quins f\u00e0rmacs poden danyar la teva audici\u00f3"},"content":{"rendered":"<p class=\"wp-block-paragraph\">Acabes un tractament i notes l'o\u00efda rara. Un brunzit que abans no hi era, la sensaci\u00f3 de tenir-la tapada o la impressi\u00f3 que la gent parla m\u00e9s fluix. No sempre \u00e9s casualitat: existeixen <strong>medicaments otot\u00f2xics<\/strong>, f\u00e0rmacs capa\u00e7os de danyar l'o\u00efda interna i d'alterar l'audici\u00f3, l'equilibri o totes dues coses. Alguns s\u00f3n d'\u00fas freq\u00fcent; d'altres es reserven per a malalties greus. Per tant, m\u00e9s que alarmar-te, el m\u00e9s \u00fatil \u00e9s saber quins s\u00f3n, quins senyals cal vigilar i quan conv\u00e9 mesurar l'audici\u00f3 en lloc d'esperar.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En aquest article repassem els grups de f\u00e0rmacs implicats seguint la informaci\u00f3 de <a href=\"https:\/\/www.merckmanuals.com\/es-us\/professional\/trastornos-otorrinolaringol%C3%B3gicos\/trastornos-del-o%C3%ADdo-interno\/ototoxicidad-inducida-por-f%C3%A1rmacos\" target=\"_blank\" rel=\"noopener\">el Manual MSD per a professionals<\/a>. Tamb\u00e9 veur\u00e0s quins factors multipliquen el risc i com funciona el seguiment audiol\u00f2gic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Abans de continuar, un av\u00eds que ens importa molt. Ning\u00fa ha d'abandonar ni modificar un tractament pel seu compte. Molts d'aquests f\u00e0rmacs s'usen en situacions greus on el benefici supera clarament el risc, i la decisi\u00f3 \u00e9s sempre del metge prescriptor. El paper del centre auditiu \u00e9s un altre: la <strong>monitoritzaci\u00f3 audiol\u00f2gica<\/strong>, \u00e9s a dir, una audiometria abans de comen\u00e7ar que serveixi de l\u00ednia de base, controls durant el tractament i seguiment despr\u00e9s.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Qu\u00e8 significa que un f\u00e0rmac sigui otot\u00f2xic<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Otot\u00f2xic vol dir, literalment, t\u00f2xic per a l'o\u00efda. Aquests f\u00e0rmacs afecten estructures de l'o\u00efda interna: la c\u00f2clea, que transforma el so en senyal nervi\u00f3s, i el sistema vestibular, que sost\u00e9 l'equilibri. El detall important \u00e9s que les seves c\u00e8l\u00b7lules sensorials no es regenereixen. D'aqu\u00ed que part del dany pugui quedar-se per sempre.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ara b\u00e9, no tots els efectes s\u00f3n iguals. Certs medicaments otot\u00f2xics provoquen una alteraci\u00f3 transit\u00f2ria que reverteix en suspendre el tractament. Altres deixen una hipoac\u00fasia permanent, de vegades profunda. I alguns afecten sobretot l'equilibri, sense que la persona noti res estrany en sentir. Si vols entendre millor com es classifica cada cas, t'ajudar\u00e0 aquest rep\u00e0s a els <a href=\"https:\/\/audiotek.es\/ca\/loida\/tipus-dhipoacusia\/\">tipus d'hipoac\u00fasia<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Coclear o vestibular: els dos fronts dels medicaments otot\u00f2xics<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Aquesta distinci\u00f3 explica per qu\u00e8 dues persones tractades amb f\u00e0rmacs semblants expliquen coses tan diferents. Una parla de xiulets; l'altra, de mareig. A la pr\u00e0ctica, el dany es reparteix aix\u00ed:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Lesi\u00f3 coclear (cocleotoxicitat)<\/strong>apareix p\u00e8rdua auditiva, gaireb\u00e9 sempre en les dues orelles, i sovint s'acompanya de <a href=\"https:\/\/audiotek.es\/ca\/loida\/tinnitus-o-acufens\/\">ac\u00fafens o tinnitus<\/a>. Sol comen\u00e7ar pels aguts, aix\u00ed que al principi costa m\u00e9s seguir les converses.<\/li>\n\n\n\n<li><strong>Lesi\u00f3 vestibular<\/strong>l'audici\u00f3 es mant\u00e9, per\u00f2 l'equilibri no. Es tradueix en inestabilitat en caminar, sensaci\u00f3 de terra que es mou o vertigen. De fet, hi ha f\u00e0rmacs la toxicitat dels quals \u00e9s sobretot vestibular.<\/li>\n\n\n\n<li><strong>Dany mixt<\/strong>alguns casos combinen ambd\u00f3s fronts.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Els antibi\u00f2tics aminogluc\u00f2sids, els medicaments otot\u00f2xics millor documentats<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">S\u00f3n el grup cl\u00e0ssic. S'usen en infeccions s\u00e8ries i el seu perfil est\u00e0 tan estudiat que se sap quin principi actiu tendeix a atacar l'o\u00efda i quin l'equilibri.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Estreptomicina<\/strong>inicia sobre tot la part vestibular, m\u00e9s que l'auditiva. El v\u00e8rtige sol ser transitori, tot i que la p\u00e8rdua vestibular pot persistir.<\/li>\n\n\n\n<li><strong>Neomicina<\/strong>\u00e9s l'antibi\u00f2tic amb major efecte cocleot\u00f2xic. Pot provocar una hipoac\u00fasia profunda i permanent.<\/li>\n\n\n\n<li><strong>Kanamicina i amikacina<\/strong>potencial cocleot\u00f2xic similar al de la neomicina, amb hipoac\u00fasia profunda i permanent, per\u00f2 sense afectar l'equilibri.<\/li>\n\n\n\n<li><strong>Gentamicina<\/strong>la seva toxicitat \u00e9s principalment vestibular.<\/li>\n\n\n\n<li><strong>Tobramicina<\/strong>: al contrari que l'anterior, actua principalment sobre la c\u00f2clea.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Vancomicina i macr\u00f2lids<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Fora del grup anterior hi ha altres antibi\u00f2tics que tamb\u00e9 figuren entre els medicaments otot\u00f2xics. La vancomicina pot causar hipo\u00fasia, sobretot en pacients amb insufici\u00e8ncia renal. I entre els macr\u00f2lids, l'azitromicina s'ha associat a una hipo\u00fasia que pot ser reversible o irreversible, tot i que en casos infreq\u00fcents.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Els quimioter\u00e0pics: cisplat\u00ed i carboplat\u00ed<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">En oncologia, el cisplat\u00ed i el carboplat\u00ed s\u00f3n els que reben m\u00e9s atenci\u00f3 des del punt de vista auditiu. Produeixen ac\u00fafens i hipoac\u00fasia bilateral, progressiva i permanent. A m\u00e9s, el moment d'aparici\u00f3 \u00e9s capritx\u00f3s: es pot notar immediatament o retardar-se mesos despr\u00e9s d'acabar el tractament.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Aquest retard fa que molts pacients no relacionin una cosa amb l'altra. Per aix\u00f2, quan s'empren medicaments otot\u00f2xics d'aquesta mena, el seguiment no hauria d'acabar el mateix dia que l'\u00faltima sessi\u00f3.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Els di\u00fcr\u00e8tics de l'ansa per via intravenosa<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">La furosemida i l'\u00e0cid etacr\u00ednic administrats per via intravenosa poden causar hipoac\u00fasia profunda i permanent en pacients amb insufici\u00e8ncia renal. Dos matisos importen: la via, que aqu\u00ed \u00e9s intravenosa, i el perfil del pacient, perqu\u00e8 el rony\u00f3 condiciona com s'elimina el f\u00e0rmac.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Aix\u00f2 no converteix qualsevol di\u00fcr\u00e8tic en un enemic. No obstant aix\u00f2, s\u00ed que explica per qu\u00e8 a l'hospital es vigila tant l'audici\u00f3 de determinats pacients quan es combinen diversos medicaments otot\u00f2xics alhora.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Aspirina, salicilats i quinina: quan l'efecte sol revertir<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Aqu\u00ed arribem al grup que m\u00e9s gent coneix de prop. Per sobre d'uns 2 grams d'aspirina al dia poden apar\u00e8ixer p\u00e8rdua auditiva i ac\u00fafens. La bona not\u00edcia \u00e9s que aquests efectes s\u00f3n t\u00edpicament reversibles en suspendre el f\u00e0rmac. Una cosa semblant passa amb la quinina, que s'associa a una hipoac\u00fasia transit\u00f2ria.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tot i aix\u00ed, un xiulet nou mai no \u00e9s un detall menor. Comenta-ho amb el teu metge i no ho normalitzis. En aquesta guia t'expliquem per qu\u00e8 pots <a href=\"https:\/\/audiotek.es\/ca\/escoltar-brunzit-a-loida\/\">sentir un xiulet a l'orella<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quins factors multipliquen el risc dels medicaments otot\u00f2xics<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">El medicament no funciona en un buit. Hi ha circumst\u00e0ncies que augmenten la probabilitat de patir danys a l&#x27;o\u00efda, i aquestes expliquen per qu\u00e8 el metge ajusta els plans de tractament o sol\u00b7licita controls.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>La dosi i la durada<\/strong> del tractament.<\/li>\n\n\n\n<li><strong>La insufici\u00e8ncia renal<\/strong>, perqu\u00e8 afecta l'eliminaci\u00f3 del f\u00e0rmac.<\/li>\n\n\n\n<li><strong>La velocitat d'infusi\u00f3<\/strong> i <strong>la dosi acumulada<\/strong>.<\/li>\n\n\n\n<li><strong>La combinaci\u00f3 de diversos f\u00e0rmacs otot\u00f2xics<\/strong> alhora.<\/li>\n\n\n\n<li><strong>La predisposici\u00f3 gen\u00e8tica<\/strong>, en concret les mutacions de l'ADN mitocondrial MT-RNR1.<\/li>\n\n\n\n<li><strong>La vellesa<\/strong> i <strong>una hipoac\u00fasia pr\u00e8via<\/strong>.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Aquest \u00faltim punt mereix una pausa. Si japarteixes d'una audici\u00f3 tocada, tens menys marge. Per aix\u00f2 els medicaments otot\u00f2xics preocupen especialment en gent gran o en persones que arrosseguin una p\u00e8rdua pr\u00e8via per soroll o per edat. La <a href=\"https:\/\/www.who.int\/es\/news-room\/fact-sheets\/detail\/deafness-and-hearing-loss\" target=\"_blank\" rel=\"noopener\">Organitzaci\u00f3 Mundial de la Salut<\/a> inclou precisament aquests f\u00e0rmacs entre les causes evitables de p\u00e8rdua auditiva.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Senyals d'alarma que no has d'ignorar<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">L'o\u00efda avisa, encara que de vegades ho fa ben fluixet. Aquests senyals haurien de portar-te a consultar sense esperar a la seg\u00fcent revisi\u00f3:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Tens d'ac\u00fafenos nous<\/strong>un xiulet, un brunzit o un siseig que abans no hi era.<\/li>\n\n\n\n<li><strong>Sensaci\u00f3 d'o\u00efda tapada<\/strong> sense refredat ni canvis de pressi\u00f3 que ho justifiquin.<\/li>\n\n\n\n<li><strong>Inestabilitat<\/strong> en caminar, mareig o sensaci\u00f3 que l'entorn es mou.<\/li>\n\n\n\n<li><strong>Dificultat per seguir converses<\/strong>, sobretot en grup o amb soroll de fons.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Cap d'aquests s\u00edmptomes confirma per si sol que la causa siguin els medicaments otot\u00f2xics. Poden ser deguts a un tap de cera o a una otitis. Tot i aix\u00ed, si coincideixen amb un tractament en curs, mereixen una prova objectiva.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">La monitoritzaci\u00f3 audiol\u00f2gica: abans, durant i despr\u00e9s<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Repetim l'av\u00eds perqu\u00e8 \u00e9s el cor d'aquest article. Ning\u00fa ha d'abandonar ni modificar un tractament pel seu compte: molts d'aquests f\u00e0rmacs s'administren en situacions greus on el benefici supera clarament el risc, i la decisi\u00f3 \u00e9s sempre del metge prescriptor. El que s\u00ed que aporta el centre auditiu \u00e9s la <strong>monitoritzaci\u00f3 audiol\u00f2gica<\/strong>, amb audiometria abans de comen\u00e7ar, controls durant el tractament i seguiment despr\u00e9s.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Abans<\/strong>una audiometria de refer\u00e8ncia. Sense aquest punt de partida \u00e9s impossible saber si alguna cosa ha canviat.<\/li>\n\n\n\n<li><strong>Durant<\/strong>: controls peri\u00f2dics segons la pauta que marqui l'equip m\u00e8dic. Detectar un descens aviat permet valorar alternatives a temps.<\/li>\n\n\n\n<li><strong>Despr\u00e9s<\/strong>: seguiment en acabar. Recorda que amb alguns f\u00e0rmacs l'efecte es pot endarrerir mesos.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">A l'audiometria tonal se li sol sumar una <a href=\"https:\/\/audiotek.es\/ca\/una-audiometria-verbal-es-una-prova-audiologica-que-avalua-la-capacitat-duna-persona-per-sentir-i-comprendre-paraules-parlades-utilitza-una-serie-de-paraules-o-frases-presentades-a-diferents-volums\/\">audiometria verbal<\/a>, que mesura una cosa molt concreta: quant entens, no nom\u00e9s quant sents. \u00c9s informaci\u00f3 valuosa, perqu\u00e8 la queixa m\u00e9s freq\u00fcent no \u00e9s \u00abno sento\u00bb, sin\u00f3 \u00absento per\u00f2 no entenc\u00bb.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Llista de verificaci\u00f3: qu\u00e8 fer si prens medicaments otot\u00f2xics<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Pregunta abans de comen\u00e7ar<\/strong>. Si et prescriuen un tractament prolongat o intraven\u00f3s, planteja el dubte directament: conv\u00e9 una audiometria de base?<\/li>\n\n\n\n<li><strong>Desa els teus informes<\/strong>. Un audiograma antic val un imperi a l'hora de comparar.<\/li>\n\n\n\n<li><strong>Anota els s\u00edmptomes i la data<\/strong>. Quan va comen\u00e7ar el xiulet, en quina o\u00efda, si va i ve.<\/li>\n\n\n\n<li><strong>Avisa el teu metge<\/strong> davant qualsevol canvi auditiu o d'equilibri. No esperis a la revisi\u00f3 anual.<\/li>\n\n\n\n<li><strong>Cuida la resta de factors<\/strong>. Protegeix-te del soroll intens mentre duri el tractament; sumar riscos mai no \u00e9s una bona idea.<\/li>\n\n\n\n<li><strong>Fes una primera comprovaci\u00f3<\/strong> amb el nostre <a href=\"https:\/\/audiotek.es\/ca\/prova-daudicio\/\">test auditiu gratu\u00eft en l\u00ednia<\/a> I, si alguna cosa no quadra, demana cita per a una audiometria completa.<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\">Preguntes freq\u00fcents sobre medicaments otot\u00f2xics<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Puc deixar el tractament si noto xiulets?<\/strong> No ho facis pel teu compte. Comunica el s\u00edmptoma com m\u00e9s aviat millor a qui te l'ha prescrit i ser\u00e0 aquesta persona qui valori si n'ajusta la dosi, canvia de f\u00e0rmac o mant\u00e9 la pauta.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>El dany \u00e9s sempre permanent?<\/strong> No. Dep\u00e8n del f\u00e0rmac: amb els salicilats o la quinina l'efecte sol revertir al suspendre'ls, mentre que amb la neomicina, l'amikacina o els quimioter\u00e0pics la hipoac\u00fasia pot ser profunda i permanent.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Un col\u00b7liri o una pomada amb antibi\u00f2tic tamb\u00e9 compten?<\/strong> La preocupaci\u00f3 principal rau en l'administraci\u00f3 sist\u00e8mica i en tractaments perllongats. Tot i aix\u00ed, si tens el timp\u00e0 perforat, consulta-ho abans d'utilitzar qualsevol producte\u00f2tic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Quan m'he de fer l'audiometria de control?<\/strong> Idealment abans d'iniciar el tractament, durant el mateix segons indiqui el teu equip m\u00e8dic i en els mesos posteriors. Amb determinats medicaments otot\u00f2xics la p\u00e8rdua apareix amb retard, aix\u00ed que el control tard\u00e0 importa.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>I si ja tinc p\u00e8rdua auditiva pr\u00e8via?<\/strong> Llavors la vigil\u00e0ncia ha de ser m\u00e9s estreta, perqu\u00e8 parteixes amb menys marge. Comenta-ho al teu metge abans de comen\u00e7ar i tingues a m\u00e0 el teu \u00faltim audiograma.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">A Audiotek t'ajudem a vigilar la teva audici\u00f3<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Portem m\u00e9s de 20 anys als centres auditius d'Audiotek, a Granollers, Terrassa, Badalona, Santa Coloma de Gramenet, Castelldefels, El Masnou i Barcelona ciutat. Els nostres audioprotetistes titulats fan avaluacions auditives completes sense comprom\u00eds, i aquest informe \u00e9s el que necessites per comparar abans, durant i despr\u00e9s d'un tractament.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Si finalment cal una soluci\u00f3 auditiva, podr\u00e0s provar audi\u00f2fons durant 30 dies en el teu dia a dia, no nom\u00e9s a la cabina. Aix\u00ed comproves de deb\u00f2 si t'aporten el que esperes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u00bfEst\u00e0s en tractament i notes alguna cosa diferent en la teva audici\u00f3? <a href=\"https:\/\/audiotek.es\/ca\/contacte\/\">Demana cita al teu centre Audiotek<\/a> i ho mesurem. El teu metge decideix sobre el f\u00e0rmac; nosaltres ens ocupem que la teva o\u00efda no passi desapercebuda.<\/p>","protected":false},"excerpt":{"rendered":"<p>Quins medicaments otot\u00f2xics poden danyar la vostra o\u00efda: antibi\u00f2tics, quimioter\u00e0pia, di\u00fcr\u00e8tics i aspirina. Senyals d'alarma i controls audiol\u00f2gics.<\/p>","protected":false},"author":7,"featured_media":9073,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"pgc_sgb_lightbox_settings":"","footnotes":""},"categories":[19],"tags":[],"class_list":["post-9078","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-consejos-de-salud"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medicamentos otot\u00f3xicos: f\u00e1rmacos que da\u00f1an la audici\u00f3n<\/title>\n<meta name=\"description\" content=\"Qu\u00e9 medicamentos otot\u00f3xicos pueden da\u00f1ar tu o\u00eddo: antibi\u00f3ticos, quimioterapia, diur\u00e9ticos y aspirina. 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