Hydroxyzine is not traditionally classified as an ototoxic drug, but one large nationwide study has flagged a possible link to hearing loss that deserves attention. The evidence is limited and comes with significant caveats, so the short answer is: hydroxyzine is not a well-established ototoxin like certain antibiotics or chemotherapy drugs, but it may carry a small, underrecognized risk.
What the Research Actually Found
A large study published in Scientific Reports analyzed electronic health records from South Korea’s national insurance database to screen for previously unknown ototoxic drugs. Researchers matched hydroxyzine users to non-users (3,193 people in each group) and tracked who developed bilateral hearing loss over time. Hydroxyzine users had roughly 2.2 times the risk of developing bilateral hearing loss compared to non-users, after adjusting for age, sex, and existing health conditions. That finding was then cross-checked against the FDA’s adverse event reporting system (FAERS), which also showed hydroxyzine had a 40% higher reporting rate for ear-related side effects compared to all other drugs in the database.
Those numbers sound alarming, but context matters. The absolute rates were low: out of 3,193 hydroxyzine users tracked over years, 18 developed bilateral hearing loss. Among the matched non-users, 13 did. We’re talking about a difference of five additional cases in a group of thousands. The study also could not determine whether the hearing loss was temporary or permanent, mild or severe, or related to the dose or duration of hydroxyzine use. Lifestyle factors like smoking, alcohol use, and BMI weren’t controlled for either. And because the study relied on diagnostic codes rather than actual hearing tests, some cases may not have been truly drug-related.
This is the only major study to date investigating hydroxyzine specifically for ototoxicity. There are no published case reports of a patient taking hydroxyzine and developing confirmed hearing damage as a direct result. So the signal is real but preliminary.
How Hydroxyzine Affects the Inner Ear
Hydroxyzine is a first-generation antihistamine that blocks histamine receptors throughout the body, including in the vestibular system, the part of your inner ear responsible for balance. This is actually why it’s sometimes prescribed for dizziness and vertigo: it quiets neural activity on both sides of the vestibular system, reducing the mismatch between ears that causes spinning sensations. The American Academy of Audiology lists hydroxyzine among drugs with known vestibular-suppressing effects, noting it takes about 3 hours to reach peak activity and lasts 4 to 6 hours.
This vestibular suppression is temporary and intentional when used for dizziness. But it’s also why audiologists ask patients to stop taking hydroxyzine before balance testing, since it can mask abnormalities and produce artificially weak results on caloric testing. The suppression itself doesn’t mean the drug is damaging inner ear structures. It’s more like turning down the volume on a system rather than breaking the speaker. Whether long-term suppression could contribute to lasting changes is an open question the current research hasn’t answered.
Hydroxyzine Is Also Used to Treat Tinnitus
Interestingly, hydroxyzine has been studied as part of a treatment combination for tinnitus, not as a cause of it. A randomized controlled trial involving 150 patients with subjective tinnitus tested hydroxyzine (25 mg twice daily) combined with another medication against placebo. The combination reduced tinnitus perception by 81% based on a subjective grading scale, significantly better than the other medication alone (56%) or placebo. Hydroxyzine’s sedative properties and its ability to dampen activity in the brain’s emotional and auditory processing areas appear to help patients perceive their tinnitus as less bothersome.
This creates a somewhat paradoxical picture: one study raises concerns about hearing loss risk, while another uses the drug to relieve an ear-related symptom. The contradiction likely reflects hydroxyzine’s broad effects on the nervous system. Calming neural circuits can be therapeutic for some ear conditions while potentially posing subtle risks through other, still-unknown mechanisms.
How It Compares to Known Ototoxic Drugs
Hydroxyzine does not belong in the same category as drugs with well-documented, dose-dependent ototoxicity. Certain IV antibiotics, platinum-based chemotherapy agents, and high-dose loop diuretics can directly destroy the hair cells in your inner ear, causing measurable, sometimes irreversible hearing loss. Their ototoxic mechanisms are well understood, and patients receiving them are routinely monitored with hearing tests.
Hydroxyzine’s situation is fundamentally different. There’s a statistical association from one population-level study, but no confirmed mechanism explaining how it would damage hearing structures, no dose-response relationship established, and no clinical guidelines recommending hearing monitoring for people who take it. The 2.2x hazard ratio, while statistically significant, had wide confidence intervals (1.05 to 4.60), meaning the true risk could be barely above baseline or several times higher. That uncertainty reflects how early this finding is.
What This Means If You Take Hydroxyzine
If you’re taking hydroxyzine for anxiety, allergies, or itching and wondering whether it’s hurting your hearing, the current evidence doesn’t support panic. The absolute risk appears very small, and no medical organization has issued warnings about hydroxyzine and hearing loss. That said, if you notice changes in your hearing, new tinnitus, or a feeling of fullness in your ears while taking it, those symptoms are worth mentioning to your prescriber. Tracking whether symptoms correlate with when you started the medication or with dose changes can help determine whether the drug is a factor.
For people already dealing with hearing loss or inner ear problems who are prescribed hydroxyzine, the question becomes more nuanced. The possible association is worth weighing against the benefits of the medication, especially if you’re taking other drugs that carry their own ototoxic risks. Combining multiple medications that each carry a small ear-related risk could, in theory, add up, though this specific interaction hasn’t been studied for hydroxyzine.