Doxycycline Tinnitus & Hearing Loss: An Ototoxic Antibiotic?

Doxycycline is a broad-spectrum antibiotic of the “tetracycline” class used to treat a variety of bacterial infections and some parasites.

Conditions commonly treated by doxycycline, include: acne; bacterial pneumonia; chlamydia; Lyme disease; cholera; typhus; and syphilis.  It is also used to prevent malaria in conjunction with quinine.

If you were prescribed doxycycline by a medical doctor (MD), it’s probably because: (A) the doctor knows that you need it for a specific infection OR (B) because it is likely to help treat symptoms that you’re dealing with.

A subset of people who are prescribed doxycycline wonder whether doxycycline causes tinnitus (ringing in the ears) and/or ototoxicity (hearing loss).

I’ve taken the time to research whether doxycycline: (1) is ototoxic, (2) can cause hearing loss, and (3) can cause tinnitus.  Why? Because I’m obsessive about the ototoxic potential of any antibiotic that I take.

Table of Contents

Doxycycline ototoxicity: Is doxycycline ototoxic?

For reference… Ototoxicity: “The state of being poisonous or damaging to the ear.”

No. There are ZERO convincing data to suggest that doxycycline is directly ototoxic and ZERO reports in which ototoxicity was documented as having resulted from doxycycline.

Doxycycline has been on the market since 1967 and is widely used today to manage/treat a variety of medical conditions – including on a long-term basis (e.g. chronic acne vulgaris)… if it were truly “ototoxic” – we’d know about it.

I managed to find ONE article by Dr. James Thambyrajah (2018), a full-time salaried general practitioner (GP) who wrote an article called “Top Tips: Tinnitus” for other medical doctors.

The article as a whole is well-written and many practitioners would benefit from reading it.

Within the article is a section entitled “Ototoxic Drugs” – under which “tetracyclines” (doxycycline and minocycline) are listed.

Essentially, the author implies that doxycycline is “ototoxic” or poisonous to audio-vestibular systems.

What is his reference?  “NICE. Tinnitus. NICE Clinical Knowledge Summary. 2017.” (R)

I examined the reference provided by Thambyrajah and could not find ANY specific mention of “ototoxic” drugs.

Then, I examined the references for the “NICE” (National Institute for Health & Care Excellence) “Tinnitus” page and found one reference to an article about tinnitus-inducing drugs.

The article: “Tinnitus: Steps to Take, Drugs to Avoid” (2014) by Zimmerman & Timboe. (R) In this article, there was ZERO mention of tetracycline antibiotics (like doxycycline) as tinnitus inducers – let alone ototoxic agents.

This makes me wonder whether: (A) tetracyclines were erroneously included in Thambyrajah’s “Ototoxic Drugs” article – or (B) he failed to provide additional information.

Essentially, the drugs documented in his article were identical to those in the MDEdge article (referenced by “NICE”) – with “tetracyclines” seemingly added without reference.

(Remember, even if doxycycline causes tinnitus – this does NOT necessarily equal “ototoxic.” If the claim of “ototoxicity” is made, there needs to be some reasonable data behind it.)

In extremely rare circumstances, tetracycline antibiotics (including doxycycline) could cause neurotoxicity in the following ways: (R)

  • Cranial nerve toxicity
  • Neuromuscular blockage
  • Intracranial hypertension

Keep in mind that “neurotoxicity” does NOT automatically guarantee “ototoxicity.”

Something can be neurotoxic without ototoxic manifestations (e.g. hearing loss & tinnitus).

That said, it is theoretically possible that a small percentage of doxycycline users develop: cranial nerve toxicity; neuromuscular blockage; or intracranial hypertension.

In these cases, ototoxicity could occur as a downstream effect of the particular adverse event (not due to direct ototoxic insult from the chemical doxycycline.)

Doxycycline otoprotective? (Specific cases)

All that said, there are other data to suggest that doxycycline is otoprotective (likely to prevent ototoxic effects) in animal models.

Doxycycline may be otoprotective via the following mechanisms:

  • TNF-alpha reduction in CSF (via inhibition of TNF-Alpha Converting Enzyme a.k.a. TACE)
  • Inhibition of inflammatory matrix metalloproteinases
  • Reduction of other inflammatory cytokines & chemokines

Meli et al. (2006): “Doxycycline, probably as a result of its anti-inflammatory properties, had broad beneficial effects in the brain and the cochlea and improved survival in this model of pneumococcal meningitis in infant rats.” (R)

Helling et al. (2011): “The application of doxycycline might offer a new therapeutic approach to prevent NO-induced cochlea damage through ototoxic substances.” (R)

Chotmongkol et al. (2012): “The data suggest that doxycycline may be an effective regimen for otosyphilis” (400 mg/day for 21 days significantly improved hearing in 9 patients). (R)

Muri et al. (2019): Combining doxycycline, ceftriaxone, and daptomycin – reduced mortality, neuroinflammation, brain damage, and hearing loss in infant rat pneumococcal meningitis. (R)

Understand:

  • Just because doxycycline is otoprotective in unique circumstances for animal models does NOT mean that it is universally otoprotective in all circumstances.
  • Moreover, we should assume that circumstance-specific otoprotection in animals equals otoprotection and non-ototoxicity in humans.

Can doxycycline cause hearing loss?

Perhaps in rare cases.  However, at standard doses for most users, the answer is a resounding “no.”

Why? Because doxycycline (the chemical) does NOT exhibit ototoxic properties or appear to exert ototoxic effects.

In rare cases, doxycycline might be capable of causing hearing loss as a result of: an abnormally high dosage; long-term administration; interaction with other drugs, supplements, and/or medical conditions; and/or kidney dysfunction.

In other rare cases, doxycycline could trigger an allergic reaction or adverse event (e.g. intracranial hypertension) – and the allergic reaction or adverse event might then go on to cause ototoxicity and subsequent hearing loss.

Hearing loss on doxycycline does NOT mean doxycycline was the cause…

Users might also erroneously suspect doxycycline as the cause of hearing loss because they developed hearing loss while using doxycycline (or shortly thereafter).

Because doxycycline is used for bacterial infections – many fail to consider that bacterial infections themselves can be ototoxic in several ways:

  1. Inflicting damage before getting killed by antibiotics (direct effect)
  2. Triggering an inflammatory immune response (high levels of TNF, cytokines, chemokines, etc.) (indirect effect)
  3. Secretion of endotoxins while getting killed by antibiotics (direct effect)

The aforementioned mechanisms by which a bacterial infection causes ototoxicity can occur regardless of doxycycline administration.

This means that even if you took an antibiotic that you perceived as being “safe” or “less toxic” than doxycycline – you still would’ve experienced tinnitus and/or hearing loss (ototoxic effects) as a result of: direct damage by the infection; inflammation from immune system responding to the infection; and/or secretion of endotoxins by the infection while getting killed by antibiotics.

Others need to consider that the tinnitus and/or hearing loss may have also been a total coincidence (unrelated to both doxycycline and the infection) – resulting from:

  • Loud noise exposure: Failing to protect your hearing around any loud noise. Listening to loud music, going to a concert, operating a chainsaw, etc.
  • Medical conditions: Any medical conditions that are unmanaged or flaring up may cause tinnitus and/or hearing loss. Doxycycline could also interact with the pathophysiology of certain medical conditions to cause hearing loss.
  • Other substances: If you take any other substances while using doxycycline, it’s possible that those other substances are to blame (at least partially) for the tinnitus and/or hearing loss. Perhaps you took something that interacted with doxycycline and the unique interaction caused hearing loss (when it wouldn’t have otherwise occurred).

In my opinion, most people should NOT be concerned about losing hearing from doxycycline.

The only individuals who should be concerned about doxycycline causing hearing loss are those who experienced hearing changes from doxycycline in the past.

Can doxycycline cause tinnitus?

Yes.  Doxycycline has been reported to cause “tinnitus” (ringing in the ears), but this is a rare side effect – and usually of “mild” severity.

Even among the small percentage of patients who develop tinnitus while using doxycycline, it’s important to avoid automatically assuming that the tinnitus is: (A) related to “ototoxicity” (inner ear damage) or (B) permanent (it may fade after doxycycline discontinuation).

Smith et al. (2011) assessed data from 15,716 patients with rheumatoid arthritis (RA) taking minocycline and doxycycline – and found that only a small percentage of doxycycline users developed tinnitus. (R)

Among those who did develop tinnitus, most often it was “mild” but in rarer cases it was “moderate.”  There are no data supporting the idea that doxycycline caused “severe” tinnitus.

(It is also important to note rheumatoid arthritis itself may cause or increase risk of tinnitus – so we cannot know what extent to which doxycycline is to blame.)

Kim et al. (2021) reported: “Doxycycline and minocycline frequently cause tinnitus.” (R)

The citation for this claim was a Rizzi & Hirose (2007) paper entitled “Aminoglycoside ototoxicity.” (R)

I searched the entire paper for keywords “doxycycline” and “minocycline” and could NOT find any reference to doxycycline or minocycline at all – let alone causing tinnitus. (Either an honest error on their part, or a misleading citation.)

(I’m not implying that Kim et al. intentionally made an unsubstantiated claim, but I do not see any articles related to tetracyclines, doxycycline, or minocycline in the paper’s references.)

If you’re going to suggest that doxycycline frequently causes tinnitus – you should have supporting evidence for this claim.

A paper entitled “Neuropsychiatric Outcomes After Mefloquine Exposure Among U.S. Military Members” estimated rates of adverse events among military members who received: mefloquine, doxycycline, and atovaquone/proguanil. (R)

One of the adverse events documented was “tinnitus,” however, there are many confounds – making it unclear as to whether the specific medication discussed was the cause vs. something else (e.g. military-related noise, other psychiatric medications).

Incidence rate (IR) of tinnitus was estimated at 18.25 cases (deployed) and 15.17 cases (non-deployed) per 1,000 “person-years” for doxycycline.

(FYI: I think “person-years” = combining total number of people and multiplying by the years the people were in the study.)

If I’m interpreting this correctly, it would mean that odds of developing tinnitus after doxycycline is about 0.01% per year. (I may be misinterpreting this.)

Another report (2020) indicated that tinnitus occurred among doxycycline users at the same ore lower rates – than mefloquine users. (R)

To be completely fair, this isn’t exactly what I’d call an encouraging finding.

Why? If tinnitus rates are similar between doxycycline and mefloquine – then doxycycline may be more toxic than evidence suggests. (Mefloquine is known to be ototoxic and tinnitus-inducing.)

Among those who experience or develop tinnitus while on doxycycline, there’s a fairly decent chance that the doxycycline itself was NOT to blame.

(More likely culprits: Existing medical condition, immune-mediated inflammation, the bacterial infection, loud noise exposure.)

Moreover, it is important to underscore that tinnitus (perceived ringing in the ears) does NOT automatically mean that an ototoxic event or hearing loss occurred.

(In other words: If you experience tinnitus from doxycycline, don’t automatically assume you lost hearing.)

Scientific Research & Analyses

European Reviews (2011 & 2020)

In an exhaustive “European Review” published in 2011, side effect and adverse event data associated with medications were analyzed and reviewed.

Medications were then assigned numbers: “1” = ototoxic; “2” = tinnitus-generating (without ototoxicity); “3” = vertigo-generating; “4” = possible audiologic effects (e.g. hearing disturbances or non-specific hearing effects).

What number(s) were assigned to doxycycline? Just the number 2.  This means “onset of tinnitus only, with no documentable hearing damage.” (R)

Additionally, I found it quite odd that drugs within the tetracycline class: doxycycline; minocycline; tigecycline – were each assigned a different number.

  • Doxycycline = 2: Tinnitus risk.
  • Minocycline = 1. Ototoxicity risk.
  • Tigecycline = 3: Vertigo risk.

Why is this odd? Because in nearly every other class of drugs – most share the exact same subtype of audio-vestibular reactions. It is rare to have completely different subtypes of reactions within the same class.

Obviously the specific chemical can play a role here, but mechanism of action (and its magnitude of impact) is usually the predominant cause tinnitus, ototoxicity, vertigo – etc.

In a subsequent updated (and more comprehensive) “European Review” published in 2020 – Doxycycline was also assigned a “2” – meaning that is among “drugs inducing tinnitus.” (R)

That said, there was no reference to indicate the prevalence of tinnitus as a side effect in doxycycline users.

This means that tinnitus might occur in many users – or might occur in a very small percentage (more likely).

Minocycline was assigned “1,” “2,” and “3” in the updated review. But tinnitus (“2”) was documented as being “very rare” (less than 0.01% of users).

To me this makes almost ZERO sense to me unless the “1” is also “very rare.”

Why? Because ototoxicity usually causes tinnitus.  (This may mean that minocycline ototoxicity is also “very rare” – but who knows.)

Tigecycline was assigned a “3” in the updated review – indicating vertigo risk exactly like the 2011 review.

Frequency of vertigo among tigecycline users is documented as “common” (1-10% of users).

Risk: Tinnitus can occur.

  • Just because the European Review documented that tinnitus can occur does NOT mean that tinnitus always occurs or is a common side effect.
  • If tinnitus occurs at a similar rate in minocycline users as doxycycline users – this side effect is thought to be experienced in less than 0.01% of users – or less than 1/100.)
  • And while the European Review suggests that tinnitus occurs without hearing loss among doxycycline users – this does NOT mean that they know for sure no hearing loss occurred.
  • For example: Those who developed tinnitus didn’t have a hearing test at baseline (pre-doxy) then again during/after treatment (post-doxy) to assess change.
  • Perhaps ultra-high or high-frequency damage did occur and wasn’t assessed. (High-frequency hearing tests are rarely conducted.)
  • That said, I think there would be at least a couple of “official” case reports documenting hearing loss from doxycycline if it were a legitimate phenomenon.

Doxycycline (StatPearls)

StatPearls is science-based, medically reviewed, and provides concise overviews of various medications (uses, common side effects, adverse reactions, etc.).

The Doxycycline “StatPearls” page does NOT list: tinnitus, hearing loss, hearing change, or ototoxicity – as side effects or adverse reactions. (R)

In other words, even tinnitus is probably so uncommon with doxycycline that it wasn’t worth documenting on the Doxycycline StatPearls page.

The page does list “migraines” and “intracranial hypertension” as severe adverse events – both of which have potential to cause tinnitus (but the tinnitus in these cases would be more of a downstream effect wherein: doxy causes migraine or IH which in turn yield tinnitus.)

Risk: None documented.

Neil Bauman (HearingLossHelp)

Neil is one of the most thorough researchers on the internet for everything related to hearing loss, tinnitus, and ototoxicity – and is very critical of medications.

He wrote an article on doxycycline & hearing loss and I’ve documented a few of his takeaways. (R)

  • “It would appear that hearing loss is NOT a big problem with drugs in the tetracycline family.”
  • “The tetracycline family is generally NOT thought to be all that ototoxic – at least to most people.”
  • “Tetracycline and doxycycline are NOT listed in the Physicians’ Desk Reference (PDR) as causing hearing loss, minocycline is.”
  • The Canadian version of the “PDR” – The Compendium of Pharmaceuticals and Specialties (CPS) lists tetracycline but NOT minocycline as causing hearing loss.

Risk: Low (2/5)  In his book “Ototoxic Drugs Exposed,” doxycycline is rated as a “2” (out of 5) in terms of risk – meaning it’s relatively unlikely to cause ototoxicity in most people.

(For reference: “5” = extremely ototoxic and “1” = lowest risk).

If you need medications and want to look at which ones are lowest risk for tinnitus/hearing loss (based on his exhaustive data collection & analysis), I highly recommend buying his book.

Takeaways from these sources…

  • If tinnitus were a common doxycycline side effect, I suspect that it would be much more consistently documented as such. (Nowhere could I find data to support the idea that tinnitus is “common”).
  • For example: StatPearls does NOT document tinnitus as an adverse reaction for doxycycline; European Review includes it (but does not mention its prevalence); the PDR does not consider doxycycline to be ototoxic.
  • Neil Bauman (PhD) who manually analyzed “adverse reactions” for doxycycline found that it was relatively unlikely to cause tinnitus and ototoxicity.
  • There is no incentive from “big pharma” to hide tinnitus or hearing loss risk associated with doxycycline – as the drug is not under patent protection (and is available as a cheap generic).

Could ototoxicity occur as a result of a doxycycline-related interaction?

Yes. There appears to be some data to suggest that ototoxicity (hearing loss & tinnitus) could occur if doxycycline is administered with antimalarial agents (e.g. mefloquine).

Karwang et al. (1994): Quinine toxicity when given with doxycycline and mefloquine. (R)

  • 26-year-old, Thai male, falciparum malaria.
  • Initially treated with IV quinine HCL (600 mg, q.i.d.) and oral doxycycline (100 mg, b.i.d.).
  • Due to nausea and tinnitus and persistence of parasitemia in peripheral blood smears – the dose of quinine was reduced 2 days after the first treatment (to 300 mg), while oral mefloquine (750 mg) was initiated with 2 divided doses ~24 hours apart.
  • During treatment, the patient developed: hearing loss and deafness (right ear) that lasted ~1-week post-quinine administration.
  • Higher plasma quinine and lower whole blood mefloquine concentrations than expected from simulation profiles were detected ~4 days after the first treatment – yet mefloquine was increased immediately upon cessation of quinine.

What can we make of this case?

  • This patient had parasitemia – which may have been directly ototoxic OR indirectly ototoxic (e.g. immune-mediated inflammation and/or toxic secretions while dying from treatment that cycled up to inner ears).
  • The patient was administered a very high dose of quinine (as it generally works for this specific type of parasite – but needs to be high-dose for a curative effect.)
  • Mefloquine was arguably administered “too quickly” after quinine cessation (given that plasma quinine remained abnormally high).
  • That said, the patient was in a serious situation and necessitated immediate treatment (hence the rapid initiation of mefloquine).
  • “Cinchonism” is a common side effect of quinine at therapeutic concentrations and is characterized by tinnitus, headache, vision changes, and sometimes “deafness.”
  • Why were concentrations of quinine abnormally high? Because there was an interaction between doxycycline and quinine wherein doxycycline caused a significant increase in plasma quinine concentrations.
  • (This is a known interaction between tetracycline antibiotics and quinine – and a likely reason as to why doxycycline bolsters quinine’s effect.)
  • Mefloquine further compounded the interaction between doxycycline and quinine likely by competing with quinine for binding sites to generate a higher “free quinine” concentration and more substantial adverse events (e.g. ototoxicity).
  • Deafness in this patient persisted after treatment (total hearing loss in right ear).

Everything considered, the ototoxicity in this case was induced by high-dose, intravenous (IV) quinine.

Doxycycline didn’t directly cause ototoxicity, but increased plasma concentrations of quinine to exacerbate its ototoxic effect.

Adding mefloquine to both quinine and doxycycline further exacerbated this ototoxicity.

Nothing in this case substantiates the idea that doxycycline is inherently ototoxic. However, one should be cautious if ever combining doxycycline with quinine and/or mefloquine.

Doxycycline & Hearing Loss, Tinnitus (Anecdotes)

HearingLossHelp “Email” Anecdotes

  • Person 1: Man had severe ototoxic reaction to Tetracycline that left him with severe hearing loss in both ears.
  • Person 2: Chlortetracycline for strep throat and experienced permanent hearing loss.
  • Person 3: Doxycycline for UTI and lost a significant amount of hearing.
  • Person 4: Doxycycline for 10 days to treat a cold and the hearing in an “already-impaired right ear” reduced to virtually zero and remained there.

Perhaps Neil Bauman has more than just 2 anecdotes for doxycycline specifically.

Everything considered, we do not know the entire medical history/statuses of these individuals nor whether other factors (e.g. other medications, medical conditions, etc.) may have caused the hearing losses – nor whether hearing improved after treatment.

Reddit Anecdotes

Anecdote #1

  • Increase in tinnitus and hyperacusis after doxycycline.
  • Details: Had infection. Had tinnitus for 10 years before doxycycline that got a little worse as time progressed.
  • Highly sensitive to sound and has a burning sensation. Has mild hearing loss.
  • After finishing antibiotics, user said “I don’t think it really has anything to do with the meds.”

Anecdote #2

  • Took 2 weeks of Doxy and after that, I noticed ears ringing.
  • Had the ringing for 6 months now.
  • Described tinnitus as “like old Sci-Fi computer sounds.”
  • This person took doxycycline for Lyme disease – which can cause tinnitus itself (or in response to doxy).

Anecdote #3

  • Started taking doxycycline for acne.
  • About 3 weeks into treatment noticed a faint flash bang-type “eeeee” ring when studying.
  • Had minor hearing loss 2 years prior to treatment but takes good care of ears otherwise.

Anecdote #4

  • Was on Doxy for a while for an infection.
  • It caused tinnitus for about 3 months.
  • Since then it completely faded or person is adjusted and desensitized to it (such that they no longer notice it).

TinnitusTalk.com Anecdotes (Doxycycline)

Many of the individuals on TinnitusTalk have preexisting hearing loss and/or tinnitus – and are prone to “hyperfixate” on everything related to ototoxicity, hearing loss, and tinnitus.

This hyperfixation is a double-edged sword: (1) detection of subtle changes in hearing that the average person probably would not notice AND (2) potential for psychosomatic “tinnitus” as a nocebo-like response to medications.

Included below are accounts of tinnitus and/or hearing loss from TinnitusTalk members.

The best way to find these is to Google: “TinnitusTalk.com” + “Doxycycline.”

(I didn’t include every single anecdote about “doxycycline” from this forum.)

  1. Tinnitus spike 1-week after doxycycline treatment completion.
  2. Tinnitus, vision loss, swallowing issues, tendon rupture after doxycycline.
  3. Started taking doxycycline (100 mg/day) and it worsened tinnitus a lot.
  4. Tinnitus & hyperacusis started while taking doxycycline.
  5. Worsening tinnitus after doxycycline – but also taking: amitriptyline, pregabalin, alverine citrate, fluoxetine, and valerian.
  6. Doxycycline and amoxicillin for Lyme disease – sudden hearing loss. May have been more from the Lyme/its reaction to meds.
  7. Doxycycline causing a tinnitus spike when taking for Lyme disease.
  8. Stopped taking doxycycline after only 3 pills as tinnitus “exploded” to the point this individual couldn’t hear anything. Individual already had drug-induced tinnitus from vancomycin.
  9. Tinnitus and hearing loss after taking doxycycline (200 mg/day) for 6 weeks to treat a sinus infection.
  10. Person with existing tinnitus claimed that doxycycline caused their ears to go “nuts” and experienced significant head pressure.
  11. Claimed that hearing dipped dramatically while taking a combination of doxycycline (300 mg/d), nortriptyline (50 mg/d), and topamax (25-75 mg/d).
  12. Developed tinnitus while taking doxycycline (over a 6-month duration) – but after ~5 months of discontinuation the tinnitus “lowered significantly in volume.”
  13. Took doxycycline (100 mg, b.i.d.) for 2 days to treat an abscess and developed tinnitus. Experienced no improvement ~6 months after stopping doxycycline but noticeable improvement 1 year later. 3 years later has “99% no noise.” (To me it sounds like doxycycline may have altered neurochemistry a bit and it took a while for things to “recalibrate” to normal).
  14. Doxycycline caused lightheadedness and tinnitus (which person had for 24 years) worsening.
  15. Tinnitus began while taking doxycycline for suspected Lyme disease – started after first 4 tablets (doses) but stopped thereafter. Additional variables: High psychological stress (deaths of family members); “shingles” rash (just after tinnitus onset); “hammering nails” to make a bed (this is when tinnitus was first noticed: ~30 minutes after); drives a relatively loud vehicle (up to 90 dB).
  16. Took doxycycline and now has a horrible noise in ears around the 7 kHz range.
  17. Tinnitus began while taking doxycycline AND Quinine HCL. (This is combination may lead to “quinine toxicity” and ototoxic manifestations.)
  18. Person with tinnitus started hearing “buzzing sounds” that were louder in the evening/night for about 2 months. Had been using both doxycycline (for an infection) and Tylenol & Aleve (for back pain).
  19. Tinnitus “seems to be” a little higher pitched after 3 days of doxycycline (200 mg/day) administration to treat a skin infection.
  20. Took doxycycline for 6 days (200 mg/day) and noticed ringing in ears ~3 days in. Had traditional (non-high-frequency hearing test) and it was totally normal.
  21. Took doxycycline for UTI and after 3 doses noticed a “new kind of tinnitus” with ringing at a deep pitch and felt extremely dizzy. Had taken Bactrim prior to doxycycline AND is a musician (regular noise exposure).
  22. Put on 300 mg/day to treat Lyme disease. Caused 2 tinnitus “spikes” and possibly hearing damage (unconfirmed). (Had tinnitus prior to taking doxycycline).
  23. “Brutal” tinnitus from doxycycline to the extent that individual went to a brain specialist, neurologist, and got an MRI which made tinnitus far worse (due to loud noise).
  24. Developed tinnitus while on doxycycline and it disappeared within 9 months. (Has theory that medication can take ~8 months or more to “clear inner ear”).

I should also underscore the fact that several reports from TinnitusTalk indicated that doxycycline was successfully used/administered without any noticeable change in tinnitus (tone/frequency, loudness, etc.).

What can we take away from these anecdotes?

Not much.  The majority of anecdotes are consistent with the scientific literature in suggesting that “tinnitus” can occur with doxycycline usage – but NOT “ototoxicity” or “hearing loss.”

Do NOT let anecdotes “scare” you away from doxycycline if it’s medically needed (e.g. for an infection).

You can Google literally any drug and there will probably be a report from someone who reported tinnitus and/or hearing loss while using it.

Chances are good that you are different from these “anecdotes” in various ways (including but not limited to):

  • Physiology & genetics
  • Specific infection & its severity
  • Dosage, duration, manufacturer, administration timing
  • Usage of other substances (meds, drugs, supplements)
  • General health & medical conditions (preexisting conditions)
  • Habits & daily routine

With regard to anecdotes, we often don’t have specific details such as:

  • Preexisting tinnitus and/or hearing damage (in the user)
  • Doxycycline dosage, duration of usage
  • Whether other substances/medications were used (including caffeine, alcohol, etc.)
  • Whether doxycycline was the likely cause vs. another variable (e.g. loud noise exposure during treatment, various medical conditions, etc.)

Therefore, you should NOT assume that you’ll develop tinnitus from doxycycline.

According to ClinCalc, there were over: (A) 5 million users & ~10.1 million prescriptions in 2018 AND (B) 5.3 million users & ~8.8 million prescriptions in 2019 – for doxycycline.

It’s fair to hypothesize that many doxycycline users probably aren’t self-aware enough to: (1) notice tinnitus while taking doxycycline (especially if mild) and/or (2) realize that doxycycline may have caused tinnitus.

Additionally, there are likely a subset of persons who may not even realize that tinnitus is abnormal –such that mild/moderate tinnitus doesn’t bother them in the slightest (perhaps due to high stress tolerance or genetic predisposition).

Plus, there are some people who probably do realize that doxycycline may have caused tinnitus – but don’t bother reporting it to a doctor, adverse events database, or writing about this reaction in a forum.

Conversely, it has been hypothesized that unwanted/negative side effects like “tinnitus” probably occur at lower rates than would be estimated after reading anecdotes online.

Why? It’s thought that those with negative experiences are most vocal on forums – and those with positive experiences don’t bother reporting anything because they were unaffected by the medication.

My guess is that there’s probably some “middle ground” wherein: (1) a subset of doxycycline users who experience tinnitus don’t bother reporting it (for various reasons) and (2) another subset of doxycycline users who develop tinnitus are extremely vocal.

It’s unclear as to whether these two types of patients “cancel” each other out.

Nonetheless, considering the number of annual doxycycline users relative to tinnitus anecdotes – it seems as though tinnitus is NOT a very common side effect.

Another interesting anecdote: Doxycycline HELPED tinnitus

I feel it is very important to underscore the fact that most doxycycline users do NOT experience tinnitus.

Furthermore, there may be a subset of users for whom doxycycline actually reduces the severity of preexisting tinnitus… below is one such anecdote.

Success with Doxycycline for Tinnitus… Doxycycline monohydrate improved tinnitus. (R)

  • Had steady tinnitus ~3 years & had “Lyme disease” in the past
  • Remembers ringing in ears when had “Lyme disease” (this is common – Lyme is ototoxic)
  • Suspected that “current tinnitus” might be related to Lyme reinfection (due to recent tick bite)
  • Was prescribed doxycycline hyclate for 10 days (100 mg, twice daily): This caused tinnitus to “stop.”
  • Tinnitus improved significantly within 24 hours and after 5 days was “pretty much gone.”
  • After finishing the 10-day course of doxycycline, the tinnitus returned within 24 hours.
  • Got a second doxycycline prescription. Tinnitus improved within 48 hours of starting second course of doxycycline.
  • During treatment, tinnitus occasionally occurred, but it was “much less severe.” (User thinks that this tinnitus was due to the doxycycline rather than preexisting tinnitus – interesting.)
  • Experienced some “residual tinnitus” about 48 hours after treatment ended. About 5 days after treatment ended, user rarely notices the tinnitus. (The tinnitus is most noticeable at night/early morning – but quickly “goes away.”)

This individual claims that doxycycline has “greatly improved the tinnitus” that had been bothersome for over a year.

What do I make of this? I do NOT know whether this individual had Lyme disease the second time (tick bites do not guarantee Lyme).

Moreover, this person had tinnitus for over 3 years prior to this course of doxycycline.

Obviously if this person did in fact have untreated Lyme disease (for a long-term), then the doxycycline may have been what improved the tinnitus.

That said, it’s also possible that this individual had longstanding neuroinflammation (perhaps due to past Lyme-related ototoxicity or resulting from other cochlear insults).

Because doxycycline is an extremely potent anti-inflammatory antibiotic, it makes logical sense that doxycycline could (theoretically) reduce/attenuate tinnitus caused (fully or partially) by chronic neuroinflammation.

In this case, when doxycycline is administered, neuroinflammation would decrease and the perceived tinnitus would also diminish (perhaps to a significant extent).

Doxycycline will not necessarily reverse or “fix” any preexisting damage that may have caused tinnitus (unless the damage was very recent).

However, it may have helped disrupt psychological feedback loops involving tinnitus sensitization & perception wherein this individual got a much-needed break from tinnitus (for a few weeks) and now there’s less focus on it (perceptually).

Is tinnitus from doxycycline permanent?

Depends on the person.  I’ve found cases in which tinnitus experienced on doxycycline fades soon after treatment is over.

I’ve found other cases in which tinnitus experienced on doxycycline fades within 6-12 months after treatment.

I’ve only found a handful of cases (TinnitusTalk.com) in which tinnitus developed while on doxycycline and has remained permanent for years (without any lessening in severity or change in tone.)

According to one TinnitusTalk.com member, German medical documentation regards tinnitus resulting from doxycycline as being fully “reversible” (or reversibel in German).

Assuming that doxycycline did NOT actually cause ototoxicity, any tinnitus that does NOT fade after treatment may be “fixable” with various forms of neuromodulation (e.g. neuropsychiatric medications, dietary supplements, habit/routine changes, etc.).

Causes of hearing loss and/or tinnitus while taking doxycycline? (Likely Reasons)

Person has infection (e.g. Lyme disease). Infection may damage ears directly before doxycycline is administered and during treatment (until fully killed off).

Immune system responds to infection. Inflammatory cytokines/chemokines are released. High concentrations of certain cytokines/chemokines may directly damage/insult the inner ears (causing tinnitus/hearing loss).

Endotoxin release during treatment. As the infection is getting killed (over a period of days or weeks) by doxycycline, it releases “endotoxins” which may damage the ears directly – and/or may trigger additional immune-mediated inflammation to inflict damage.

Doxycycline might directly cause tinnitus and/or hearing loss in some people. Risk would be greater in long-term and/or high-dose users.

  • Excessive anti-inflammatory effect: Anti-inflammatory drugs (e.g. NSAIDs) are associated with tinnitus and hearing loss because anti-inflammatory actions may reduce cochlear blood flow. (Something similar could be occurring with doxycycline – as it is an extremely potent anti-inflammatory and seems protective against inflammatory-related ototoxicity.)
  • Direct chemical insult (e.g. allergic reaction): Some people might develop tinnitus due to an allergic reaction to doxycycline OR just because the chemical doxycycline is toxic for whatever reason to a specific person. Additives and/or toxins in the manufacturing process may also be to blame here.

Doxycycline might interact with other substances (meds, drugs, supplements, etc.): Even if just coffee or alcohol. Dietary supplements may interact in unpredictable ways with doxycycline (possibly to cause toxicity when there wouldn’t have otherwise been one).

Interaction with medical conditions: Perhaps doxycycline interacts with the pathophysiology of a particular medical condition that a person has to cause tinnitus and/or hearing loss. (This would be difficult to confirm.)

Other possible causes of tinnitus and/or hearing loss from doxycycline…

  • Acid reflux (?): This is extremely unlikely, but it’s important to know that doxycycline is a highly acidic medication. In some users it may trigger severe acid reflux – particularly if the person isn’t “upright” for at least 30 minutes after ingestion. Acid may “reflux” up into the sinuses and inner ears – causing tinnitus and/or hearing changes.
  • Additives & toxins (specific manufacturer): Doxycycline preparations differ in both additives and quality control based on the specific manufacturer. It’s theoretically possible that additives from certain manufacturers could be toxic to the ears (even in small concentrations). It’s also possible that poor quality control oversight could lead to “contamination” with toxins – which could damage hearing. (This may explain why people have no problem with one manufacturer and reactions with another.)
  • Blood flow & pressure changes: There may be changes in blood flow/pressure via possible vasodilation or vasoconstriction following administration of doxycycline which could contribute to tinnitus. Pressure changes in otolaryngologic systems (ear, nose, throat) might give rise to tinnitus or “weird sounds.”
  • Allergic reaction: In the event that you’re allergic to the chemical doxycycline, there’s a chance that this may trigger an allergic reaction and cause inflammation and tinnitus. Assuming the reaction is identified and managed promptly, there should be no lasting effect.
  • Altered mucosal flow: Perhaps “mucus” within your ear, nose, throat area becomes altered while using doxycycline in a way that might cause tinnitus. (If this is the case, the tinnitus should reverse after treatment.)
  • Commensal bacteria “die off”: It’s possible that typical commensal bacteria in and/or around the inner ear could trigger some inflammatory response while dying off in response to doxycycline administration and cause transient tinnitus or hearing loss.
  • High stress: Many people are highly stressed (psychologically and physiologically) when fighting an infection and thinking about using an antibiotic. This stress might interact with other variables to cause tinnitus and/or amplify existing tinnitus.
  • Monohydrate vs. Hyclate: Doxycycline is sold as “doxycycline monohydrate” and “doxycycline hyclate” – these are variants of the same drug with no difference in efficacy. Some believe that the “monohydrate” format may be more tolerable (and cause fewer side effects).
  • Nocebo-like effect: Doxycycline isn’t a “placebo” but it may give rise to nocebo-like effects wherein you’re afraid to take it due to tinnitus, become stressed, and your body changes in such a way as to cause “tinnitus” or you become convinced that “phantom sounds” are tinnitus (such as in complete silence) due to elevated stress.
  • Neurotransmitter changes: Doxycycline may alter neurotransmitter concentrations in the brain to a reasonable extent. Alteration of neurotransmitters (particularly serotonin) might cause preexisting tinnitus to become “louder” (perceptually).
  • Perceptual changes: Doxycycline may alter your state of consciousness (even subtly) as a result of its physiologic effects. A perceptual change might result in tinnitus or make you more aware of existing tinnitus.
  • Yeast (e.g. candida): A relatively “far out” hypothesis for why doxycycline may cause tinnitus and/or hearing loss is yeast (e.g. candida) overgrowth. Most candida growth will be localized (e.g. within the mouth) among persons with healthy immune function – and should not affect hearing. However, it’s possible that yeast could somehow spread to the inner ears and trigger an inflammatory response with tinnitus and hearing loss.

Risk factors for hearing loss & tinnitus with doxycycline

Because doxycycline isn’t regarded as frequently causing tinnitus, there are no scientifically-substantiated risk factors.

However, below are risk factors that I’ve come up with (based on what I’ve read and suspicions).

Infection specifics (exact infection, severity, duration before treatment)

  • The infection is likely more culpable for the hearing loss than doxycycline (in most cases).
  • Specific infections like Lyme disease seem to cause tinnitus and hearing loss more often than others.
  • If the infection is severe and/or not treated quickly – risk of tinnitus may increase.
  • That said, there’s likely an interaction between: severe infections (and immune response); doxycycline (high-dose & long-term); and endotoxin-release (during treatment).

Past tinnitus with tetracycline antibiotics (including doxycycline)

If you’ve experienced any tinnitus from tetracyclines, you may have at higher risk of experiencing it with doxycycline.

Preexisting tinnitus and/or hearing loss

  • Doxycycline might impact your physiology in a way that changes your “normal tone” to something different – which causes anxiety/stress.
  • (In some cases this tinnitus and/or hearing loss may be subclinical prior to doxycycline.)

Co-administered substances (meds, alcohol/caffeine, drugs, supplements)

  • For example, doxycycline can elevate concentrations of quinine to induce quinine toxicity (ototoxicity, hearing loss, tinnitus).
  • That said, doxycycline may interact with other substances in ways that have not been documented – so proceed with caution when using both.
  • (Usually doxycycline isn’t the culprit of the tinnitus in interactions though).

Note: Talk to a pharmacist if you have any questions about whether doxycycline interacts with any other substances you use (e.g. medications & OTC drugs, vitamins & supplements, illicit drugs, etc.).

High-dose (e.g. 300+ mg/day)

Tinnitus and hearing loss risk may be greater among those who take high-dose doxycycline (300-600 mg/day) – especially if body dimensions are small (e.g. short & skinny).

Long-term administration

  • Using doxycycline for a long-term may increase risk of tinnitus and/or hearing loss – particularly if the dosage is high (e.g. 300+ mg/day).
  • This may be partly why individuals treated for conditions like Lyme disease (which often requires a full month of treatment) experience tinnitus.

Old age

  • Older adults (65+ years of age) may have preexisting otic (ear-related) damage from a combination of aging, noise exposure, and other medications taken throughout life.
  • Additionally, endogenous antioxidant responses may be lower in older adults – and duration to excrete doxycycline may be longer than younger individuals.
  • For these reasons, older adults may be more susceptible to tinnitus and/or hearing loss while on doxycycline.

User-specific pharmacokinetics

Doxycycline may exhibit differences in pharmacokinetics between users which could influence likelihood of causing tinnitus and/or hearing loss.

  • Administration details: Empty stomach vs. with food; time of administration (circadian interactions); degree of hydration; one large dose vs. divided doses; etc. – may affect likelihood of tinnitus and/or hearing loss.
  • Kinetic variables: The AUC (area under the curve); bioavailability; clearance/elimination rate; peak concentration – may differ between users and influence likelihood of adverse reactions (e.g. tinnitus & hearing loss).
  • Organ function: The half-life of doxycycline can increase in persons with kidney disease (slightly) and liver disease (significantly). You may be more susceptible to ototoxic reactions if your kidneys/liver aren’t functioning normally.

Genetic susceptibility

There may be certain genes and/or gene combinations that influence susceptibility to developing tinnitus and/or losing hearing while taking doxycycline.

How to minimize risk of tinnitus & hearing loss with doxycycline…

There’s no exact science here – and much of this is a hypothesis.  These are my ideas and are NOT medical advice.

Consult a medical doctor and verify safety of these methods before implementation.

Use the minimal effective dose

Ask your doctor what the smallest effective dose of doxycycline is for the condition it was prescribed to treat.

Take the minimal effective dose – and do NOT exceed this amount.

The thought here is that if doxycycline or any additive/inert component is “toxic” – you’ll be limiting the toxicity.

Take for the minimal necessary duration

Take doxycycline for the least amount of time to treat your specific medical condition (e.g. infection) – but do NOT take for longer than that.

I’d personally avoid using doxycycline long-term for management of skin conditions (unless nothing safer works).

Do not take other medications unless necessary

There are times when doxycycline might interact with other medications (even if not necessarily documented in pharmacy literature.)

Ask both your doctor AND pharmacist about all possible interactions between doxycycline and your current medication regimen (assuming you take other meds).

I’d personally avoid taking other medications with doxycycline unless medically necessary.

Avoid certain supplements (?)

It is unknown as to how doxycycline interacts with all supplements.

Some supplements are understood to decrease doxycycline absorption and effectiveness (and these should be avoided because otherwise doxy won’t treat your infection properly.)

  • Dairy, antacids, calcium, iron, laxatives, magnesium, bile acid sequestrants: Should not be administered for at least 2-4+ hours after doxycycline and 6-8+ hours before doxycycline – as they interfere with absorption/efficacy.
  • CYP450 modulators: Any substance that modulates CYP450 enzymes has the potential to influence doxycycline pharmacokinetics – and possible adverse events.

Use otoprotective supplements (?)

Taking otoprotective agents while on doxycycline may be of benefit in reducing likelihood of ototoxic effects.

Below are supplements I’ve taken with doxycycline and that I suspect should help prevent tinnitus and/or hearing loss.

Note: These are affiliate links – meaning I earn a small amount if you purchase though me. The cost is the exact same and it helps me support running this website.

Important: These should NOT be taken at least ~2-4+ hours after doxycycline and at least 6-8+ hours before doxycycline dosing. (Talk to a pharmacist and doctor for accurate information.)

That said, supplements could interact in unforeseen/weird ways with doxycycline and may have the opposite effect in some cases – so do NOT assume that what I’ve listed are 100% safe.

I would avoid both caffeine and alcohol while on doxycycline – this means zero coffee or alcohol.

I’d administer all of the supplements in the morning (except melatonin) with fatty food (~2-4+ hours after doxycycline) AND the carrots (Vitamin A) and almonds (Vitamin E).

Note: Vitamin A & Vitamin E should be used with caution to avoid toxicity (these are fat soluble vitamins) – particularly if you already use a multivitamin.

I’d also administer Vitamin C, NAC, Alpha Lipoic Acid, Taurine, Magnesium – again at night (~2-4+ hours after second doxycycline dose).

At night I’d take high-dose melatonin (10+ mg) for its antioxidant and anti-inflammatory effects.

Keep stress as low as possible

High stress may increase inflammation, alter blood flow, and increase susceptibility to hearing loss (in general).

Furthermore, stress might make you focus obsessively and excessively on your “hearing” resulting in you perceiving phantom sound in complete silence as “ringing.”

Do whatever works to help manage stress. Healthy recommendations include: cardiovascular exercise; body-scan meditation; self-hypnosis.

Stay hydrated

Although doxycycline is excreted extrarenally (not requiring kidneys), I suspect that hydration still helps with elimination/excretion.

For this reason, I recommend maintaining adequate hydration throughout treatment. (Don’t go overboard, but make sure you’re drinking enough water.)

Manage yeast

Though I’m not convinced that “yeast” overgrowth is a mechanism by which antibiotics cause ototoxicity/tinnitus, it’s a possibility. How can you manage yeast?

Ensure that you’re brushing your teeth regularly, using mouthwash, and brushing yeast off of your tongue.

(Yeast or “candida” overgrowth is more likely in immunocompromised persons – but may happen to anyone while on antibiotics.)

Protect hearing

This means wearing earplugs, NR-25+ earmuffs, and avoiding all loud noise while on doxycycline. Why? Just for good measure.

If doxycycline somehow lowers the threshold for noise-induced hearing loss, you’ll be protecting yourself from this possibility.

(I don’t think it does, but this is a general precaution I recommend for all antibiotic users).

Supplement AFTER doxycycline (?)

If you experience tinnitus or any change in hearing, you may want to continue supplementing AFTER the treatment ends.

My personal stack would look something like this:

AM: Multivitamin, Vitamin D3 (2000 mg), Calcium-d-glucarate, Vitamin C (1000 mg), Alpha Lipoic Acid, Alpha-GPC, NAC (1200 mg), Taurine (1000 mg), Quercetin with Bromelain, Magnesium Citrate or Glycinate or Threonate (200-400% RDA), Ubiquinol, Carrots (3+ oz), Almonds (1/2 cup) – all taken together after a fatty meal.

PM: Vitamin C (1000 mg), NAC (1200 mg), Taurine (1000 mg), Magnesium (200-400% RDA), Alpha Lipoic Acid + Melatonin (10 mg before bed) – all on an empty stomach.

Note: This is my personal stack. Not everyone will react well to it. Verify safety with a medical doctor & pharmacist if you want to try.

What about probiotics? I’m not a big fan of probiotics.

Research suggests that probiotics result in slower recovery after antibiotics (contrary to most “advice” online).

The other problem with probiotics is that they may introduce bacteria with antibiotic resistance genes into your body (very bad if this happens).

I’m not telling you what to do for your recovery/body – just sharing my thoughts here on probiotics.

If you want to use probiotics, that’s your call. I also suspect that probiotics may increase a “die off” (Herxheimer-esque) reaction [in select cases] if administered while on antibiotics – which may increase inflammation/endotoxin secretion and likelihood of adverse events.

What if you develop tinnitus or hearing loss while using doxycycline?

Inform your doctor and/or pharmacist IMMEDIATELY and talk about potential alternative solutions (if there are any).

The tinnitus is often reversible such that it may fade after doxycycline treatment ends.

However, hearing loss may be permanent and could signal that doxycycline is incompatible with your particular physiology.

That said, do NOT stop doxycycline without getting the “okay” from your doctor.

Why? If you have a serious infection, it could cause the infection to become antibiotic-resistant and/or stopping treatment may harm your health.

Obviously if you’re dealing with something like “acne” (not a severe infection) – doxycycline can be stopped immediately upon experiencing any adverse events.

Keep in mind that any tinnitus and/or hearing loss on doxycycline may be more due to the infection interacting with doxycycline (e.g. releasing endotoxins) – than from the doxycycline itself.

I’d also consider supplementing with otoprotective agents during the remainder of your treatment and after treatment (as these might promote hearing recovery).

How do you know if doxycycline caused your tinnitus and/or hearing loss?

Most doxycycline users probably can’t know with 100% certainty that tinnitus and/or hearing loss were from doxycycline.

I’d guess you can be fairly certain that doxycycline caused tinnitus and/or hearing loss if you:

  • Did NOT taking doxycycline for a severe infection (e.g. using it for acne)
  • Eat a nutritionally adequate diet & exercise
  • Were NOT highly stressed
  • Have no significant preexisting medical conditions
  • Were NOT exposed to loud noise (e.g. concerts, sirens, construction, etc.)
  • Were NOT using other ototoxic medications, drugs, or supplements
  • Do NOT have preexisting tinnitus or hearing issues
  • Used doxycycline at a conventional, appropriate dose

You can still be relatively certain that doxycycline caused tinnitus and/or hearing loss if you didn’t have a severe infection and tinnitus/hearing loss occurred during treatment.

My experiences taking doxycycline…

Of all the times I’ve been on doxycycline – it was either prescribed (1) erroneously OR (2) to play it safe in case I had an infection.

All of the times I’d been prescribed doxycycline, it was administered on an empty stomach – twice per day: once in the morning (100 mg) and once in the evening (100 mg).

Course #1: 7-days (200 mg/day)

The first time the doctor thought I might have a bacterial infection (yet testing came back negative) – I’d already finished the entire 7-day course by the time I heard back from the doctor with test results.

Although I was nervous to take it, I experienced zero change in hearing or tinnitus/ringing in the ears.  (This was back in winter ~2016.)

Course #2: 21-30 days (200 mg/day)

The second time I took doxycycline was for ~21-30 days (I believe a full month) and it was administered with the thought that I might have “Lyme disease.”

I tested negative for Lyme and doctor told me I can just finish the course to play it safe.  I took the full 30-day course of doxycycline. (This was back in summer 2017.)

Between then and now, I’ve been exposed to: vancomycin (IV) + levofloxacin (IV) – for over a week in the emergency room (turned out I didn’t need ANY of these – docs were playing it safe).

Took azithromycin + ethambutol + rifampin Mon, Wed, Fri for ~2 years straight for a lung infection – completed these April ~2019.

I experienced transient bouts of mild tinnitus during treatment – but all faded post-treatment.

Related: Azithromycin & Hearing Loss

At one point (2018) I got the influenza vaccine and experienced faint albeit annoying tinnitus (sounded like “wind blowing”) in one ear that thankfully faded to nothing over the course of several months post-vaccination.

Moreover, I survived the delta strain of COVID-19 (prior to vaccines being available) and experienced some mild tinnitus during the infection but it faded away once recovered. I received both Pfizer vaccines without any adverse events.

Course #3: 200 mg/day

As of January 2022, doctor suspects that I might have a sinus infection (despite the fact that I don’t think I do… zero runny nose, no pressure/pain in sinus area, etc.).

Only symptoms: “globus pharyngeus” and postnasal drip sensation (wasn’t sure if it actually was postnasal drip – thought it could be reflux-related).

I hesitated to start doxycycline but figured I had nothing major to lose (other than some gut bacteria) by trying doxycycline to determine whether it would help my globus pharyngeus subside.

The doctor had me convinced that it could be a bacterial infection.

For this reason, I started doxycycline in the evening (100 mg) then woke up and took another dose (100 mg) ~12 hours apart from the first.

Then took another dose (100 mg) the following evening.  After 3 doses, I experienced some extremely brief (1-3 second) aches in the ears (not simultaneously).

After sleeping through my third dose, I woke up and noticed very faint tinnitus (akin to what I’d experienced from both azithromycin (transiently).

Initially I perceived the tinnitus as only being in my left ear – but later realized it was also in my right ear.

Thankfully the tinnitus is extremely faint and my guess is that it’s unlikely to be permanent.

I may discontinue treatment, get a second opinion on the diagnosis, and see if the mild tinnitus goes away. (Will update this in the future once I’ve been off of doxycycline for a while.)

The tinnitus seems to fluctuate a bit perceptually and is very faint. The tones are slightly different in each ear and do not seem to be a consistent tone.

Had tinnitus that fluctuated in both ears around ~5 hours after my fourth dose.

(Took the dose at 8 AM and had some mild tinnitus at 1 PM. However, it faded by 3 PM.)

Note: I have considered the possibility that I’m analyzing my ears more and therefore perceiving “phantom sounds” as tinnitus – that were “there all along.” I’ve also considered the possibility that doxycycline is merely changing my “perception” of phantom sounds (in complete silence) rather than causing tinnitus.

Update: The tinnitus or tinnitus-like sounds I experienced on doxycycline were transient and I actually doubt they were from the doxycycline. (More likely: Acid reflux was affecting my ears.)

Doxycycline helps tinnitus & hearing vs. causes/worsens tinnitus & hearing loss

Included below are hypothetical scenarios I could think of regarding doxycycline and its potential to cause vs. reduce tinnitus and hearing loss.

None of these are necessarily substantiated by data/science, just my hypotheses.

Doxycycline helps preexisting tinnitus: Depends.

  • Inflammatory states e.g. neuroinflammation-related tinnitus (significantly lowers inflammation).
  • Atypical neurotransmission (alters neurochemistry).
  • Infectious tinnitus (it treats the infection).

Doxycycline helps hearing: Depends.

  • If hearing loss is resulting from an infection – doxycycline can help treat the infection and reduce excessive immune-mediated inflammation.
  • If treated in a timely manner, hearing may improve (to some extent) during or after doxycycline treatment (ears heal partially or fully when the infection is gone).

Doxycycline causes tinnitus: Small percentage of individuals.

  • My guess = ~1/100. Long-term use/high dose may increase risk. Could be related to excessive anti-inflammatory effect (which may impair cochlear blood flow).
  • Combining with other anti-inflammatory agents (may exacerbate blood flow impairment).
  • Neuromodulation another potential mechanism (e.g. changes in neurotransmitters like serotonin from doxycycline).

Doxycycline causes hearing loss: Unlikely.

  • Perhaps in the case of an extremely rare adverse reaction OR allergy to doxycycline.
  • More likely: Hearing loss occurs in response to infection reacting to doxycycline (e.g. secreting endotoxins).
  • Excessive anti-inflammatory effect could be to blame in long-term, moderate-dose users (chronic blood flow impairment).

What’s my final stance on doxycycline & tinnitus, hearing loss? (Summary)

  • Doxycycline is one of the only antibiotics that I personally trust as being non-ototoxic (in most cases) and unlikely to cause permanent hearing loss.
  • Doxycycline may cause mild tinnitus in rare cases (a small percentage of users) – and moderate tinnitus in even rarer cases (a smaller percentage of users).
  • If tinnitus is developed while taking doxycycline, there’s a good chance that it will fully subside following the completion of doxycycline treatment (days, weeks, months) – German medical literature indicates it’s 100% reversible.
  • Doxycycline may attenuate infection-related ototoxicity (e.g. ototoxicity stemming from infectious insult and/or inflammatory reactions to the infection) if administered swiftly after infection onset.
  • There’s a chance that doxycycline is “otoprotective” in some cases (reducing likelihood that you’ll develop inner ear damage or lose hearing) – particularly in cases of excessive or unchecked inflammation (e.g. following aminoglycoside administration).
  • Many people who experience tinnitus and/or hearing loss while using doxycycline probably would’ve experienced the tinnitus and/or hearing loss without the doxycycline.
  • I could NOT find any direct anecdotes online from persons who experienced permanent “hearing loss” wherein doxycycline seemed like the “most likely cause.”
  • I was able to find a few anecdotes from users who experienced “tinnitus” from doxycycline – but some of these individuals had tinnitus prior to doxycycline treatment.
  • Whenever I have a medical condition (e.g. bacterial infection) that requires antibiotics, I always ask if doxycycline would be an option. If doxycycline is an option – it’s my “go to.”

Have you experienced tinnitus or hearing loss on doxycycline?

I’m just trying to get a better understanding of tinnitus/hearing loss cases among doxycycline users.

  • Did you have any tinnitus or hearing loss prior to using doxycycline?
  • What dosage was your doxycycline and how long did you take it?
  • Did you take any other substances/medications with doxycycline?
  • Do you have any medical conditions besides the one requiring doxycycline?
  • What infection were you diagnosed with – and how severe was it? (Did you consider that: (1) the infection itself OR (2) the doxycycline killing the infection – may have caused hearing loss?)
  • If you experienced hearing loss and/or tinnitus on doxycycline: How soon after treatment onset did it “start” and did it eventually subside or improve after doxycycline discontinuation?

Also feel free to comment if you used doxycycline and experienced no significant change in tinnitus and/or hearing.

This article took way more time than I expected it to – and I was excessively “wordy” but I enjoyed writing it.

Motives for writing it? (1) Research for myself. (2) Providing information to those concerned about tinnitus, hearing loss, ototoxicity from doxycycline. (3) Providing information to those who developed tinnitus while using doxycycline.

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