Ototoxicity : ARB

Based on Valsartan Drug Leaflet

• No side effect of tinnitus / ototoxicity
• Uncommon (0.1% to 1%): Vertigo

Based on Valsartan + Hydrochlorothiazide Drug Leaflet

• Rare (less than 0.1%): Vertigo, tinnitus

Based on limited evidence:

• The common side effect with ARB are vertigo, while combination with diuretics were seen to also cause tinnitus

Mechanism

• There is evidence about inner ear tissues being immunologically, biochemically and functionally related to kidney tissues.
• It seems that medications affecting sodium and potassium transport alter ionic homeostasis of the inner ear causing functional problems like hearing loss, tinnitus and vertigo  
• Renal pharmacological adverse reactions have been studied in the effort of finding predictive signs of possible ADRs related to the inner ear or to the labyrinth and about medication class’s influence upon ionic transportation.
• Resulting data showed that renal ADRs couldn’t be considered markers of pharmacologically induced disturbances to the inner ear or labyrinth.
• Nevertheless, the ability of these drugs to influence the ion transport system and the ion channels and so influencing the ear and kidney ionic homeostasis could be a predicting factor for a possible pharmaceutical related ototoxicity
• Some speculate speculate that tinnitus might be related to an imbalance between the systemic and cochlear circulation, which in turn might be related to underlying pathophysiologic conditions and drug treatment

References:

1. Prevalence of Tinnitus in Patients with Hypertension and the Impact of Different Antihypertensive Drugs on the Incidence of Tinnitus: A Prospective, Single-Blind, Observational Study.
2. Ototoxicity- the hidden menace. Neil G Bauman 
3. www.drugs.com
4. Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus a reasoned and updated guide. European Review for Medical and Pharmacological Sciences. 2011; 15: 601-636