Can Tepezza Cause Permanent Hearing Loss? What to Know

Tepezza can cause hearing changes; many improve after treatment, but some persist, and the exact chance of permanent loss is not known. Because of this risk, it is highly recommended to get a baseline hearing test before starting treatment and to monitor your hearing throughout the course of therapy ^[1].

Tepezza (teprotumumab) is a biologic treatment approved for thyroid eye disease ^[2]. While it can help manage the condition, it carries a documented risk of hearing-related adverse effects (sometimes referred to as ototoxicity). Clinical trials and real-world studies show that a portion of people receiving the drug experience new ear or hearing-related symptoms ^[3]. These symptoms often emerge around the third to sixth infusion, though they can occur earlier, later, or even after the treatment course is finished ^[4][5].

Common Hearing Symptoms

If you are taking Tepezza, it is important to be aware of the specific auditory symptoms that can occur. These include:

• Subjective hearing loss: A gradual decrease in your ability to hear or comprehend words, often in both ears ^[6][4].
• Tinnitus: A ringing, buzzing, or roaring sound in the ears ^[6][7].
• Autophony: Hearing your own voice, breathing, or bodily sounds unusually loudly ^[4][8].
• Aural fullness: A feeling that your ears are plugged or under pressure ^[9][4].

Are the Hearing Changes Permanent?

The reversibility of these side effects often depends on the specific symptom. Transient symptoms like tinnitus, ear fullness, and autophony frequently resolve entirely or significantly improve within weeks or months after the final infusion ^[4].

However, subjective and measured hearing loss is less consistently reversible ^[4][6]. In a 2026 meta-analysis combining multiple studies, researchers estimated that among patients who already developed hearing symptoms, roughly 39% had persistent hearing impairment at their last medical follow-up ^[10]. It is important to note that “persistent at the last follow-up” is not necessarily the same as permanent, and follow-up times varied across the studies.

Still, several case reports have documented persistent, potentially irreversible sensorineural hearing loss (nerve-related hearing damage) that did not improve even after the medication was stopped ^[11][12][13]. Some studies also show that patients’ hearing thresholds may partially recover after treatment but may not return completely to their pre-treatment baseline ^[14][6]. While case reports occasionally describe patients receiving steroids for this hearing loss, there is no proven, guaranteed medical treatment to reverse it ^[15].

The Importance of a Baseline Audiogram and Monitoring

Because of the risk of persistent changes, clinical experts strongly recommend undergoing a comprehensive baseline hearing assessment before starting Tepezza ^[1][4]. A baseline evaluation should ideally include:

• Audiometry (Audiogram): A formal hearing test to measure your ability to hear different sound frequencies.
• Word-recognition testing: To evaluate how well you understand spoken words.
• Tympanometry: To measure how well your eardrum moves and check for eustachian tube dysfunction (problems with the tube connecting your middle ear to the back of your throat) ^[1].

This baseline testing is critical because subjective symptoms do not always accurately reflect the physical changes happening in the ear; some patients show measurable high-frequency hearing loss on tests before they even notice a change in their hearing ^[16][17]. Having a baseline allows your medical team (which should ideally include your prescribing doctor and an audiologist or Ear, Nose, and Throat specialist) to compare your hearing during and after treatment.

Some studies suggest that older adults and patients who have a prior history of hearing loss may be at a higher risk of developing hearing complications from Tepezza ^[4][5].

What to Do If Symptoms Occur

• Report gradual changes promptly: If you develop new tinnitus, ear fullness, or gradual hearing changes, notify your prescribing doctor so they can arrange for repeat audiometry.
• Do not stop treatment independently: Do not skip or stop an infusion on your own. Discuss pausing or adjusting treatment with your medical team, as this is a shared, individualized decision based on the severity of your eye disease versus the risk to your hearing.
• Seek urgent care for sudden changes: If you experience sudden hearing loss (especially in just one ear) or sudden severe dizziness/vertigo, this is a medical emergency. Seek same-day urgent care or an emergency Ear, Nose, and Throat (ENT) evaluation. Do not wait for your next routine infusion appointment ^[12].