I think a combo of ototoxicity and noise exposure can be very dangerous, the ear is compromised and unprotected when under the influence of some of these common drugs, even over the counter pain killers can linger in the ear. Sure, a lot of people have tinnitus triggered by noise exposure, yet when seeking help, professionals fail to recognize how the patients ears may have been in a weakened poisoned state at the time of the event. Only the noise exposure is taken into consideration.
I think the big picture is missing. Even things like cigarettes can damage/weaken the ear, and cause deafness and tinnitus. Maybe a smoker, or worse yet, a drunk smoker on multiple medications, goes to a concert and and walks out with serious ear trauma. Most of the time only the noise event will be considered the culprit, and all other factors left out.
Obviously I'm not arguing that noise alone can damage the ear, my point here is that a lot of the time there are other factors involved but are rarely considered.