Ototoxicity

Updated: Apr 25, 2024
  • Author: Pamela A Mudd, MD, MBA; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Overview

Overview

Any drug with the potential to cause toxic reactions to structures of the inner ear, including the cochlea, vestibule, semicircular canals, and otoliths, is considered ototoxic. Drug-induced damage to these structures of the auditory and balance system can result in hearing loss, tinnitus, and dysequilibrium or dizziness. The propensity of specific classes of drugs to cause ototoxicity has been well established, and over 100 classes of drugs have been associated with ototoxicity. [1]

Ototoxicity came to the forefront of clinical attention with the discovery of streptomycin in 1944. Streptomycin was used successfully in the treatment of tuberculosis; however, a substantial number of treated patients were found to develop irreversible cochlear and vestibular dysfunction. [2] These findings, coupled with ototoxicity associated with later development of other aminoglycosides, led to a great deal of clinical and basic scientific research into the etiology and mechanisms of ototoxicity. Today, many well-known pharmacologic agents have been shown to have toxic effects to the cochleovestibular system. The list includes aminoglycosides and other antibiotics, platinum-based antineoplastic agents, salicylates, quinine, and loop diuretics.

An image depicting inner ear anatomy can be seen below.

Inner ear anatomy. Inner ear anatomy.

Ototoxicity is typically associated with bilateral high-frequency sensorineural hearing lossand tinnitus. Hearing loss can be temporary but is usually irreversible with most agents.

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