Ototoxicity
Information For Physicians Regarding Ototoxicity Audiological Assessment
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Ototoxicity
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Drug-induced ototoxicity refers to hearing or balance problems that are caused by medications or drugs. Certain medications can damage the structures of the inner ear, leading to hearing loss, tinnitus, or balance issues. The extent of ototoxicity can depend on the drug, dosage, duration of use, and individual susceptibility.
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Common Ototoxic Medications
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Aminoglycosides antibiotics
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Platinum-Based Chemotherapeutic agents
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Loop Diuretics
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Antimalarials
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Non-steroidal anti-inflamatory drugs (NSAIDs)
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For a more comprehensive list of ototoxic medications, please see Appendix S1. Ototoxic medications from
"Drug-Induced Ototoxicity: A Comprehensive Review and Reference Guide
Habib G. Rizk,, Joshua A. Lee,, Yuan F. Liu,, Lauren Endriukaitis,, Julianne L. Isaac,, Wendy M. Bullington
First published: 20 October 2020"
Recommended Protocol for Platinum-Based Chemotherapy Ototoxicity Monitoring
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Establish a baseline hearing assessment prior to the first treatment.
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Monitor hearing just before each subsequent course of treatment.
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Conduct a follow-up hearing test 3 months after the treatment has stopped.
Recommended Protocol for For IV-Administered Aminoglycoside Ototoxicity Monitoring
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Establish a baseline hearing assessment prior to the first treatment, when possible.
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A baseline hearing assessment can still be established up to 72 hours after the first round of aminoglycoside administration.
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Monitor hearing on a weekly or biweekly basis during treatment.
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Conduct a follow-up hearing test 3 months after the treatment has stopped.
Criteria for Determining Significant Change in Hearing (ASHA, 1994)
To assess whether a clinically significant change has occurred, the following criteria are used:
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Pure Tone Audiometry:
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A ≥ 20 dB change at any one test frequency.
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A ≥ 10 dB change at any two adjacent frequencies.
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Loss of response at three consecutive frequencies where responses were previously obtained.
Otoacoustic Emissions (OAEs):
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A change in DPOAE amplitude of ≥ 2.4 dB.