Drug-induced ototoxicity is ear damage from medications causing disturbances of hearing, balance, or both. Acute and chronic forms can sometimes be distinguished.

• Acute – Diuretics, anti-inflammatory drugs, and aminoglycosides may be associated with acute temporary hearing loss or vestibular dysfunction.
• Chronic – Long-term treatment with antineoplastic drugs or aminoglycosides can cause delayed but permanent loss of hearing due to auditory sensory cell damage.

Impaired hearing function can present with tinnitus and hearing loss. Damage to vestibular function can manifest with nystagmus, ataxia, oscillopsia, disequilibrium, dizziness, imbalance, lightheadedness, nausea, vomiting, and vertigo. It is usually bilateral, and in those cases, vertigo is less prominent.

Prevention includes careful review of family history for susceptibility to certain drugs known to induce ototoxicity. Management includes careful monitoring of adverse effects to avoid irreversible damage. Onset of ototoxicity and other adverse effects may call for discontinuation or dosage adjustment and choice of alternative medications.

Related topic: sensorineural deafness