Ototoxicity: Signs, Symptoms and Treatment

This compilation focuses on Ototoxicity, the adverse pharmacological reaction affecting the inner ear or auditory nerve, characterized by cochlear or vestibular dysfunction. Although ototoxic medications play an essential role in modern medicine, they can cause harm and lead to significant morbidity. The authors discuss aminoglycoside antibiotics, loop diuretics, platinum-based chemotherapeutic agents, macrolide antibiotics and antimalarial medications which are among the 600 frequently used ototoxic drugs. Next, an overview of cisplatin-associated ototoxicity, namely its clinical features, incidence rates, molecular and cellular mechanisms and risk factors is provided for health care practitioners managing patients with cancer. Ototoxicity and neurotoxicity are defined from the perspective of chemical agents, nicotine and cotinine, that individuals experience through cigarette smoking and environmental tobacco smoke exposure. Mechanisms for toxicity are described by review of animal and human studies revealing changes in peripheral and central auditory structures after exposure to nicotine. The mechanisms of ototoxicity induced by aminoglycoside are also discussed, as well as the usage of these drugs for treatment of several disorders such as Meniere disease, and possible protective agents. In closing, the authors highlight the serious issue of aminoglycoside mediated hearing loss in cystic fibrosis patients, and also discuss alternative approaches for avoiding aminoglycoside-induced cochleotoxicity.