Platinum-related ototoxicity can permanently affect language, learning and quality of life after childhood cancer. This structured narrative review evaluates pharmacological prevention, audiological monitoring, molecular biomarkers and genetic susceptibility, principally for cisplatin. Targeted PubMed/MEDLINE and source-based searches informed the review through 30 July 2026. Evidence was appraised narratively; no formal study-level risk-of-bias assessment or de novo GRADE assessment was performed. Delayed intravenous sodium thiosulfate (STS) is the only pharmacological otoprotectant supported by phase III paediatric trials, with the strongest direct evidence in standard-risk hepatoblastoma. Its authorised use is restricted to eligible children with localised, non-metastatic solid tumours; long-term oncological safety cannot be assumed across all malignancies, particularly disseminated disease. Intratympanic STS remains investigational. All platinum-exposed children require age-appropriate audiological surveillance, intensified according to risk; carboplatin is less ototoxic overall but is not risk-free. Prestin and other molecular markers remain unvalidated for routine decisions. The externally validated clinical PedsHEAR model is a useful development but does not establish the utility of biomarker-genomic prediction or genotype-directed chemotherapy changes. Priorities are harmonised auditory outcomes, tumour-specific safety follow-up, staged paediatric local-delivery trials and prospective validation of biomarkers and integrated models. Non-systematic selection, incomplete search documentation and heterogeneous evidence limit the review. No protocol was prospectively registered.
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