Pharmacological Ototoxicity: Pathophysiology, Clinical Impact, and Current Preventive Options

Introduction: Ototoxicity, involving damage to the cochlear and vestibular structures of the inner ear, is a complication of pharmacotherapy.Hearing loss and balance disorders caused by medications are of particular clinical significance because they significantly impair the quality of life in adults and speech development in children.Objective: We aim to summarize current knowledge on ototoxic drugs and hearing protection strategies.Material and methods: We reviewed the scientific literature published from 2004 to mid-2025.Results: The main groups of ototoxic drugs include aminoglycosides, loop diuretics, platinum-based compounds, salicylates/ Non-steroidal anti-inflammatory drugs (NSAIDs), antimalarial agents, and immunotherapies.Ototoxicity is often irreversible, especially with aminoglycosides and platinum compounds.This information is critical in children and in patients treated for drug-resistant tuberculosis, because the risk may be increased and the effects can be long-lasting.To minimize irreversible damage, primary otoprotection efforts focus on reducing exposure and on early detection of warning signs.Methods include modifying dose schedules and preserving renal function to prevent drug accumulation.Patients should limit their noise exposure and have regular audiological examinations.Sodium thiosulfate is currently the only otoprotective drug with strong clinical data and is approved in selected pediatric indications.It is administered after cisplatin, with a delay, to reduce ototoxicity while preserving the antitumor effect.Conclusions: It is essential to apply otoprotective strategies consistently.Sodium thiosulfate may be considered in selected patients.Research into new otoprotective agents should be continued.