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Examples of causes

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The most frequently used drugs that can be ototoxic are:

  • aminoglycosides - the single most important class of ototoxic drug:
    • streptomycin - mainly vestibulotoxic in adults but in children, cochleotoxicity is prominent
    • neomycin - mainly cochleotoxic
    • gentamicin - mainly vestibulotoxic
  • loop diuretics, particularly, ethacrynic acid and frusemide may cause sensorineural hearing loss. Singly, the effect is usually reversible, but they show synergistic ototoxicity when combined with aminoglycosides, and may cause irreversible damage.

Less commonly used ototoxic drugs include:

  • alcohol, and tobacco - may cause sensorineural deafness
  • aspirin, and quinine and its derivatives - may cause reversible tinnitus and a sensorineural nerve deafness


  • cytotoxic agents - such as cisplatin and nitrogen mustard - sensorineural hearing loss
  • beta-blockers - particularly, practolol - cochleotoxic
  • anticonvulsants - especially, phenytoin and ethosuximide - vestibulotoxic
  • thalidomide used in pregnancy is ototoxic
  • erythromycin - deafness may rarely occur with high doses

Ref: Ototoxicity. Moffat. In: Scott Brown's Otolaryngology. Fifth Edition (1987). Butterworths.

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