Ototoxicity refers to injury of the inner ear (cochlear and/or vestibular end organs) as the result of exposure to chemicals or medications. Although ototoxic injury is often unavoidable, certain measures may reduce the risk.  The treating physician should consider choosing a therapeutically equivalent non-ototoxic drug whenever one is available, especially in patients with heightened risk (e.g. pre-existing cochlear hearing loss, renal insufficiency).  During therapy with potentially ototoxic medications use the lowest dose compatible with therapeutic efficacy and, when indicated, periodically monitor serum peak and trough levels.  Avoid simultaneous use of multiple ototoxic medications (e.g. aminoglycosides and loop diuretics) whenever clinical circumstances permit as this may increase the risk of permanent deficit.  Should a patient develop auditory (hearing loss, tinnitus) or vestibular (vertigo or disequilibrium) symptoms during therapy with a potentially ototoxic medication, referral for audiometric testing is recommended and consideration should be given to obtaining the opinion of an otolaryngologist.

Approved 12/1/2006

Important Disclaimer Notice

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery, Inc. or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements as guidance for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.

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