Ototoksiliste

Ototoksiliste, or ototoxic substances, are agents that can damage the inner ear and vestibular system, potentially causing hearing loss, tinnitus, or balance problems. The term covers drugs and chemicals with the potential to injure cochlear hair cells, the stria vascularis, or the vestibular apparatus. Susceptibility varies with dose, duration, age, kidney function, and concurrent exposure to noise or other ototoxins.

Mechanisms include direct cellular injury and disruption of ionic homeostasis, oxidative stress, and apoptosis in sensory cells. In many cases, damage is progressive and may be permanent, though some reversible components may exist if exposure stops early.

Common ototoxins include aminoglycoside antibiotics (gentamicin, amikacin), platinum-based chemotherapies (cisplatin, carboplatin), loop diuretics (furosemide, bumetanide), high-dose salicylates and nonsteroidal anti-inflammatory drugs, and certain antimalarials such as quinine. Environmental and occupational exposures to solvents (for example toluene) and heavy metals can augment risk, especially with concurrent noise exposure.

Clinically, ototoxicity presents as sensorineural hearing loss that often begins at high frequencies, possibly accompanied by tinnitus and vertigo. It may be bilateral and dose-related. Diagnosis relies on baseline and periodic audiometric testing in patients receiving known ototoxins, with vestibular testing if dizziness occurs.

Management emphasizes prevention and early detection: limit exposure, adjust or discontinue the offending agent when feasible, and provide hearing rehabilitation or balance therapy as needed. Understanding ototoksiliste is essential in pharmacovigilance and occupational health, guiding safer prescribing and monitoring practices.