Ototoksiske

Ototoksiske, or ototoxic, describes substances or exposures that can damage the inner ear or vestibulocochlear nerve, leading to hearing loss, tinnitus, or vertigo. The term classifies drugs and chemicals with potential cochlear or vestibular injury. Effects may be temporary or permanent and can affect one or both ears.

Mechanisms vary but commonly involve injury to cochlear hair cells, disruption of fluid balance in the inner ear, oxidative stress, and inflammation. The vestibular system may be affected, causing imbalance.

Well-known ototoxic agents include aminoglycoside antibiotics (gentamicin, amikacin, tobramycin), platinum chemotherapy (cisplatin), and loop diuretics (furosemide, bumetanide). High doses of salicylates (aspirin), certain NSAIDs, and quinine are also linked to ototoxicity. Some antibiotics such as vancomycin carry a risk, especially with other exposures.

Risk factors include older age, pre-existing hearing loss, kidney dysfunction, dehydration, high cumulative dose, concurrent use of multiple ototoxic drugs, and genetic susceptibility.

Clinical features typically include sensorineural hearing loss (often high-frequency and bilateral), tinnitus, and vertigo or dizziness. Onset can be gradual or abrupt and may precede other signs.

Diagnosis relies on baseline and periodic audiometry during exposure, supplemented by high-frequency testing, otoacoustic emissions, and vestibular assessment if symptoms arise.

Prevention and management focus on avoiding or limiting exposure, using the lowest effective dose, monitoring kidney function and hearing, and substituting safer alternatives when possible. If ototoxicity occurs, discontinue or modify the drug and use hearing aids, cochlear implants, or vestibular rehabilitation as needed.

Prognosis varies; some cases are reversible, but many result in permanent deficits. Research continues on protective strategies and early detection methods.