Ototoxicity refers to injury of the inner ear as the result of exposure to chemicals or medications. When use of an ototoxic medication is medically necessary with no reasonable alternatives, the lowest therapeutic dose should be used. In addition, simultaneous use of multiple ototoxic medications such as, but not limited to, aminoglycosides, loop diuretics, and chemotherapeutic agents should be avoided as this may synergistically increase the ototoxic effects. Clinicians should be aware of patients with heightened risks (e.g. pre-existing sensorineural hearing loss, renal insufficiency, genetic susceptibility, children on platinum-based chemotherapy). Pre-therapy baseline audiograms and otoacoustic emissions, followed by serial audiograms over the course of therapy with known ototoxic medications may help detect high frequency hearing loss, potentially allowing for earlier changes to medication regimens. Should a patient develop auditory (hearing loss, tinnitus) or vestibular (vertigo or disequilibrium) symptoms during therapy with a potentially ototoxic medication, the medication should be stopped if possible, and clinicians should refer the patient for evaluation by an Otolaryngologist.
Important Disclaimer Notice (Updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery 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. Position statements are not intended to and should not be treated as legal, medical, or business advice.