Mechanisms of Aminoglycoside- and Cisplatin-Induced Ototoxicity.
Peter S Steyger
PMID 34415784WHAT IT FOUND
Aminoglycosides and cisplatin enter inner ear hair cells through specific ion channels, causing permanent hearing and balance loss.
Inflammation, noise exposure, and certain co-administered drugs significantly worsen this damage. Clinicians should monitor high-risk patients closely during and after treatment.
Key findings
01Aminoglycoside-induced hearing loss occurs in 20%–63% of patients receiving the drug for multiple days, with vestibular issues often reported before hearing loss is detected.
02Cisplatin causes dose-dependent hearing loss and vestibular hair cell loss, with damage initially affecting high-frequency hearing in the basal cochlea before progressing to lower frequencies.
03Systemic inflammation, fever, noise exposure, and co-administration of loop diuretics or vancomycin synergistically enhance the ototoxicity of aminoglycosides and cisplatin.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review notes that incidence data is unclear due to variable dosing regimens and limited high-frequency audiometric testing in clinical practice. Vestibular toxicity is likely underreported because clinical apparatus for vestibular testing is not widely available outside major academic centers. Many mechanisms of drug entry and cellular damage are described as 'unknown' or 'poorly characterized' in human populations, with much evidence derived from preclinical models. Genetic predispositions to ototoxicity are known but have poor predictive value in clinical settings.
Declared interests
The study was supported by the National Institute on Deafness and Other Communication Disorders (R01 awards). No commercial conflicts of interest are declared.
The easy way to misread this
Do not assume that standard pure-tone audiometry (up to 8 kHz) is sufficient to detect early ototoxicity. The review states that hearing loss incidence is unclear partly because testing often omits frequencies above 8 kHz, where damage begins. Additionally, vestibular issues may appear before hearing loss is detected, so relying solely on auditory symptoms may miss early toxicity.