A literature search was performed using PUBMED, Google Scholar, and Cochrane Central Register for controlled trials. Keywords or phrases were “drug-induced ototoxicity”, “treatments for ototoxicity”, “mechanisms of action of ototoxic drugs”, “ototoxic agents”, “prevention of ototoxicity”, and “Animal model of ototoxicity”.

The top drugs inducing hearing loss include antimicrobials (aminoglycosides, vancomycin, anti-malaria drugs), platinum and other anticancer drugs (cisplatin, methotrexate), etc. The possible mechanisms are nerve demyelination, apoptosis via caspase cascade, glutamate toxicity, reactive oxidative species, inner ear hypo-perfusion, ion disturbance on the background of gene mutations, and increased permeability of triggered drugs. If multiple trigger drugs are used simultaneously, the risk of hearing loss will be increased. Intrauterine exposure to aminoglycosides and loop diuretics has been incriminated to cause hearing loss in children by age two. 

The current study will alert physicians of drug-induced hearing loss and the risk assessment for certain populations. Because hearing loss could be irreversible in some cases, avoiding the concomitant use of multiple triggered drugs should be recommended to reduce this side effect. Additionally, treatment with these drugs should start at the lowest dose. Finally, it is worth noting that there is a greater need for experiments and clinical trials to investigate the mechanism of drug-induced hearing loss and the strategies to prevent this side effect.