The major ototoxic agents in use remain cisplatin and aminoglycosides. Cisplatin ototoxicity manifests as hearing loss, while aminoglycosides may cause auditory and/or vestibular complaints. Gentamicin and streptomycin are much more likely to present with vestibular complaints, specifically imbalance. In contrast, amikacin, kanamycin, and dihydrostreptomycin are more toxic to the cochlea. Tobramycin carries an approximately equivalent risk of toxicity to the cochlea and vestibular labyrinth.
Loop diuretics and vancomycin are rarely ototoxic on their own; more commonly, they potentiate the ototoxic effects of the aminoglycosides or cisplatin. High-dose intravenous erythromycin may cause a reversible sensorineural hearing loss. Quinine derivatives and salicylates can cause reversible tinnitus.
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