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Ototoxicity (OTX)

Ototoxicity (OTX): Overview, Causes, Symptoms, and Management

Ototoxicity (OTX) refers to damage to the inner ear caused by certain medications or chemicals, leading to hearing loss, tinnitus, or balance problems. This condition affects the cochlea and vestibular system, which are responsible for hearing and balance, respectively. Below is a detailed overview of ototoxicity, including its causes, symptoms, diagnosis, and management strategies.

Causes of Ototoxicity

1. Medications:
   • Aminoglycoside Antibiotics: Gentamicin, streptomycin, tobramycin, and amikacin are well-known for their ototoxic effects24.
   • Platinum-Based Chemotherapy: Cisplatin and carboplatin can cause hearing loss and tinnitus13.
   • Loop Diuretics: Furosemide (Lasix) may lead to ototoxicity, especially at high doses14.
   • Salicylates: Aspirin can cause reversible hearing loss and tinnitus at high doses37.
   • Quinine: Used for malaria treatment, quinine can cause temporary hearing loss3.
2. Environmental Chemicals:
   • Mercury and Lead: Exposure to these heavy metals can lead to ototoxic effects15.
   • Carbon Monoxide: Though less common, exposure can affect inner ear function1.

Symptoms of Ototoxicity

Symptoms can vary from mild to severe and may include:

• Hearing Loss: Ranges from mild to profound, often affecting high-frequency sounds first16.
• Tinnitus: Ringing, buzzing, or other sounds in the ears16.
• Balance Problems: Dizziness, nausea, and difficulty walking due to vestibular system damage16.
• Oscillopsia: Blurry vision when moving the head36.
• Fullness in the Ears: Feeling of pressure or blockage3.

Diagnosis of Ototoxicity

Diagnosis is based on a combination of:

1. Medical History: Exposure to known ototoxic substances14.
2. Symptoms: Patient reports of hearing loss, tinnitus, or balance issues16.
3. Audiometric Testing: Pure-tone audiograms to assess hearing thresholds17.
4. Vestibular Function Tests: To evaluate balance and vestibular system integrity14.

Management and Prevention

1. Medication Monitoring: Regular hearing tests for patients on ototoxic medications18.
2. Dose Adjustment: Reducing or changing medications when possible3.
3. Hearing Protection: Avoiding loud noises and using ear protection1.
4. Stay Hydrated: Maintaining adequate hydration to reduce risk1.
5. Otoprotective Agents: Research into agents that may protect against ototoxicity is ongoing5.

Conclusion

Ototoxicity is a significant concern for individuals exposed to certain medications or chemicals. Early detection and management are crucial to prevent permanent damage. Understanding the causes and symptoms of ototoxicity helps in developing strategies for prevention and treatment.

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References

1. American Academy of Audiology: Ototoxicity
2. Wikipedia: Ototoxicity
3. WebMD: What to Know About Ototoxicity
4. Medscape: Ototoxicity Overview
5. PMC: Mechanisms of Ototoxicity & Otoprotection
6. KidsHealth: Ototoxicity
7. MSD Manuals: Drug-Induced Ototoxicity
8. ASHA: Ototoxic Medications