Pathogenesis and detection of aminoglycoside ototoxicity

Aminoglycoside antibiotics are widely prescribed in the treatment of serious gram negative sepsis. The more recently developed members of this group, although purporting to be less ototoxic, are also capable of producing inner ear damage in sufficiently high doses. This paper reviews the morphological, histochemical, and electrophysiological evidence concerning the mode of action of aminoglycosides on the auditory and vestibular systems and discusses the available methods for the detection of possible clinical ototoxicity. Guidelines are proposed to assist the otolaryngologist when advising about the prevention of ototoxicity and the management of patients with established auditory or vestibular dysfunction.