Cancer therapy-induced ototoxicity: Current challenges and emerging management strategies.

Abstract

Cochleovestibular impairment is a debilitating sequela of oncological intervention, resulting from multifaceted organic damage to the inner ear. Clinically manifesting as sensorineural hearing loss and vestibular dysfunction, ototoxicity significantly compromises cognitive health and long-term quality of life. Despite its prevalence, early detection and prophylactic intervention remain clinically suboptimal. This review provides a comprehensive analysis of the molecular pathogenesis and risk factors-including age, specific genetic polymorphisms, and cumulative dosage-associated with various cancer modalities such as platinum-based chemotherapy, radiotherapy, and emerging immunotherapies. We specifically evaluate the cellular mechanisms of cisplatin-induced irreversible damage to the stria vascularis and hair cells. Furthermore, this article critiques current clinical monitoring protocols, advocating for the integration of baseline audiological screening and high-frequency auditory assessments as mandatory standards of care. Finally, we synthesize the current therapeutic landscape, ranging from established otoprotective agents and cochlear implants to novel candidate drugs in the preclinical pipeline. By bridging mechanistic research with translational evidence, this review emphasizes a precision-medicine approach to balance therapeutic efficacy with the preservation of auditory integrity for cancer survivors.