Ototoxicity is a known toxicity of which agent?

• A. Methotrexate
• B. Vincristine
• C. Bevacizumab
• D. Cisplatin

Answer: (D)

Ototoxicity refers to damage to the inner ear from certain medicines, which can cause hearing loss and sometimes tinnitus. Among common chemotherapy agents, cisplatin is the classic drug known for this toxicity. It builds up in the cochlea and injures the sensory hair cells, especially the outer hair cells responsible for hearing in the higher frequencies. This leads to a bilateral, sensorineural hearing loss that often begins in the high frequencies and becomes more pronounced as the total dose increases.

Risk is higher with greater cumulative dose, in younger patients (especially children), and with renal impairment or concurrent use of other ototoxic agents. Clinically, this means baseline and periodic audiology testing during therapy, and adjustments to treatment if hearing declines. Protective strategies exist but vary in effectiveness, so prevention and early detection are key.

Other drugs listed have different toxicity profiles: methotrexate is more commonly associated with mucosal, hepatic, and marrow toxicity; vincristine mainly causes peripheral neuropathy; bevacizumab has vascular and wound-healing risks rather than ototoxicity.