Gentamicin-induced Hearing Loss: Ototoxicity, Challenges, Pathogenesis and Mechanism

Background: The most well-known side-effect of Aminoglycoside antibiotics is significant hearing loss and balance issues. For instance, Gentamicin has been widely recognized for causing hearing loss in most patients. Aimes: This study explored the available evidence on hearing loss following Gentamicin use. Methods: We conducted a comprehensive literature search using Web of Science and PubMed, with the keywords: "Deafness," "Hearing Loss," "Drugs," "Adverse Drug Reaction," "Ototoxicity," "Gentamicin," "Aminoglycosides," "Inner Ear," and "Audiogram." All data were independently extracted and relevant research was used to write this review article. Results: The reviewed studies highlight the critical factors influencing the severity of Gentamicin-induced hearing loss, including the site of administration, dosage, and co-administration with other ototoxic agents like Vancomycin. The mechanisms underlying Gentamicin ototoxicity involve oxidative stress, inflammation, and apoptosis of sensory hair cells. The literature also suggests safer alternatives within the aminoglycoside class, such as apramycin and Gentamicin C1a, which could be considered for future clinical use. Conclusion: Gentamicin has been consistently associated with significant ototoxic effects, particularly hearing loss, across various species and clinical contexts. Balancing its therapeutic benefits against potential hearing loss is essential. Developing more targeted interventions that preserve its antimicrobial efficacy while minimizing hearing loss risk may be possible.