The use of hematopoietic stem cell transplantation (HSCT) is increasing for a variety of diseases. Ototoxicity from this procedure has not been extensively studied. A retrospective chart review examined 275 patients from this institution that received a HSCT from January 1, 2007, to April 30, 2017. Data extracted included therapy before HSCT and the subsequent transplant course. Evaluable patients had complete medical records and interpretable audiograms. Ototoxicity constituted significant threshold changes from baseline or changes in SIOP grades comparing audiogram results just prior to HSCT with those following the transplant procedure. One hundred and forty-seven patients were evaluable. Ototoxicity was observed in 10.2% of patients. Higher SIOP grade prior to HSCT was significantly associated with a higher risk of post-transplant ototoxicity (p <0.01). Prior cisplatin (p <0.01), but not carboplatin or radiation, was also associated with ototoxicity. Solid tumor or brain tumor diagnoses (p <0.01) and those who received an autologous transplant (p=.0002) were also at increased risk. No post-transplant events were significantly associated with ototoxicity. Ototoxicity affects a significant percentage of patients undergoing HSCT. Careful monitoring is needed to identify patients impacted by this procedure.