Ototoxicity may arise from a variety of medications, chemical solvents, or environmental compounds. The resulting changes in auditory or vestibular function may cause significant morbidity as well as devastating effects on socioeconomic productivity and overall quality of life. Through careful attention to drug selection, dose, monitoring, and antecedent risk factors, ototoxic damage can be minimized or even prevented. Otolaryngologists play a critical role in identifying ototoxicity and in the treatment and rehabilitation of affected patients.