The word “ototoxicity” broadly refers to the damaging (toxic) effects that various chemical agents (such as therapeutic drugs or industrial compounds) can have on hearing and balance. While there is substantial literature on this topic, there is also substantial controversy. Some drugs are better documented to have toxic effects on balance and/or hearing. For other drugs, the connection is less clear. When evaluating a patient for possible ototoxicity, the most important first step is to identify whether there are measurable deficits in balance and/or hearing, which usually requires formal vestibular and audiologic testing The vast majority of cases of ototoxicity are irreversible. Nevertheless, if objective evidence of auditory and/or vestibular deficits are found in a patient in whom there is reasonable suspicion that potentially ototoxic agents may be contributory, then if medically feasible it is reasonable to stop the offending medication and avoid its use in the future. For some life-threatening diseases, current treatments have known ototoxicity, but withholding the treatment may not be a realistic option, so patients and their practitioners proceed with treatment in full awareness of this risk. The diseases in question are usually various infections (that require treatment with aminoglycoside antibiotics) and malignancies (that require treatment with platinum-based chemotherapeutic agents).