In cisplatin ototoxicity, what is the typical sequence of sensory loss?

• A. Tinnitus and central processing deficits
• B. High-frequency hearing loss followed by bilateral vestibular loss
• C. Low-frequency loss followed by tinnitus
• D. Tinnitus alone

Answer: (B)

The key idea is that cisplatin toxicity targets the inner ear in a characteristic sequence: the cochlea is affected first, with damage to the outer hair cells in the basal turn causing high-frequency sensorineural hearing loss (often with tinnitus). If exposure continues or the dose is higher, the vestibular system can be impacted, leading to bilateral vestibular dysfunction. Since the cochlea—and particularly the high-frequency region at the base—is more sensitive to cisplatin, high-frequency loss tends to appear before vestibular signs, and bilateral vestibular loss can develop with ongoing treatment. While vestibular toxicity is not universal, when it does occur it typically follows the initial cochlear damage, making high-frequency loss followed by bilateral vestibular loss the best description of the typical sequence.