Therapeutic regimens often impose adverse effects that have to be weighed against the expected benefits. Ototoxicity, drug-induced damage to the inner ear, can be transitory or permanent. The most widely used ototoxic drugs in pediatrics are aminoglycoside antibiotics. They are mainly used to treat gram-negative bacterial sepsis and carry the risk of causing permanent hearing loss. Brainstem response audiometry, a new method of testing hearing, reveals potentially significant subclinical changes in hearing of neonates due to amino-glycoside therapy. Recent investigation of these and other ototoxic drugs is shedding new light on therapy management. Nurses need to be aware of this research in order to minimize the risk of permanent hearing loss.