A variety of drugs and topical agents have the potential of causing vestibulocochlear toxicity. It is a topic that generates significant interest and controversy among physicians and basic scientists. Neurologists need to be aware that drugs ranging from the well-known aminoglycosides to non-steroidal and anti-inflammatory drugs can have effects on the balance and hearing systems. Ototoxicity from topical preparations is an area of interest and concern for otolaryngologists utilizing drops in the presence of perforated tympanic membranes, however, neurologists need to be aware as well of the potential damage to hearing. Vestibular damage from drugs can be put to efficacious use in the treatment of Meniere's disease as will be discussed. As pointed out by Rybak1, ototoxicity monitoring is in a constant state of flux and information is presented discussing monitoring of drug levels as well as auditory function. It is the intention of this brief review to present the effects of commonly employed agents on the cochlear and vestibular system so that neurologists may recognize and understand the potential for imbalance and hearing disorders caused by ototoxic drugs.