There are a wide range of medications that have ototoxic effects, and the list is growing with the introduction of new chemotherapeutic agents. It is important to recognize this condition early to offer early therapeutic intervention. Monitoring of ototoxic effects requires multi-disciplinary coordination and appropriate baseline and post-therapeutic audiologic monitoring. The goals of this program will be to review many of the ototoxic medications and discuss the components necessary for establishing an ototoxicity monitoring protocol (OMP). In addition, we will review various therapeutic options. We aim to raise awareness about this significant issue and offer insights as to how to manage a complex clinical problem.