Ototoxicity of loop diuretics   Many loop diuretics, especially
ethacrynic acid and furosemide, cause both temporary and
permanent hearing loss. Loss of hearing occurs very rapidly
after intravenous administration. Risk factors are high doses,
acute or chronic renal failure, cirrhosis, and in premature
infants. Cases of permanent hearing loss have occurred with
ethacrynic acid mostly in patients with renal failure.
Fruosemide is more likely to cause reversible sensorineural
hearing loss.   Loop diuretics cause:  The morphological
alterations described in humans have included extensive outer
hair cell losses in the basal turn of the cochlea, cystic
changes in the stria vascularis, rupture of endothelial layers,
and edema of the marginal cells of the stria vascularis. Death
of the hair cells in the organ of Corti causes permanent hearing
loss. When loop diuretics are given with aminoglycosides,
morphologic changes occur within 1 hour.  The stria vascularis
contains a Na/K/2Cl transporter presumably binds booth