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Clinically manifesting as sensorineural hearing loss and vestibular dysfunction, ototoxicity significantly compromises cognitive health and long\u2010term quality of life. Despite its prevalence, early detection and prophylactic intervention remain clinically suboptimal. This review provides a comprehensive analysis of the molecular pathogenesis and risk factors\u2014including age, specific genetic polymorphisms, and cumulative dosage\u2014associated with various cancer modalities such as platinum\u2010based chemotherapy, radiotherapy, and emerging immunotherapies. We specifically evaluate the cellular mechanisms of cisplatin\u2010induced irreversible damage to the stria vascularis and hair cells. Furthermore, this article critiques current clinical monitoring protocols, advocating for the integration of baseline audiological screening and high\u2010frequency auditory assessments as mandatory standards of care. 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