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The sensitivity of the peripheral auditory system to both transient and permanent impairment has been well recognized for decades. It has long been appreciated that aminoglycoside antibiotics and platinum-containing chemotherapeutic agents carry a risk of producing permanent functional impairment and injury while loop diuretics and aspirin can produce transient effects. While mechanisms by which these impairments occur have recently been postulated and are under continuing study, the topic of ototoxicity has garnered recent attention because of the wide range of chemicals that are also able to damage the cochlea or increase sensitivity of this end organ to noise. Here again several mechanisms have been posited, but far more work is required. This chapter elucidates the structure and normal function of the cochlea, explores potential mechanisms responsible for ototoxicity, and surveys a variety of such chemical ototoxicants.