This evidence-based learning activity spotlights the imperative yet overlooked issue of ototoxicity – sensory damage to hearing and balance systems induced by common therapeutic medication classes. It equips nurses with foundational knowledge for championing prevention, early recognition, supportive interventions, and safety protocols that respect patient-centeredness when ototoxic drugs prove essential for treatment. High-risk groups span from tiny preemies to elderly adults, with chemotherapies, antibiotics, diuretics and NSAIDs implicating dangers of temporary to permanent deficits that radically reduce quality of life. Nurses hold invaluable power to shift outcomes through awareness building, careful administration, patient education, emerging objective monitoring approaches, prompt recognition and referrals, interprofessional collaboration maximizing the risk-benefit ratio for each individual, and advocating institution-wide reforms. By illuminating this rarely-discussed topic and providing assessment tools, management guidelines and implementation strategies, this learning activity engages nurses in upholding the Hippocratic oath – first, do no harm – even amid circumstances where some risk proves unavoidable.