<s>[INST] context: S/E of Aminoglycoside includes: 1. OTOTOXICITY: Due to accumulation of these in labyrinthine fluid.The Vestibular or Cochlear sensory cells and hairs undergo concentration dependent destructive changes. Aminoglycoside ear drops can cause ototoxicity when instilled in patients with perforated eardrum and so are contraindicated in them.No regeneration of the sensory cells occurs and the hearing loss is permanent. Cochlear damage - stas from Base and spreads to Apex; hearing loss affects high frequency sounds first then progressively involves the lower frequencies as well. Kanamycin and Amikacin produce greater cochlear damage than other aminoglycosides. Vestibular damage - Headache is usually first to appear other symptoms include Nystagmus, Veigo and Ataxia. Permanency of changes depends on the extent of initial damage and the age of the patient; Elderly have poor recovery. 2. NEPHROTOXICITY: Manifests as Tubular damage resulting in loss of urinary concentrating power, Nitrogen retention ,Low GFR, Albuminuria and casts.Concurrent use with Loop Diuretics (e.g Furosemide, Ethacrynic acid) or other Nephrotoxic antimicrobial agents (e.g Vancomycin or Amphotericin) can potentiate Nephrotoxicity and should be avoided if possible. 3. NEUROTOXICITY: Aminoglycosides reduce Ach release from the motor nerve endings byinterfering with mobilization of centrally located synaptic vesicles to fuse with the terminal membrane (probably by antagonizing Ca2+) and also decreases sensitivity of the muscle end plates to Ach. [/INST] question: Aminoglycoside side effects include : Cochlear toxicity Vestibular toxicity Neuromuscular Blockade | options: A: Only 1 B: 1 and 2 C: 1,2 and 3 D: 2 and 3 | answer: C </s>