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Pycnogenol prevents cisplatin-induced cochlear apoptosis and is protective against cisplatin ototoxicity ( 3.1.12 Silymarin Silymarin, a lipophilic extract from the seeds of Silybum marianum, is protective against ototoxicity by inhibiting the expression of caspase-3 and PARP in cisplatin-induced cleavage through mechanisms such as scavenging of free radicals, reduction of ROS formation, and inhibition of fatty acid peroxidation ( 3.2 Non-flavonoids 3.2.1 Ferulic acid (FA) FA belongs to the phenolic acid family and is abundant in fruits and vegetables.FA acts as a potent antioxidant by up-regulating the cytoprotective system for scavenging free radicals and enhancing cellular stress response (Mancuso and Santangelo, 2014).FA inhibits cisplatin-induced cytotoxicity by blocking ROS formation and inducing endogenous antioxidant production, which in turn inhibits cisplatin-induced cytotoxicity (Paciello et al., 2020)

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After a full-text review of 39 studies, the authors included five randomized controlled clinical trials in the final analysis

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