Aminoglycoside antibiotics are commonly used because of their ability to treat bacterial infections, yet they also are a major cause of deafness. Aminoglycosides selectively damage the cochlea's sensory hair cells, the receptors that respond to the fluid movement in the cochlea to produce neural signals that are relayed to the brain. Sensory hair cell death in the inner ear can lead to permanent hearing loss and balance impairment. A primary mechanism of aminoglycoside-induced hair cell death is the induction of apoptosis. Apoptosis is an evolutionarily conserved form of cell death that provides organisms with a method to remove unwanted or damaged cells without injuring neighboring cells. The role of apoptosis in aminoglycoside-induced hair cell death is discussed in this article, as are the implications for developing methods to protect sensory hair cells.