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Systemic poisoning related to cobalt–chromium total hip arthroplasty can affect multiple organs. In the otolaryngologic area the most frequent symptoms are tinnitus and hearing loss. In this report, we describe 2 patients with cobalt-containing hip prostheses who presented with otologic symptoms. The first case describes a patient with an extremely high cobalt blood level, which we believe may be one of the highest reported to date, after replacing a broken ceramic-on-ceramic prosthesis with a metal-on-metal prosthesis. This patient suffered all known complications associated with cobalt poisoning and survived. The second case, a female patient with a left resurfacing metal-on-metal prothesis, presented with bilateral continuous high-pitched tinnitus that started 8 months after surgery. Orthopedic surgeons and otologists should be vigilant for cobalt-induced ototoxicity in patients with metal-on-metal total hip prostheses. [ABSTRACT FROM AUTHOR]