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Investigation of vestibular damage by antituberculous drugs
1Department of Internal Medicine, Yokosuka Kyosai Hospital, Japan.
Abstract:
Vestibular function testing was performed regularly on patients who were administered streptomycin, kanamycin, or enviomycin, and vestibular damage was detected at an early stage, and quantitatively. We investigated the point in time at which the therapy should be discontinued. Subjects consisted of 204 cases of tuberculosis treated with streptomycin, kanamycin, enviomycin. They were admitted to the hospital between December 1984 and August 1989. Twenty-eight cases of vestibular dysfunction due to streptomycin, kanamycin, and enviomycin could easily be detected at an early stage by performing Meyer zum Gottesberge's head-shaking test for the evaluation of jumbling, together with Romberg's test and the stepping test. All cases who had vestibular dysfunction completely recovered because of early detection. In addition, 7 cases recovered afterwards from temporary vestibular damage shown only in Meyer zum Gottesberge's head-shaking test (abnormality of vestibulo-ocular reflex was only detected and vestibulo-spinal reflex remained intact), despite continuation of streptomycin injection. When the results of the head-shaking test are less than 50% and when a sway and/or rotation in the stepping test occurs, the injections should be discontinued.
Insights
Early detection of vestibular damage from ototoxic antibiotics like streptomycin is crucial. Specific tests can identify issues, allowing for timely intervention and full recovery in tuberculosis patients.
Area of Science:
- Ototoxic drug effects
- Vestibular function assessment
- Neurology
Background:
- Streptomycin, kanamycin, and enviomycin are antibiotics used for tuberculosis treatment.
- These drugs can cause ototoxicity, leading to vestibular dysfunction.
- Early detection and management of vestibular damage are essential to prevent permanent deficits.
Purpose of the Study:
- To investigate early detection methods for vestibular damage caused by streptomycin, kanamycin, and enviomycin.
- To determine the optimal time to discontinue these ototoxic therapies.
- To assess the recovery of vestibular function after early intervention.
Main Methods:
- Regular vestibular function testing was performed on 204 tuberculosis patients treated with streptomycin, kanamycin, or enviomycin.
- Key tests included Meyer zum Gottesberge's head-shaking test, Romberg's test, and the stepping test.
- Vestibular dysfunction was quantitatively assessed to identify early-stage damage.
Main Results:
- Twenty-eight cases of vestibular dysfunction were detected early using the head-shaking, Romberg, and stepping tests.
- All 28 cases with detected vestibular dysfunction recovered completely due to early detection.
- Seven additional cases with temporary vestibulo-ocular reflex abnormalities recovered despite continued streptomycin, highlighting the sensitivity of the head-shaking test.
Conclusions:
- Meyer zum Gottesberge's head-shaking test, combined with Romberg's and stepping tests, enables early and quantitative detection of ototoxic vestibular damage.
- Discontinuation of streptomycin, kanamycin, or enviomycin is recommended when head-shaking test results are below 50% or when sway/rotation occurs in the stepping test.
- Early detection and intervention strategies for drug-induced vestibular dysfunction lead to complete recovery.