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Gentamicin vestibulotoxicity with modern systemic dosing regimens: a prospective study using video-oculography
Duncan Smyth1, Stuart Mossman1, Mark Weatherall2
1a Department of Neurology, Wellington Hospital , Wellington , New Zealand.
Acta Oto-Laryngologica
|July 18, 2019
Summary
Gentamicin can cause temporary, asymptomatic inner ear damage (vestibulotoxicity) in some patients. Routine video-oculography may help monitor this, but widespread use presents challenges.
Area of Science:
- Ototoxicity research
- Vestibular system function
- Clinical pharmacology
Background:
- Gentamicin is a critical antibiotic, but its ototoxic potential necessitates careful monitoring.
- Current dosing regimens and their impact on vestibular function require updated evaluation.
- Video-oculography offers a potential method for objective assessment of vestibular impairment.
Purpose of the Study:
- To ascertain the incidence of gentamicin-induced vestibulotoxicity with contemporary dosing protocols.
- To assess the practicality of implementing routine video-oculography for patients receiving gentamicin.
- To investigate the relationship between gentamicin exposure and horizontal vestibulo-ocular reflex (HVOR) gain.
Main Methods:
- A prospective incidence study design was employed.
- Serial horizontal vestibulo-ocular reflex (HVOR) gain measurements were collected using video-oculography.
- Adult inpatients receiving intravenous gentamicin were enrolled, with HVOR gain impairment as the primary outcome.
Main Results:
- Three out of 42 analyzed patients (7.1%) exhibited asymptomatic vestibulotoxicity, with deficits resolving in two cases.
- No patients developed symptomatic vestibulotoxicity or showed a generalized decrease in group HVOR gain over time.
- HVOR gain did not correlate with total gentamicin dose, dynamic visual acuity, or self-reported imbalance.
Conclusions:
- Gentamicin administration can lead to reversible, asymptomatic vestibulotoxicity.
- Video-oculography demonstrates potential utility in monitoring gentamicin-induced vestibulotoxicity.
- Routine application of video-oculography for all gentamicin-treated patients may face logistical hurdles.
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