Prevention of Severe Vestibular Hypofunction after Systemic Gentamicin

Area of Science:

• Otolaryngology
• Neurology
• Infectious Diseases

Background:

• Infective endocarditis (IE) requires systemic antibiotic treatment, often with gentamicin.
• Gentamicin can cause ototoxicity, affecting vestibular function.
• The impact of IE and gentamicin on patient quality of life, particularly vestibular function, is not fully understood.

Purpose of the Study:

• To evaluate the importance of early neurotologist assessment in IE patients treated with gentamicin.
• To determine the impact of neurotologist involvement on vestibular function and quality of life.

Main Methods:

• Longitudinal retrospective cohort study of 29 IE patients treated with intravenous gentamicin.
• Patients divided into two groups: pre-neurotologist inclusion (Group A) and post-neurotologist inclusion (Group B).
• Measured vestibulo-ocular reflex (VOR) gain using video head impulse test (vHIT) and assessed oscillopsia symptoms.

Main Results:

• Group B (with neurotologist) showed significantly higher VOR gain (0.71 best side, 0.64 worst side) compared to Group A (0.44 best side, 0.39 worst side) (p < 0.0001).
• Patients reporting oscillopsia had lower VOR gain (0.41 best side, 0.35 worst side).
• Early neurotologist evaluation correlated with improved VOR gain.

Conclusions:

• Neurotologist evaluation is crucial for IE patients receiving gentamicin.
• Incorporating vestibular function assessment into IE treatment protocols is recommended.
• Early intervention can mitigate gentamicin-induced ototoxicity and improve patient outcomes.