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A Prospective Study on the Vestibular Toxicity of Gentamicin in a Clinical Setting
Sophie Chatterton, Chao Wang, Hans Satyan1
1Department of Audiology, Royal North Shore Hospital.
Objective:
Gentamicin is a widely used aminoglycoside with ototoxicity as a known adverse effect. Because of the difficulty in clinical recognition, the prevalence of gentamicin ototoxicity in practice is thought to be higher than reported. This study aimed to prospectively assess the effect of gentamicin on vestibular function and whether ototoxicity is underrecognized.
Study Design:
Single-center, prospective, nonblinded trial.
Setting:
Inpatient tertiary hospital setting followed by vestibular outpatient clinic review.
Patients:
Forty-eight patients undergoing a urologic procedure were recruited, with 24 and 17 patients having one or two follow-up tests, respectively, after initial gentamicin administration.
Interventions:
Single dose of gentamicin during a urologic procedure.
Main Outcome Measures:
Gains for the vestibuloocular reflex (VOR) were measured using the video head impulse test before receiving gentamicin and at two other timepoints after gentamicin. The gains in VOR were then compared with previous testing sessions to determine if there was a deterioration after gentamicin use.
Results:
Before receiving gentamicin, the gains for horizontal VOR were measured for 48 patients. The gains were measured a second time for 24 patients at varying durations postgentamicin (1-56 d) and a third time for 17 patients (14-152 d) postgentamicin. The mean VOR gain for Timepoints 1, 2, and 3 were 0.72 ± 0.13, 0.75 ± 0.16, and 0.79 ± 0.18, respectively. Linear-mixed model with repeated-measure analysis revealed no significant difference in VOR gain between Timepoints 1 and 2 ( p = 0.19).
Conclusion:
There was no significant effect observed on mean VOR gain decrement after a single dose of gentamicin.
Insights
A single dose of gentamicin did not significantly impact vestibular function, specifically the vestibulo-ocular reflex (VOR) gain. This suggests gentamicin ototoxicity may not be as common as previously suspected after short-term use.
Area of Science:
- Ototoxicity and Vestibular Function
Background:
- Gentamicin, a common aminoglycoside antibiotic, is known to cause ototoxicity.
- Clinical recognition of gentamicin-induced ototoxicity is challenging, potentially leading to underreporting.
- The actual prevalence of gentamicin ototoxicity may be higher than currently documented.
Purpose of the Study:
- To prospectively evaluate the impact of gentamicin on vestibular function.
- To determine if gentamicin ototoxicity is underrecognized in clinical practice.
Main Methods:
- A single-center, prospective, nonblinded trial was conducted in an inpatient tertiary hospital.
- Forty-eight patients undergoing urologic procedures received a single dose of gentamicin.
- Vestibulo-ocular reflex (VOR) gain was measured using the video head impulse test before and after gentamicin administration.
Main Results:
- Horizontal VOR gain was measured in 48 patients pre-gentamicin and in subsets of patients at two later timepoints.
- Mean VOR gains were 0.72 ± 0.13, 0.75 ± 0.16, and 0.79 ± 0.18 at the three timepoints.
- Statistical analysis revealed no significant difference in VOR gain between the pre-gentamicin measurement and the first follow-up measurement (p = 0.19).
Conclusions:
- A single dose of gentamicin did not result in a significant decrement in mean VOR gain.
- These findings suggest that short-term gentamicin use may not significantly impair vestibular function.
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