Topical gentamicin-induced acute vestibulopathy: A case report
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Teik Beng Lau1, Jeyasakthy Saniasiaya2, Revadi Govindaraju3
1MBBS, Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Jalan Universiti, Kuala Lumpur, Malaysia.
Abstract:
Evidence suggests that otologic injury from ototopical aminoglycoside preparations is infrequent when used to treat ear infections with an intact tympanic membrane. Meanwhile, parenteral administration of aminoglycosides, is well known to be associated with a significant incidence of cochlear and vestibular damage. The discrepancy between topical and parenteral ototoxic effects is thought to result from a combination of factors, including the protective function of debris overlying the round window membrane, low antibiotic concentrations of topical antibiotic preparations, length of exposure and inability to detect subtle hearing or vestibular changes. Herein, we present a case of acute vestibulopathy following a 2-week course of topical gentamicin otic drops. Awareness of vestibulotoxicity following topical gentamicin therapy is prudent as vestibulopathic symptoms can be severely debilitating.
Insights
Topical aminoglycosides are rarely ototoxic, unlike systemic use. This case highlights potential vestibulotoxicity from topical gentamicin ear drops, emphasizing the need for awareness.
Area of Science:
- Otolaryngology
- Nephrology
- Pharmacology
Background:
- Aminoglycosides administered systemically are known ototoxic agents, causing cochlear and vestibular damage.
- Ototopical aminoglycosides are generally considered safe for ear infections with an intact tympanic membrane.
- Factors contributing to lower topical ototoxicity include protective barriers and lower drug concentrations.
Observation:
- A patient developed acute vestibulopathy after a two-week course of topical gentamicin otic drops.
- This contrasts with the generally accepted low risk of ototoxicity from topical aminoglycosides.
Findings:
- Topical gentamicin, despite its formulation for ear use, can cause significant vestibular dysfunction.
- The case suggests that topical aminoglycoside ototoxicity may be under-recognized.
Implications:
- Clinicians should maintain awareness of potential vestibulotoxicity from topical gentamicin therapy.
- Prompt recognition and management of vestibulopathic symptoms are crucial due to their debilitating nature.
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