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Neomycin-induced perception deafness following bladder irrigation in patients with end-stage renal disease
E W Gerharz1, K Weingärtner, M D Melekos
1Department of Urology, Philipps-University Medical School, Marburg, Germany.
Objective:
To report a serious side-effect of intravesical instillations of neomycin in patients with end-stage renal disease.
Patients And Methods:
Three patients (two men and a woman, aged 51.71 and 54 respectively) with end-stage renal disease who had undergone bladder irrigation with neomycin sulphate solution suffered complete irreversible deafness, which was assessed by audiogram.
Results:
All three patients developed complete perception deafness after 3, 4 and 10 months, with characteristic changes in the audiogram. The severe progressive hearing loss was maximal in the high-frequency range. A high-pitched tinnitus was the first sign of impending hearing difficulty and two patients developed a spontaneous nystagmus.
Conclusion:
In view of the doubtful efficacy and, most importantly, the risk of severe disabling side-effects such as ototoxicity, we recommend the avoidance of intravesical instillation with neomycin whenever possible.