Halmagyi et al (Otolaryngology and Head and Neck Surgery) recently reviewed retrospectively 36 patients with ototoxicity due to Gentamicin. They found gait ataxia in every patient but only 50% reported oscillopsia. Patients rarely have hearing loss and never vertigo. The onset of symptoms, when it could be clearly determined, could be as long as 1 week after the medication was stopped. In many patients the lack of activity precluded identifying exactly when the ototoxic symptoms began. 50% of patients did not have excessive total dose or abnormal peak or trough levels. The duration of treatment could be as low as 3 days. Age, underlying labyrinthine disease and previous antibiotic administration may predispose patients to ototoxicity. Older patients do not recover as well. Mild toxicity is probably reversible, so that the earliest signs of ototoxicity must be recognized at the bedside so the antibiotics can be stopped.
A daily Romberg test and measurement of the visual acuity with head rotation are simple bedside techniques that should be done every day. Physical therapy programs are very effective in such patients, especially for recovery of balance.
Original Date: Feb 10, 1995
Last Update: Feb 10, 1995