Gentamicin vestibulotoxicity with modern systemic dosing regimens: a prospective study using video-oculography. (2nd September 2019)

• Record Type: Journal Article
• Authors: Smyth, Duncan; Mossman, Stuart; Weatherall, Mark; Jolliffe, Evan; Joshi, Purwa; Taylor, Jennifer; Thorne, Katie; Watson, Eloise; Leadbetter, Ruth; Mossman, Benjamin; Moss, Tawhai; Todd, Nicholas; Schneider, Erich
• Is Part Of: Acta oto-laryngologica. Volume 139:Number 9(2019)
• Page Start: 759
• Page End: 768
• Publication Date: 2019-09-02
• Subjects: Gentamicin -- aminoglycosides -- vestibulotoxicity -- ototoxicity -- video head impulse testing -- incidence; Otolaryngology -- Periodicals; Ear -- Diseases -- Periodicals; Throat -- Diseases -- Periodicals; Otolaryngology -- Electronic Resources; Otorhinolaryngologic Diseases; 617.8
• DOI: 10.1080/00016489.2019.1637935
• Languages: English
• ISSNs: 0001-6489

Abstract

Abstract: Objectives: To determine the incidence of gentamicin vestibulotoxicity with current dosing regimens, and to evaluate the feasibility of routine video-oculography on all patients given gentamicin. Materials and methods: In this prospective incidence study serial horizontal vestibulo-ocular reflex (HVOR) gain measurements were recorded using video-oculography on adult inpatients receiving intravenous gentamicin. The primary outcome was the proportion of patients developing impairment of their HVOR gain. Results: After exclusions, 42 patients were included in the analysis. Three patients (7.1%) developed asymptomatic vestibulotoxicity, exact 95% confidence interval 1.5–19.5%. In two of these patients the deficit resolved within several hours. No patients developed symptomatic vestibulotoxicity. There was no evidence for a generalised reduction in group HVOR gain with time. HVOR gain was not associated with total gentamicin dose, dynamic visual acuity or subjective imbalance. Conclusions and significance: Gentamicin may cause reversible, asymptomatic vestibulotoxicity. Video-oculography may be useful to monitor for vestibulotoxicity in patients treated with gentamcin; however, testing all patients routinely may be challenging.