Gentamicin vestibulotoxicity with modern systemic dosing regimens: a prospective study using video-oculography

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.

Chinese abstract

目的：探讨按目前给药方案用庆大霉素治疗后, 前庭毒性的发生率。评价所有庆大霉素给药患者行常规视频眼科检查的可行性。

材料和方法：在这项前瞻性发病率研究中, 对接受静脉注射庆大霉素的成年住院患者进行了一系列水平前庭-眼反射（HVOR）增益测量。主要结果是HVOR增益受损的患者比例。

结果：经筛选, 42例患者被纳入分析。三名患者（7.1%）发生无症状前庭毒性, 95%置信区间为1.5-19.5%。其中两名患者在几个小时内就痊愈了。没有患者出现症状性前庭毒性。没有证据表明随着时间的推移, 群体HVOR增益普遍减少。HVOR增益与庆大霉素总剂量、动态视力或主观失衡无关。

结论与意义：庆大霉素可引起可逆性的、无症状的前庭毒性。视频眼科检查可能有助于监测使用庆大霉素治疗的患者的前庭毒性；然而, 常规检查所有患者可能会比较困难。

Keywords:

• Gentamicin
• aminoglycosides
• vestibulotoxicity
• ototoxicity
• video head impulse testing
• incidence

Acknowledgements

We wish to acknowledge the assistance in recruiting patients we received from clinical staff at Wellington Hospital, in particular Doreen Grant and Sharon Clarke from the pharmacy department.

Disclosure statement

Dr Smyth, Dr S. Mossman, Prof Weatherall, Dr Jolliffe, Dr Joshi, Dr Taylor, Dr Thorne, Dr Watson, Dr Leadbetter, Mr B. Mossman and Mr Moss declare no conflict of interest. Mr Todd is an employee of EyeSeeTec GmbH (manufacturer of EyeSeeCam). Prof Schneider has received speaker honoraria from Actelion, he is a shareholder and the managing director of EyeSeeTec GmbH (manufacturer of EyeSeeCam), and he is an unpaid consultant for Interacoustics (distributor of EyeSeeCam).

Additional information

Funding

Funding assistance was obtained from the Wellington Hospital Neurology Department Research Trust Fund.