Introduction: Aspartame may have idiosyncratic toxic effects for some people; however, there are few case reports published in the medical literature. We present two case reports in a pair of siblings, one with a vestibular and the other with a cochlear toxicity to aspartame. The cochlear toxicity is the first case to be reported, while the vestibular toxicity is the second case to be reported.

IntroductionAspartame may have idiosyncratic toxic effects for some people; however, there are few case reports published in the medical literature. We present two case reports in a pair of siblings, one with a vestibular and the other with a cochlear toxicity to aspartame. The cochlear toxicity is the first case to be reported, while the vestibular toxicity is the second case to be reported.Case presentationA 29-year-old white female had a 20-month history of nausea and headache, progressively getting worse with time and eventually to also involve vomiting, vertigo, and ataxia. She was extensively evaluated and diagnosed with a vestibular neuronitis versus a chronic labyrinthitis and treated symptomatically with limited success. In response to a newspaper article, she stopped her aspartame consumption with total cessation of her symptoms. Fifteen years later, her then 47-year-old white brother had a 30-month history of an intermittent, initially 5-10 minute long episode of a mild sensorineural hearing loss in his right ear that progressed over time to several hour episodes of a moderately severe high-frequency sensorineural hearing loss to include tinnitus and a hypoesthetic area in front of his right tragus. After a negative magnetic resonance scan of the brain, he remembered his sister's experience with aspartame and stopped his consumption of aspartame with resolution of his symptoms, although the very high frequency hearing loss took at least 15 months to resolve. For both, subsequent intentional challenges with aspartame and unintentional exposures brought back each of their respective symptoms.ConclusionAspartame had a vestibulocochlear toxicity in a pair of siblings, suggesting a genetic susceptibility to aspartame toxicity. Even though the yield may be low, asking patients with dizziness, vertigo, tinnitus, or high-frequency hearing loss about their aspartame consumption and suggesting cessation of its use, may prove helpful for some.

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INTRODUCTION: Asthma affects around 5% of the United States population, with 50% having uncontrolled symptoms. AIM: To improve asthma care by seeing if the inhaled corticosteroid to bronchodilator ratio (RATIO) is associated with asthma control and if non-clinical factors were associated with adherence to asthma guidelines. METHOD: A retrospective study using University of Oklahoma-Tulsa, School of Community Medicine Family Medicine Clinic electronic medical records of a random sample of 49 patients with asthma who were seen at least twice from July 2003 through June 2007 and did not have a diagnosis of chronic obstructive pulmonary disease or exercise-induced asthma. RESULTS: The RATIO for those prescribed corticosteroid inhalers was directly related to the actual step of asthma care (STEP) but inversely related to the number of prednisone courses prescribed per year (R2=.30, p=0.0012). The difference between the actual STEP and ideal STEP (had corticosteroid inhalers been prescribed for all the months in the study) was directly related to the percent of available salbutamol (albuterol) inhalers that non-clinicians refilled and inversely related to the actual STEP (R2=.45, p=1.8 x 10-5). The available corticosteroid inhalers prescribed was directly related to the actual STEP and inversely related to the number of comorbid diagnoses addressed at the last asthma visit (R2=.70, p=5.8 x 10-10). DISCUSSION: Efforts to both limit salbutamol medications, especially by non-clinicians, and simultaneously prescribe appropriate amounts of inhaled corticosteroids, through a dedicated asthma visit, should improve asthma control. A higher RATIO implies better asthma control. KEYWORDS: Asthma; anti-inflammatory agents; albuterol; bronchodilator agents; drug therapy, combination; medical audit

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