Prevention of Severe Vestibular Hypofunction after Systemic Gentamicin

Abstract

The importance of early evaluation by a neurotologist in patients with infective endocarditis treated with systemic gentamicin and its impact on the patients’ quality of life was evaluated. This is a longitudinal retrospective cohort study of 29 patients who received intravenous gentamicin for the treatment of infective endocarditis. Patients were classified into two groups: group A, before a neurotologist was included in the treatment protocol, and group B, after the inclusion of a neurotologist. The frequency of the different symptoms in each group was measured, and the gain of the vestibulo-ocular reflex (VOR) and its relationship with the presence of oscillopsia. In total, 13 and 16 patients were assigned to groups A and B, respectively. The mean gain of the VOR measured using the video head impulse test in group A was 0.44 in the best side and 0.39 in the worst side. In group B, the mean gain was 0.71 (best side) and 0.64 (worst side) (p < 0.0001). The patients who complained about oscillopsia had a main gain of 0.41 in the best side and 0.35 in the worst side. Evaluation of vestibular function should be included in the infective endocarditis treatment protocol, including the adverse effects of systemic gentamicin.

Recent Advances in the Diagnosis and Treatment of Vestibular Disorders

“…First, Esteban-Sanchez and Martin-Sanz [ 13 ] have covered the topic of acute unilateral vestibulopathy in a rigorous and detailed study during a follow-up, trying to correlate measures of functional damage, postural deficiency, and disability to the clinical state of compensation, with clinical implications when vestibular rehabilitation is the treatment of choice. Induced bilateral vestibulopathy is the unwanted effect of some systemic medications, such as gentamicin; in their study, Ferreira-Cendón et al have shown how this effect could be reduced in patients with infectious endocarditis when an otoneurologist is included in the treating team to provide careful and continued measures of vestibular function to help in the continuation, or not, of gentamicin [ 14 ]. This probably could be expanded to other treatments with potentially ototoxic medications.…”