Vestibular Ototoxicity: The Importance and Pragmatics of Monitoring

ABSTRACT

Ototoxicity is an unfortunate consequence of the availability and use of medications that are used to prolong life by treating serious infections and cancer. Specifically, aminoglycoside antibiotics and antineoplastic (chemotherapeutic) agents have the greatest ototoxic potential, often resulting in permanent changes in hearing and/or balance. Although there is ample evidence regarding changes in auditory function secondary to treatment, and protocols have been established to monitor hearing during and following each treatment course, less is known about the impact of medications and other agents on the vestibular system. The purpose of this article is to discuss the audiological management of vestibular ototoxicity. The discussion includes a description of the clinical features of vestibular loss, the tools that are available to assess damage to the vestibular system during treatment, and experimental evidence of the impact of various agents on the auditory and vestibular systems. Selected cases are presented to illustrate the variable presentation of vestibular loss across affected individuals, as well as the complex relationship between hearing and vestibular system status. Finally, various options for monitoring vestibular system function are proposed, including a discussion of the pragmatic aspects of establishing a monitoring program.

KEYWORDS

Ototoxicity - aminoglycosides - monitoring - vestibular - oscillopsia

REFERENCES

• 1 Living without a balancing mechanism.  N Engl J Med. 1952;  246 458-460
• 2 Halmagyi G M, Curthoys I S. A clinical sign of canal paresis.  Arch Neurol. 1988;  45 737-739
• 3 Desmond A L. Vestibular Function Evaluation and Treatment. New York: Thieme; 2004: 45-62
• 4 Zee D S, Fletcher W A. Bedside examination. In: Balogh R W, Halmagyi C M, eds. Disorders of the Vestibular System. New York: Oxford University Press; 1996: 178-190
• 5 Furman J M, Wall III C, Kamerer D B. Alternate and simultaneous binaural bithermal caloric testing: a comparison.  Ann Otol Rhinol Laryngol. 1988;  97 (4 Pt 1) 359-364
• 6 Jacobson G P, Newman C W. The development of the Dizziness Handicap Inventory.  Arch Otolaryngol Head Neck Surg. 1990;  116 424-427
• 7 Newman C W, Jacobson G P. Applications of self report scales in balance function handicap assessment and management.  Semin Hear. 1993;  14 363-376
• 8 Newman C W, Jacobson G P. Assessing balance handicap. In: Jacobson G P, Newman C W, Kartush J, eds. Handbook of Balance Function Testing. Chicago, IL: Mosby-Yearbook; 1993: 380-391
• 9 Jacobson G P, Calder J H. Self-perceived balance disability/handicap in the presence of bilateral peripheral vestibular system impairment.  J Am Acad Audiol. 2000;  11 76-83
• 10 Calder J H, Jacobson G P. Acquired bilateral peripheral vestibular system impairment: rehabilitative options and potential outcomes.  J Am Acad Audiol. 2000;  11 514-521
• 11 Black F O, Pesznecker S, Stallings V. Permanent gentamicin vestibulotoxicity.  Otol Neurotol. 2004;  25 559-569
• 12 Dhanireddy S, Liles W C, Gates G A. Vestibular toxic effects induced by once-daily aminoglycoside therapy.  Arch Otolaryngol Head Neck Surg. 2005;  131 46-48