Vestibular Toxicity: Causes, Evaluation Protocols, Intervention, and Management

Abstract

The loss of vestibular function, typically bilateral, due to chemical solvents and pharmacological agents is not rare and has been investigated and reported for many years. The successful treatment of bacterial infections and sepsis with IV antibiotics and cancer-fighting drugs like cisplatin makes the decision to use these life-saving drugs less of a debate, despite their potential deleterious effect on balance and equilibrium. The purpose of this article is to provide the reader with an overview of the more common substances found in industry and medicine which may decrease or permanently destroy peripheral and/or central vestibular function. A review of bedside and clinical evaluation protocols will be discussed as well as best practice intervention with balance retraining therapy. Finally, the role of the audiologist and opportunities for participation in an interdisciplinary approach to evaluation and management will be presented.

Keywords

vestibular - vestibulotoxic - balance retraining - fall-risk management

• References

• 1 Frisina RD, Wheeler HE, Fossa SD. , et al. Comprehensive audiometric analysis of hearing impairment and tinnitus after cisplatin-based chemotherapy in survivors of adult-onset cancer. J Clin Oncol 2016; 34 (23) 2712-2720
• 2 Gans R. Vestibular rehabilitative therapy. In: Handbook of Clinical Audiology Seventh Edition. Katz J, Chasin M, English KM, Hood LJ, Tillery KL. , eds. Lippincott William & Wilkins; 2015: 425-433
• 3 Arlien-Søborg P, Zilstorff K, Grandjean B, Milling Pedersen L. Vestibular dysfunction in occupational chronic solvent intoxication. Clin Otolaryngol Allied Sci 1981; 6 (04) 285-290
• 4 Campbell KCM, Le Prell CG. Drug-induced ototoxicity: diagnosis and monitoring. Drug Saf 2018; 41 (05) 451-464
• 5 Sepsis. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/sepsis/index.html . Published July 20, 2018 . Accessed December 10, 2018
• 6 Roberts RA, Gans RE. Comparison of horizontal and vertical dynamic visual acuity in patients with vestibular dysfunction and nonvestibular dizziness. J Am Acad Audiol 2007; 18 (03) 236-244
• 7 Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol 1988; 45 (07) 737-739
• 8 To-Alemanji J, Ryan C, Schubert MC. Experiences engaging healthcare when dizzy. Otol Neurotol 2016; 37 (08) 1122-1127
• 9 Horak FB, Jones-Rycewicz C, Black FO, Shumway-Cook A. Effects of vestibular rehabilitation on dizziness and imbalance. Otolaryngol Head Neck Surg 1992; 106 (02) 175-180
• 10 Schubert MC, Herdman SJ, Tusa RJ. Vertical dynamic visual acuity in normal subjects and patients with vestibular hypofunction. Otol Neurotol 2002; 23 (03) 372-377
• 11 Gans RE, Yellin MW. Assessment of vestibular function. In: Roeser RJ, Valente M, Hosford-Dunn H. , eds. Audiology: Diagnosis. 2nd ed. New York: Thieme; 2007: 540-566
• 12 Neri SG, Cardoso JR, Cruz L. , et al. Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis. Clin Rehabil 2017; 31 (10) 1292-1304