Aminoglycoside vestibulotoxicity monitoring in adults

Posted by 2563 on July 20, 2017

Aminoglycoside vestibulotoxicity monitoring in adults

July 20, 2017 at 11:07 AM

Dear Colleague,

I am a consultant ENT surgeon undertaking an MSc in otology and audiology. My research project entails looking at how units monitor vestibulotoxicity during aminoglycoside treatment.
Aminoglycosides are one of the most widely used class of antibiotics in the world, particularly in developing nations, largely because it is readily available and cost effective especially against gram-negative aerobic bacteria. The main draw backs have been the serious side effects of nephrotoxicity and ototoxicity. Whilst the effects of aminoglycoside on the ascending loop of Henle may be reversible, the effects on the hair cells are permanent. 
The development of ototoxicity may not be immediately apparent as it is not related to serum levels, and some patients may be genetically more susceptible to it. The clinical manifestation may also be delayed due to patient related factors e.g. the level unconsciousness or the clinical team’s failure to recognise the early signs.

Ototoxicity comprises of both cochleotoxicity and vestibulototoxicity relating to the effects of drugs on the cochlear and vestibular organs respectively. In 1990, the American Speech-language-Hearing Association (ASHA), produced guidelines for monitoring aminoglycoside cochleotoxicity but did not produce a protocol for the monitoring of vestibulotoxicity largely because the diagnostic criteria at the time were unclear and it was thought that the diagnostic equipment available at the time were either too expensive or cumbersome. This lead to some authors proposing screening for selected groups undergoing treatment with ototoxic drugs. These groups include those with the following risk factors- age over 60, family history of hearing loss, elevated gentamicin levels, concomitant noise exposure, concurrent administration of other potentially ototoxic agents, kidney failure.

Recently clinical tests and affordable diagnostic equipment have become available, so perhaps the time is right to develop a systematic and cost-effective protocol to assist in the prevention and management of vestibulototoxicity. 
I would like to conduct a national survey of how units in the United Kingdom monitor vestibulotoxicity in patients given aminoglycosides as a means of identifying areas of best practice and possibly developing a cost-effective means of managing and preventing aminoglycoside vestibulotoxicity in patients.

The online survey is to be distributed across specialties involved in the administration of aminoglycosides and the management of vestibulotoxicity.

Presently, there are no validated questionnaires or set protocols for managing patients with vestibulotoxicity so I have designed one which has been reviewed by a panel of experts which I believe would help answer the research questions. The link to the questionnaire.

I would most obliged if you could tick the most appropriate response or responses. The question should take no more than 2 minutes.

Anthony Owa