Disturbances of equilibrium with aminoglycoside antibiotics

Abstract

From January 1974 to December 1978, in the Department of Otorhinolaryngology, Gifu University School of Medicine, there were 12 cases of vestibular ototoxicity caused by aminoglycoside antibiotics.Eight cases were due to streptomycin sulfate (SM), two cases to kanamycin (KM), one case was due to aminodeoxy kanamycin (AKM), and one to a combination of KM, AKM and dibekacin sulfate (DKB).Characteristics of the equilibrium disturbances and the prognosis were studied. The results were as follows : (1) There were many cases of equilibrium disturbances among those who injected an aminoglycoside antibiotic of 1gm. per day for over 2 weeks.(2) Equilibrium disturbances were more prominent than disturbances of hearing among those prescribed not only SM but also KM, AKM or a combination of KM, AKM and DKB.(3) The chief complaint on the first visit was not deafness but disturbances of standing and walking and disturbances in visual fixation while walking and running (jumbling phenomenon), in all cases. In 5, deafness was a subjective symptom, but not the chief complaint.(4) The characteristic complaint of jumbling phenomenon was that the outside world appeared to be moving up and down during walking and running.(5) There were 11 with a hearing loss under 30dB and one with a loss of over 30dB. In all cases, a C5 dip or C6dip was evident (audiometry).(6) In the equilibrium test, a marked or moderate disturbance of standing with eyes closed was noted in all patients.There were 11 with decrease of labyrinthine excitability and one with bilateral loss of labyrinthine excitability.(7) The galvanic test revealed that the site of damage was the vestibular neuroepithelium.(8) In those in whom labyrinthine excitability was not lost, jumbling phenomenon was also observed.(9) Five appeared to be recovering from the loss or decrease of labyrinthine excitability and jumbling phenomenon after being off the drugs for over 2 weeks.(10) There was one with an advanced depression seen in the rotatory and caloric responses where bilateral loss of labyrinthine excitability was also observed after cessation of administration of SM.