Vestibular Ototoxicity: The Importance and Pragmatics of Monitoring

摘要

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, aminoglycoskle antibiotics and antineoplastic (chernotherapeutic) agents have the greatest ototoxtc potential, often resulting in permanent changes in hearing and/or balance. Although there is ample evidence regarding changes in auditor}' 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 dining 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.