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Clinical Predictors of Streptomycin-Vestibulotoxicity

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

The Global tuberculosis control is challenged with a growing resistance to antitubercular treatment (ATT) culminating in resistant (MDR/XDR) strains; an important factor being premature withdrawal of streptomycin owing to its morbidity particularly nephrotoxicity and cochleotoxicity as guidelines for their prevention exist. An attempt is made here to address the least recognized and most debilitating vestibular toxic effects of streptomycin and defining a vestibular-protocol for its early detection and progression. Thirty two prospective patients (treatment-failures, relapse and default cases) undergoing ATT (24 shots of IM streptomycin 15–20 mg/kg over 8 weeks) underwent complete vestibular workup including vestibulo-ocular and vestibulo-spinal reflex assessment with an attempt to closely follow them. Four categories (I: No-, II: Occult-, III: Delayed-Manifest- and IV: Manifest-vestibulotoxicity) were defined. The DHI and casual gait abnormality clearly differentiated III/IV from I/II. The occilopsia and head thrust tests significantly differentiated II from I. Rotation and bithermal calorics significantly differentiated I from II and II from III/IV. The Fukuda, Rhomberg, Tandem-Rhomberg and CTSIB were significant in differentiating I from II and II from III/IV. Dix-Hallpike and Positional tests were of no significance in the entire study. The Occilopsia and Head-Thrust tests that showed 100 % positivity for II to IV are more likely to better predict ‘manifest’ or ‘occult’ -vestibulotoxicity while DHI and casual gait assessment may be carried out by a paramedic at a peripheral center to suspect vestibulotoxicity. Since we found absolute compliance with our series we feel that vestibulotoxicity may not be a deciding factor for termination of streptomycin provided an in-built mechanism for patient support/counseling be incorporated in management schedule.

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Acknowledgments

AM would like to acknowledge Dr. Nimisha Shukla MD from California, USA for making substantial contributions to conception and design as well as revising the manuscript critically for important intellectual content, but still did not meet the criteria for authorship. In addition Professor RAS Kushwaha of Pulmonary Medicine KGMU has to be acknowledged for his moral support as well as ensuring the free supply of antitubercular-drugs to the patients. Professor GK Shukla of IIM Lucknow needs to be acknowledged for his inputs regarding statistical corrections.

Authors’ Contributions

MA in this Masters thesis project of his was the key person to recruit the patients from the departments of Pulmonary Medicine (with help from RG) and Internal Medicine (with help from KKS). He also conducted the basic anamnesis, otolaryngological examination, data entry and collection of references. The original idea of this work and design of study was framed by AM (corresponding author) who was the chief guide and supervisor of MA for his Masters thesis project of Otolaryngology. AM was the final authority to decide the results of vestibular examination in situations of divided opinions if any. AM was also the main person to draft the manuscript and obtaining inputs from the statistician. KKS helped in recruitment of patients from department of Internal Medicine and examining them medically. He also took the decision regarding the treatment aspects in close collaboration with RG. RG was the key person who helped in recruitment of the patients from the department of pulmonary medicine, deciding the treatment to be given and facilitating the follow up. VV, HPS, SK were instrumental in assisting AM in vestibular assessment of the patients in the department of otolaryngology as well as providing important inputs for manuscript writing as RG and KKS. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Departments of Otolaryngology and Head and Neck Surgery, King George Medical University, Shahmeena Road, Lucknow, India

    Miraj Ahmed, Anupam Mishra, Veerendra Verma, Hitendra Prakash Singh & Sunil Kumar

  2. Departments of Internal Medicine, King George Medical University, Lucknow, India

    Kamal Kumar Sawlani

  3. Departments of Pulmonary Medicine, King George Medical University, Lucknow, India

    Rajiv Garg

Authors
  1. Miraj Ahmed
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  2. Anupam Mishra
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  3. Kamal Kumar Sawlani
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  4. Veerendra Verma
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  5. Rajiv Garg
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  6. Hitendra Prakash Singh
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  7. Sunil Kumar
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Corresponding author

Correspondence to Anupam Mishra.

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All the authors declare that they have no conflict of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

The current study was a part of the thesis work carried out by Dr Miraj Ahmad for Masters in Otorhinolaryngology under chief supervision or the corresponding author (Anupam Mishra).

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Ahmed, M., Mishra, A., Sawlani, K.K. et al. Clinical Predictors of Streptomycin-Vestibulotoxicity. Indian J Otolaryngol Head Neck Surg 68, 359–366 (2016). https://doi.org/10.1007/s12070-015-0949-x

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  • DOI: https://doi.org/10.1007/s12070-015-0949-x

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