PubMed1986
Ototoxicity, though a significant disabling complication of aminoglycoside antibiotic therapy, is monitored infrequently. Chronic osteomyelitis patients treated with an aminoglycoside are in a group at higher risk due to the length of therapy and large total dose of drug required for treatment. Serum levels of gentamicin should be maintained within therapeutic ranges but below toxic levels. Gentamicin ototoxicity is vestibular in two thirds of patients and cochlear in one third. One half of the patients with cochlear toxicity also have vestibular symptoms. Symptoms are often vague, insidious in onset, and masked by the critical presentation of the primary infectious process. Symptoms may occur immediately upon initiation of therapy, any time during the course of treatment, or after administration has been completed. The development of toxicity should be monitored on a regular basis by specifically asking the patient whether there has been any subjective hearing loss, ear fullness, tinnitus, or vertigo supplemented by pretreatment and follow-up audiogram and electronystagmogram (ENG). Therapy should be discontinued at the first sign of alteration of cochlear or vestibular function. Ototoxic recovery occurs in only about 50% of the patients affected.