Vancomycin and my hearing loss Please help

[jacksmul]

Please help:

I had an infection while in the hospital. I was given Vancomycin for nearly a month and as a result I am totally and permanently deaf.

Could you provide me the names of experts on ototoxity and articles that address the ototoxity of Vancomycin.

  Thank you in advance.   Jack

[jacksmul]

Please help:

I had an infection while in the hospital. I was given Vancomycin for nearly a month and as a result I am totally and permanently deaf.

Could you provide me the names of experts on ototoxity and articles that address the ototoxity of Vancomycin.

  Thank you in advance.   Jack

[ENTMD]

Here are a couple of article summaries from PubMed.  I don't know off the top of my head who the 'experts' are in this field and your location may also be rather important.  Start with these and considering contacting either of institutions.


Ototoxicity of vancomycin and analogues.Brummett RE.
Oregon Health Sciences University, Portland.

This article details clinical reports and animal studies of ototoxicity associated with vancomycin and its analogues. From these studies, the ototoxicity of these agents is still not clear. In the author's opinion, vancomycin must affect the auditory system in a manner that results in augmentation of the usual ototoxicity of aminoglycoside antibiotics. This postulated effect may manifest as a temporary hearing loss in humans. More studies are needed, however, before a definitive conclusion can be made.

PMID: 8233491 [PubMed - indexed for MEDLINE]


Vancomycin ototoxicity: a reevaluation in an era of increasing doses.Forouzesh A, Moise PA, Sakoulas G.
New York Medical College, Valhalla, USA.

Nephrotoxicity and ototoxicity have historically been documented as relatively rare complications of vancomycin monotherapy. Recent reports have linked aggressive vancomycin dosing strategies to significant risks of nephrotoxicity. We evaluated the rate of high-frequency hearing loss detected by audiometry for patients on vancomycin therapy. For this purpose, we used retrospective case-control analysis of audiometry results for patients on vancomycin therapy for whom baseline and follow-up exams were available. Analysis of 89 patients for whom audiograms were performed after an average of 27 days of vancomycin therapy showed a 12% rate of high-frequency hearing loss, with a trend in univariate analysis toward a higher rate with advanced age. The mean of the highest vancomycin trough levels for both patients with worsening audiograms and those without worsening audiograms was 19 mg/liter. Regression tree modeling demonstrated that for patients 53 years old, the incidence was 19% (P = 0.008). We conclude that a significant rate of high-frequency hearing loss in older patients receiving vancomycin monotherapy was detected by audiometry. While these data urge caution against continued indiscriminate vancomycin dose escalation to treat infections caused by Staphylococcus aureus strains for which vancomycin MICs are 2 mg/liter, further prospective studies are needed to determine the clinical significance and reversibility of these effects.

PMID: 19001107 [PubMed - indexed for MEDLINE]
PMCID: PMC2630630

[Wear/a/Jimmy]

vancomycin therapy showed a 12% rate ....

12% is a rather vague figure, meaining 12% of a pta, if so what were the frequencies used to calculate the pta?  Further 27 days and we see an A-gram difference. What we also know is that the outer hair cells will display damage far before an A-gram will.

Point is, a more sensitive test (OAE) could have been used for those that did not show an A-gram slip and I would bet a cookie we would see the OAEs results show that the meds are harming the patient.

For those interested and especially those in the field of speech and hearing sciences, Audiologists, ENTs etc I would suggest that they would read this boodk

http://www.ata.org/store/books/ototoxic-drugs-exposed-second-edition-neil-bauman-phd

[ENTMD]

I am a little skeptical of this book to which you refer.  The author seems to have no more than anecdotes in his characterization of many of these drugs (and he names many!).  Not very good science.  While no respect for the ototoxic potential of some drugs is dangerous, casting too wide a net can be dangerous for other reasons (people unecessarily avoiding important treatments, needless additional stress/fear (which, ironically, has been linked to tinnitus exacerbation!)).

[Wear/a/Jimmy]

In some respects I do agree, but where there is smoke there is fire....

I also believe in "full disclosure," "patient consent," and "do no harm."