I Can’t Hear You!

​A 50-year-old man presented to the emergency department complaining of ringing in his ears and difficulty understanding what people were saying. He was concerned that he was having a stroke. A full neurological exam was unremarkable aside from decreased hearing, but his hearing deficits appeared to be equal bilaterally. Otoscopic exam demonstrated a normal tympanic membrane, and the rest of his physical exam was unremarkable. The patient's past medical history was significant for hypertension and hypercholesterolemia, for which he took lisinopril and atorvastatin. He was recently treated with a 10-day course of doxycycline for cellulitis of his left arm.Mechanisms of Drug-Induced OtotoxicityThe outer hair cells and the stria vascularis are targets for ototoxicity. The outer hair cells in the organ of Corti are responsible for converting mechanical waves into neural signals, while the stria vascularis in the cochlea is responsible for the electrochemical gradient that drives sound transduction.Drugs associated with tinnitus include salicylates, quinine, streptomycin, neomycin, indomethacin, doxycycline, furosemide, metals, and caffeine. Ototoxicity at therapeutic dosing of most of the drugs listed below is unlikely. The risk of ototoxicity may increase with higher or prolonged dosing, individual susceptibilities (i.e., genetic predispositions), or synergistic effects with other ototoxic agents.Drugs that can result in hearing loss include diuretics (furosemide, acetazolamid...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs