Aminoglycosides like gentamicin are ototoxic and can exacerbate pre-existing hearing loss, potentially leading to irreversible damage.
Contraindicated in patients with significant hearing impairment due to high risk of further ototoxicity.
Vestibular toxicity may also occur, leading to dizziness or ataxia.
Risk is dose-dependent and higher in elderly or those with renal impairment.
Genetic factors (e.g., mitochondrial mutations) may predispose to severe reactions.
Aminoglycosides accumulate in the inner ear, where they bind to iron and generate reactive oxygen species, causing damage to cochlear hair cells and auditory nerve, worsening underlying hearing impairment.
Increased risk of permanent hearing loss, tinnitus, vertigo, and balance disturbances; effects may be bilateral and irreversible, especially in those with compromised auditory function.
Avoid aminoglycosides in patients with pre-existing hearing loss if possible; if unavoidable, obtain baseline audiometry, monitor closely with serial hearing tests, use lowest effective dose for shortest duration, and consider alternatives like non-ototoxic antibiotics.
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