Medication making me deaf.. (13)

1 Name: Anonymous : 2008-11-08 02:04 ID:JamJ2wpZ

I've been having chronic Upper Respiratory Infection so that my doctor prescribed me gentamicin.

I didn't know at the time, but this drug is toxic to hearing?? It's called an "ototoxic drug".

It feels like I'm gradually losing my hearing. I can still speak but I can't hear my phone anymore and social situations that use spoken communication (ie. talking to girls at parties) have become increasingly awkward.

I don't know what to do. I've been to the audiologist and he said his hands were tied and that nothing can be done without the consent of the physician. I called my doctor and he said he forgot to mention that part, the good news is that my URI is gone.

What should I do? Can anyone help me? The computer is the only way I can communicate to the outside world.. can anyone hear me

2 Name: 43 : 2008-11-08 04:03 ID:Heaven

so the infection is gone completely?
Are you still on gentamicin?
If so, have you seen an otorhinolaryngologist since you quit gentamicin and how long ago did you quit gentamicin?
Else, is there an alternative to gentmicin?
What kind of infection did you have? was it viral or bacterial?
Have you asked whether the damage from gentamicin is permanent?

3 Name: Mishka Zena : 2008-11-08 16:05 ID:j+AOx1SB

Why don't you get an audiological evaluation and see if you can get a hearing aid or a cochlear implant?

The damage from the antibiotics are usually irreversible.

4 Name: Anonymous : 2008-11-08 17:48 ID:wRDWzG69

"and he said he forgot to mention that part"

Not only do you need to find a new doctor, you have EVERY right to take legal action against the previous one. That's waaaaaaaaaaaaaaaaaay too important for someone to forget to mention.

5 Name: MedStudent Anon : 2008-11-08 18:23 ID:gUACEmTM

Hi, I'm a 2nd-year medical student and I thought I'd reply with some of what we've studied last year and this year about what can cause hearing loss, how it presents, and how you can diagnose it.

There are several potent antibacterials which have the unfortunate side-effect of ototoxicity. The more potent ones such as gentamicin are normally held off unless the patient is combating an especially nasty infection. However, all antibiotics have dangerous side-effects which manifest in a small (like, 1 in a million) percentage of the population, and these side-effects must be listed on the prescription bottle label as per Federal law.

However! Let's consider the facts: you say you had an upper respiratory infection. That's the #1 thing I would blame for hearing loss -- temporary hearing loss caused by a middle ear infection. In fact, part of why doctors prescribe antibiotics so insistently for URIs is because they don't want a bad middle ear infection to get worse or for one that hasn't started to start in the first place. Bad middle ear infections can affect the ossicles' ability to conduct sound from the air to your cochlea, right? and if your eardrum was scarred by a middle ear infection, then that too would affect your hearing.

Finally, ototoxicity usually refers to damage to cells in your 8th cranial nerve (the one responsible for hearing and balance) or in the cochlea (e.g. the hair cells). These are inner ear (rather than middle or outer ear) problems and they can be identified separately from middle ear (conductive) hearing losses through some of the following tests in my next four replies. (Yes, I will be replying 5 times in a row. Sorry if this upsets anybody!)

6 Name: MedStudent Anon : 2008-11-08 18:27 ID:gUACEmTM

HERE'S A SIMPLE TEST YOU CAN DO AT HOME! One that tells middle ear or conductive hearing loss apart from inner ear or sensorineural hearing loss.

  1. What you'll want is a 256-Hz tuning fork. You can use a tuning fork with another appropriate frequency; the frequency you choose entirely depends on your personal (baseline) ability to hear it under normal conditions. If you have high-frequency or low-frequency hearing loss from before, it will affect whether you select a 256-Hz or a 512-Hz tuning fork, for example.
  2. Ask your parents or a friend to take the tuning fork and ding it on a hard surface (e.g. table) to get it to start vibrating. A tuning fork is shaped like the letter Y, and I will refer to the bottom part of the letter Y as the "stalk" or "handle" and to the two arms of the letter Y as the "prongs." By the way, you can do this yourself but it may be better to have an assistant help you so that you remove yourself from experimental bias in interpreting your own data.
  3. Ask your assistant to place THE STALK of the vibrating tuning fork onto your mastoid process. ( http://en.wikipedia.org/wiki/Mastoid_process ) This is the large round bony bump/hill you feel behind your lower ear. They should take care not to kill the tuning fork's vibration by accidentally touching the prongs with their own fingers. (Very easily done!) They may also need to be encouraged to place it more firmly on your mastoid process -- sometimes people are afraid that they will hurt you by firmly pressing the hard metal stalk against you head. But they should definitely start off gentle in case of possible mastoiditis.
  4. Tell them when you hear the sound. This establishes that we've begun the experiment correctly. If they did not hit the fork hard enough on the hard surface from before, you may not hear anything at all despite having perfectly normal hearing. And if they hit it too hard, then you may actually be listening to the noise echoing from the prongs into your ear canal, even though the prongs are pointing away from your head at this time. The goal is to get an intermediate noise. We want a baseline where the loudest noise to you is the noise generated by the vibrations into your mastoid process and not from the vibrations of air particles near your head.

If you do not hear any sound out of that ear EVER (or not without extreme difficulty) during this first step, it may be prudent to skip the rest of this experiment for the ear you're examining right now and to start over again with the other ear. In fact, you may wish to start with your healthy ear first for this very reason. Personally? I prefer to go from a hearing deficit to normal hearing because I think it's easier for patients to tell them apart that way. Just don't beat a dead horse! i.e. don't keep trying to test the bad ear until you get it right. Try it a couple of times and if you still can't get it to work, try the other ear. Or, avoid this by starting with the healthy ear first. It's your call.

If you have a problem with getting this step of the experiment to work, if that problem persists in one or both ears after repeated attempts, and if you are certain you are doing the experiment correctly, I would recommend to you that you consult a physician as soon as you can (and if necessary go to the hospital and be seen today) as it may be indicative of sensorineural hearing loss. BUT DON'T FREAK OUT if this happens! There are lots of possibilities and I am not a doctor, okay?

5. Your parents/friend should hold the fork over your mastoid process until you say "I don't hear any more sound." (Tell them!) That's when they need to QUICKLY pick the fork up from your mastoid process and now point the prongs of the fork closer to your ear canal.

6. Do you hear the noise again? Answer "Yes" or "No."

7. Repeat Steps 1-5 for the other ear, be that your good ear or your bad ear.

7 Name: MedStudent Anon : 2008-11-08 18:29 ID:gUACEmTM

For text-limit reasons, I had to relocate this part here:

The first test I told you about is called the Rinne test. You can read about it here: http://en.wikipedia.org/wiki/Rinne_test

This second test I'm going to be talking about is the Weber test, and you can read about it here if my explanation is confusing or too long: http://en.wikipedia.org/wiki/Weber_test

HERE'S ANOTHER SIMPLE TEST YOU CAN DO AT HOME! All you need is the tuning fork from before.

  1. As before, strike a tuning fork against a hard surface.
  2. Place the tuning fork on top of your head in the midline. You may have to press down fairly firmly to hear any noise at first, so be sure to try to press down harder if at first you cannot hear any noise.
  3. Ask yourself: do I hear the sound loudest out of my left ear? my right ear? or does it sound equally loud in both ears?

We'll discuss the results in the 5th reply.

8 Name: MedStudent Anon : 2008-11-08 18:29 ID:gUACEmTM

HERE'S A FINAL TEST, SIMPLEST OF ALL! And all you will need is the tuning fork from before. But this test should only be done after you have completed the first two tests and will require someone else's assistance. This test can help to really convince patient and physician alike what the nature of the hearing loss is. This test need only be done if the patient reports air conductive hearing in both ears but can't tell if it's quieter in one ear, the other, or neither.

  1. As before, strike a tuning fork against a hard surface.
  2. Ask the patient to close his or her eyes.
  3. Place the tuning fork's prongs a certain distance away from their left ear. (It doesn't matter, so long as the distance is close enough that they are able to hear the sound initially.)
  4. When the patient reports to you, "I can't hear the sound anymore ..."
  5. QUICKLY relocate the tuning fork to the right side of the patient's head and ask the patient if they can hear the sound again.
  6. Repeat steps 1-5 but beginning with the right ear instead in Step 3 and switching to the left ear in Step 5.

9 Name: MedStudent Anon : 2008-11-08 18:31 ID:gUACEmTM

Final reply! The interpretation of your results.

DISCLAIMER: I am not a medical physician! I am a 2nd-year medical student. The results to any of these tests should be confirmed by a trained physician. The following interpretations may hold true in general but can be rendered false under certain complicating circumstances. These interpretations are also all made under the assumption that the patient has hearing loss in only one ear.

-INTERPRETATION OF THE RINNE TEST-
--NORMAL HEARING: You heard the sound in Ear #1 through the mastoid process; after it faded away, you heard the sound again when the tuning fork's prongs were placed closer to your ear canal. The effect was roughly the same in both ears.
--CONDUCTIVE HEARING LOSS: You heard the sound in Ear #1 just fine through the mastoid process; but when the fork was taken to the outside of your ear, you didn't hear anything -OR- you didn't hear the noise as well as when you repeated this experiment for Ear #2.
--SENSORINEURAL HEARING LOSS: You heard the sound in Ear #1 in the mastoid process; and when it faded away and the fork's prongs were placed near your ear canal you again (perhaps) heard the noise for a little bit before it too faded away. BUT! You noticed that even when the fork was on your mastoid process for Ear #1, the intensity of the sound and/or the duration of audibility was much less for than it was for Ear #2.

-INTERPRETATION OF THE WEBER TEST-
--NORMAL HEARING: You don't feel that you hear the tuning fork any louder from one ear than from the other.
--CONDUCTIVE HEARING LOSS: You hear the sound louder in the affected ear. This is because, according to the theory, you don't have any ambient noise from the room (PC fan, fridge motor, etc) entering in through that ear's ear canal but you do in the good ear. So the good ear has to muck around with more noises, diminishing the tuning fork's signal. It's ironically the BAD ear that therefore hears the pure tuning fork best/loudest, because you still have a good healthy cochlea and CN VIII.
--SENSORINEURAL HEARING LOSS: You hear the sound louder in your healthy, unaffected ear. This is as we would expect.

-INTERPRETATION OF THE FINAL TEST-
--NORMAL HEARING: When the sound fades from the left ear, relocation of the tuning fork to the right side of the head should have no effect. And vice-versa.
--UNILATERAL HEARING LOSS (say in the left ear): the first time, the patient will say that they heard the noise again when you relocated the fork to their right side. But the second time they will report no positive change.
--NON-UNIFORMLY BILATERAL HEARING LOSS: could present as unilateral hearing loss.
--UNIFORMLY BILATERAL HEARING LOSS: could present as normal hearing.

10 Name: MedStudent Anon : 2008-11-08 18:36 ID:gUACEmTM

(Okay, so I lied: one last reply for now and then I swear I'm done.)

As you can see, it is possible to think both ears are fine when in fact both ears have problems. Or it's possible to think that you have hearing loss in one ear when in fact you have two perfectly healthy ears if you do the experiment incorrectly. So my advice? Try this out at home if you're really anxious and you have some tuning forks in your house. But don't go buying tuning forks just to do this unless you're really that concerned and you can find some locally for cheap. If possible, call friends, physics teachers, or musicians -- any of whom may have tuning forks they would be willing to let you borrow after hearing your story. And no matter what, do go see your physician, even if he can't see you for a couple of days.

Also! I really hope (and am very confident) that you just have an middle ear infection from your URI and it's causing conductive hearing loss. I really hope (and believe) you'll be back to normal in a couple of weeks. I have submitted these tests in the hopes that they will help you to convince yourself that any hearing loss you may have is of the conductive (and not the sensorineural) variety, and that you should keep taking your antibiotics. But if you do these experiments and they point towards sensorineural hearing loss, and if I were in your shoes? (This is me talking as Joe Schmoe citizen and NOT legal medical advice!!) I would not take the medicine anymore. I would hold off until I'd seen somebody in the health care system. And if I did these tests and they pointed to sensorineural? I'd go to the ER if a regular doctor couldn't see me because of his busy schedule.

GOOD LUCK!

11 Name: Anonymous : 2008-11-08 19:22 ID:p8W9qO/a

I did not bother to read the whole thread, but I would like to mention than in situations like this it's not a bad idea to have a second opinion: go see another doctor and see what he has to say about your situation.

12 Name: Weeble : 2008-11-10 01:11 ID:VaignyTD

Anonymous, I was damaged by gentamicin over 8 years ago but in my case it caused me to lose my vestibular system (inner ear balance system). The doctors here use it because it is cheaper than other antibiotics. They know it causes deafness, balance problems and can damage kidney funtion but they don't seem to care. I can no longer do many of the things I used to do such as ride a bike, go hiking, bowl, etc. I fall very easily and I have oscillopsia. Oscillopsia is bouncing vision. It is caused by the loss of your balance system. The inner ear eighth nerve fibers in your ear send a signal to your brain whenever your head moves and in turn the brain signals your eyes and tells them how to keep your vision focused. I sued and won my case. There are many people who have been damaged by gent both with balance and hearing problems. We belong to a web site called Wobbers.com. We welcome anyone who has suffered from gent damage.

13 Name: Anonymous : 2008-11-10 06:40 ID:Heaven

This thread helped me to realize that my mastoid process hurts like a bitch.

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