Pharmaceutical/Ototoxocity

Medication use consistently has been associated with falls.¹
Polypharmacy (taking four or more medications and/or use of psychotropic medications) significantly increases fall risk about 70%.²
Patients undergoing treatment with ototoxic medications often do not realize that they have a balance problem until they get out of their hospital bed and try to ambulate.³
Reducing or modifying medication use has been an important component in multifactoral, community-based studies related to the reduction of fall risk.^{4, 5}
Acquired bilateral vestibular impairment is frequently the result of aminoglycoside-induced toxicity.³
Patients with bilateral vestibular loss due to aminoglycoside antibiotics have demonstrated problems related to vestibulo-ocular and vestibulo-spinal dysfunction.⁶
Gentamicin and streptomycin are commonly used aminoglycoside antibiotics that are also vestibulotoxins.⁷
Clinical prevalence of gentamicin ototoxicity is estimated at 2-3%.⁸
In the diabetic population, resultant tissue and bone infections (such as osteomyelitis) are treated with aminoglycosides; overall incidence of ototoxicity is approximately 11%.⁹
In renal failure/dialysis patients receiving aminoglycosides for peritonitis, incidence of ototoxicity is estimated at 20%.⁷

References:

Center for Disease Control. www.cdc.gov/od/pgo/funding/02151.htm. Accessed 6/18/02.
Leipzig RM, Cumming RG, Tinetti ME (1999). Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. J Amer Geriatrics Soc 47:30-39.
Calder JH, Jacobson GP (2000). Acquired bilateral peripheral vestibular system impairment: Rehabilitative options and potential outcomes. J Am Acad Audiol 11: 514-521.
Campbell AJ, Robertson MC, Gardner MM et al (1999). Psychotropic medication withdrawal and a home-based exercise program to prevent falls: A randomized controlled trial. J Amer Geriatrics Soc 47:850-853.
Close J, Ellis M, Hooper R et al (1999). Prevention of falls in the elderly trial (PROFET): A randomized controlled trial. Lancet 353:93-97.
Herdman SJ, et al (1994). Characteristics of postural instability in patients with aminoglycoside toxicity. J Vestib Research 4: 71-80.
Herdman, S; University of Miami, As presented at APTA Annual Convention, June 1999.
Hewitt, 1974, Postgrad Med J.
Kahlmeter & Dahlager, (1984). J Antimicrob Chemother 13:9-22.