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Common Ototoxic Medications Category Antibiotics Chemotherapy Agents Diuretics NSAIDs and Salicylates Representative Examples and Comments aminoglycosides exert their ototoxic effects by damaging vestibular and cochlear hair cells, streptomyocin and gentamicin affect vestibular function more than auditory function (hearing loss occurs initially with supra-audiological thresholds, 8 kHz), vancomyocin causes binary options 30 seconds ototoxic effects with aminoglycosides cisplatin may cause auditory nerve and vestibular toxicity furosemide and ethacrynic acid are the most common diuretic ototoxic agents, often potentiate other ototoxic medications aspirin is the most common medication to cause tinnitus (reversible with discontinued use) AssociatedSymptoms:auralfullness,fevers,vertigo,tinnitus(see below), otalgia, otorrhea, weight loss, other neurologic complaints Think KITTENS for differential diagnosis (see Table 62) Physical Exam and Hearing Tests OtoscopyMicroscopy:inspectionofEAC(cerumenimpaction, lesions, masses) and tympanic membrane (color, thickness, presence of fluid, myringosclerosis, perforations, lesions), Valsalva test (test patency of eustachian tube by having subject perform Valsalva maneuver and inspect TM for mobility) Pneumatic Otoscopy: test mobility of TM with positive and negative pressure, fistula test (positive pressure causes nystagmus which reverses with negative pressure, may be seen in perilymph fistulas and syphilitic labyrinthitis) InspectionandPalpation:inspectouterearforlesions, malformations, auricular pits, scars, edema, swelling, mastoid tenderness, tragal tenderness Complete Head and Neck Exam: cervical lymphadenopathy, neurologic and vestibular exam, bruits Tuning Fork Tests Rinne Test: typically uses a 512 Hz (C1 fork) and 1024 Hz tuning forks to compare air conduction (AC) and bone conduction (BC); 400 Index tadalafil (cont.Vol.
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