trainee · Clinical case

Case 8 — Slowly worsening unsteadiness in a CF patient

Vignette
A 41-year-old woman with cystic fibrosis has had multiple intravenous tobramycin courses (estimated total dose over 15 years: ~300 g) for pulmonary exacerbations. Over the past year she has noticed worsening unsteadiness, particularly on stairs and in dim light, and bouncing of her visual field when running. Hearing is normal. There is no history of vertigo. She is currently between exacerbations.

Six-canal vHIT

0100200R latg=0.300100200L latg=0.280100200R antg=0.450100200L antg=0.460100200R postg=0.520100200L postg=0.50

Audiogram

2505001k2k4k8k020406080100120Frequency (Hz)Hearing level (dB HL)○ right× left

Which clinical action does this finding most strongly support?

References

  1. Aw ST, Todd MJ, Aw GE, Weber KP, Halmagyi GM. Gentamicin vestibulotoxicity impairs human electrically evoked vestibulo-ocular reflex. Neurology 2008;71:1776–82.
  2. Strupp M, Kim JS, Murofushi T, Straumann D, Jen JC, Rosengren SM, Della Santina CC, Kingma H. Bilateral vestibulopathy: diagnostic criteria consensus document of the Classification Committee of the Bárány Society. Journal of Vestibular Research 2017;27:177–89.
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