Ototoxicity from Aminoglycoside Eye Drops (Tobramycin)

My tinnitus developed 8 months ago after using Tobradex, which contains the extremely ototoxic antibiotic Tobramycin.

The route, through the eyelids which are very vascular, can cause immediate systemic absorption. Think of a Fentanyl patch on dry skin working systemically, the eyelid is a mucous membrane.

There have been reports of fainting due to low heart rate and blood pressure from beta blocker eye drops, those are very small doses of what people take pills for for high blood pressure.

The amount of Tobramycin I used had to be in the micrograms. One tube is 3 milligrams. I used a TINY amount.

There is a well documented genetic mutation that can make people even more susceptible to their ototoxic properties. I’m not sure if I have it. But I know immediately after using it my ears were fried.

I was also taking a lose dose 20 mg Lasix at the same time which is ototoxic itself. And is documented to potentiate aminoglycoside toxicity.

There are about a dozen anecdotal reports of people complaining of hearing issues after topical eye medication.

But I still can’t wrap my brain around it.

Here’s a physician (Dr. Nagler) doing the math, which I’ve also done:

Eye Drops (Tobramycin, Dexamethasone, Diclofenac) for Laser Eye Surgery — Risk for Tinnitus?

But it HAPPENED.

Any ideas? Or am I crazy?

 

Anyone?

I’m so freaked out.

 

I think it's possible. The topical beta blocker/ systemic absorption is well documented in some individuals (esp with conjuctival hyperemia which would increase vasculature).

Of course, Lasix can do it, too. Separately or additively.

Did you have other hearing changes?

 

Yes. It gave me bilateral cochlear hydrops. I’m so screwed.

 

How did they diagnose the hydrops? What are your symptoms?

 

When I woke up with my ears raging, I stopped all medications. I was put on oral steroids and my symptoms improved dramatically.

Then after a few weeks my tinnitus came back but this time with bilateral severe pressure/fullness.

I kept going to ENTs until I got diagnosed.

I was given intratympanic steroids and they helped but then the symptoms returned.

They even put tubes in to try to figure out the severe sensation of pressure.
They aren’t working.

I’m on steroids again now while on vacation and they aren’t working either.

I’m on low sodium diet and on a diuretic.

I really can’t live like this anymore.
I have a lot to lose in life and am so miserable.

 

I have bilatetal antibiotic ototoxicity as well (high dose Azithromycin due to a misdiagnosis). It's absolutely miserable and life ruining.

Things that got better for me:

Ear fullness. It took about 9 or 10 months but fully resolved. It was very severe, felt like my ears were suffocating.

Some of the reactivity: after about a year, the extra ring in household appliances disappeared except for the fridge.

Tinnitus: started out mild, a month or two later was severe (only sounds as loud as a hairdryer or louder could mask it) and after a few months of that (this was a few years ago so I don't remember exactly how long), it settled to about a 6/10. Maskable but annoying. I have two main tones: "crickets" and about a 12000 Hz pure tone (I think?).

Things that didn't get better:

I still can't listen to any music. This is soul crushing to me. But I have measurable hearing loss (severe above 10000 Hz and I can't hear anything below 100 Hz, so things like thunder sound bizarre and clipped). Early steroids might have saved you here.

It cost me my career and my marriage but I have a lot of bizarre hearing damage and a very selfish ex husband.

Anyway, in addition to diet and low salt, I would *highly* recommend lots of Magnesium. I did best with Magnesium chloride (the oral kind, not the topical). I felt it helped me way more than the diet did. I didn't have hydrops though but interestingly, they treated me as if I did initially.

As an aside, protect your ears. After two years, I managed to give myself an acoustic shock and now have ear pain (hopefully it will resolve with time). I never had any of those problems before but damaged ears are more prone to injury.

Hang in there and keep us posted. The ear fullness will very likely get better soon. It's just a slow process.