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Streptomycin Ototoxicity — SCE Infectious Diseases MCQ

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EasyTuberculosisStreptomycin OtotoxicitySCE Infectious Diseases

A 60-year-old man with TB meningitis on RHZE plus Dexamethasone develops hearing loss at week 4 of treatment. An aminoglycoside (Streptomycin) had been added to his regimen for the first 2 months. What is the most likely cause of hearing loss?

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Correct answer: B — Streptomycin ototoxicity — aminoglycosides cause irreversible vestibulotoxicity and cochleotoxicity; Streptomycin should be stopped and hearing formally assessed

Streptomycin (and all aminoglycosides) cause dose- and duration-dependent ototoxicity affecting both cochlear (hearing loss — typically high-frequency first) and vestibular (vertigo, ataxia) function. The damage is to hair cells in the inner ear and is usually IRREVERSIBLE. Risk factors: prolonged use, high cumulative dose, renal impairment, concurrent ototoxic drugs. Streptomycin must be stopped immediately when ototoxicity is suspected. Audiometry should be performed. While TB meningitis can cause CN VIII involvement, aminoglycoside ototoxicity is far more common in this context.

Reference: BNF 2024 – Streptomycin; NICE NG33 2016 – TB; BSAC 2023 – Aminoglycoside TDM