INTRAVENOUS GENTAMICIN & THE HUMAN LABYRINTHINE SAMPLING MODEL (HLSM)
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Rapid elevation of gentamicin levels in the human labyrinth following intravenous administration.
Becvarovski Z, Michaelides EM, Kartush JM, Bojrab DI, LaRouere MJ.
Michigan Ear
Institute, Farmington Hills; Providence Hospital,
Southfield; Wayne State University, Department of
Otolaryngology, Detroit, Michigan, USA.
Michigan Ear Institute, Farmington Hills, Michigan 48334, U.S.A.
HYPOTHESIS: Adequate quantities of labyrinthine fluid can be sampled from the
human labyrinth to perform quantitative analysis of medications. A rapid
elevation of intralabyrinthine gentamicin levels after intravenous
administration can be measured. A model for the sampling of human inner ear
fluid in this manner is described.
BACKGROUND: The risk of aminoglycoside ototoxicity has been a long-standing concern. The kinetics of gentamicin diffusion into the inner ear have been extrapolated to humans from various animal models. The validity of extrapolation to humans is unknown. We have developed a new model to measure the uptake of gentamicin in vivo.
METHODS: A single intravenous dose of gentamicin (80 mg) was given perioperatively to 13 patients undergoing translabyrinthine acoustic neuroma surgery. The lateral semicircular canal and vestibule were opened and a microsyringe was used to obtain a sample of labyrinthine fluid concomitant with a serum sample. The gentamicin concentration of the labyrinthine fluid and serum was analyzed using a standard chemistry analyzer.
RESULTS: After parenteral administration of gentamicin, fluid was obtained from the inner ear of 13 acoustic neuroma patients. Inner ear concentrations were between 1.0 and 3.8 mg/L. Serum gentamicin levels ranged from 1.2 to 10.5 mg/L.
CONCLUSIONS: This method allows the sampling of intralabyrinthine fluid in
humans. Gentamicin was noted immediately in the labyrinth after intravenous
administration. This model may be expanded to measure other compounds given
either by intravenous or transtympanic routes.
Laryngoscope 2002 Jul;112(7 Pt 1):1163-5
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Dr Zoran Becvarovski MBBS, FRACS
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