Ototoxicity from Paromomycin (Aminoglycoside). My Story and Questions.

[tiniturtle]

About a month ago exactly I had taken one 250mg capsule of Paromomycin, which is an aminoglycoside. I sat on it for a few weeks, I knew of the risks, but I thought maybe I was being too cautious. I had taken it for a GI parasite, Blastocystis Hominis, which is turning out to be near impossible to get rid of. Within 2-3 hours of taking it, I had developed ringing in my ears, some dizziness/balance issues, and some blurry vision. I had stopped the drug immediately. It's not supposed to be absorbed systemically, but due to the GI infection, I probably have higher intestinal permeability, and it obviously had been absorbed systemically. My symptoms have not subsided at all. I have constant tinnitus bilaterally, and in my left ear, it seems to change pitch/frequency, which is really strange.

I'm hoping that since I had taken a very lose dose, that these symptoms might subside, but I've read generally damage from these drugs is permanent and irreversible. My primary and ENT were of no help at all. My primary said it was all in my head and the ENT just didn't know what to do. I took it upon myself to try to mitigate the damage.

My audiology report is within the normal range, and hasn't changed over the past few weeks. Below 10db loss across the board. 0 in some frequencies. I'm not seeing the typical high frequency loss associated with drug ototoxicity. And my 12khz range was good too.

I had tried alpha lipoic acid, l-carnitine, n-acetyl cysteine. As well as daily vitamin C, E, fish oil, b-50 complex, etc. I don't want to to overdo it on the supplements either.

What seems to have helped:

1. NAC actually seems to have lowered the volume of the tinnitus for a few hours. Reduces the dizziness as well. This could be due to the antioxidant effect mitigating the oxidative stress incurred by the drug.

2. Ibuprofen, surprisingly. Seems to have done the same as above for a time. I had taken it for a headache.

As I understand it, once an aminoglycoside enters the tissues of the ears and/or kidneys, it tends to stick around for a few months to a year and cause progressive damage. I don't know if that's the case here or not. I assume it is.

Over the past week I've started experiencing shaking in my hands as well. And I really don't know if that can be attributed to the paromomycin, the supplements, or extreme stress. As I've been dealing with some relationship issues exactly at the same time of this event. I was very healthy before this incident, with the exception of that GI parasite.

I've read some accounts that prednisone early on can help. There are some studies where early administration of prednisone had reversed ototoxicity. Anyone have any real experience with this? Is there anything additional I could/should do at this point?

I'm trying to stay positive, and not stopping living during this period of time. I'm hoping it will get better with time.

My ears are definitely more sensitive. And if I'm in a loud location, I have to wear earplugs. To me, this sort of indicates that the drug is still affecting my ears, and there is injury of some sort, and I might just have to give it time to heal. Again, hoping that there will be minimal, or no lasting injury.

I'm still using the gym. Running and weights. Drinking lots of water. Hoping this will help flush things out. I feel like moving around takes a lot more effort now, but I can't just stop either.

Does anyone have any suggestions or input? Has anyone else experienced aminoglycoside ototocity? What was your outcome?

 

[Samantha R]

@tiniturtle
I am sorry to hear that this is happening for you. You are doing the best thing by continuing to live your life as normal, that's great for your state of mind.
Doing some Googling on aminoglycoside ototoxicity and yes, it's certainly most likely this caused your symptoms.... and I would say the timeframe they came on confirms yours suspicion.
I know prednisone is used in cases of acoustic trauma, but it must be administered as soon as possible and it's not really a guaranteed treatment for any hearing loss / tinnitus. It's really the only things that we have right now however.
If your ears are more sensitive, then it is a good idea to protect them, give them the best opportunity to heal if there has been some damage.
This is certainly not all in your head as your doctor suggested, unfortunately they just don't have anything they can offer to help us, which is no fault on their part, but they could be more compassionate and understanding.
At least your hearing seems to be OK, so that's a good thing.
Hopefully these symptoms subside for you a little as time goes on, just take care of your ears.

 

[StephanieLC]

I've been researching a different antibiotic , Neomycin, of the same family lately.

The drug you used is one of the least toxic of these drugs (but still toxic of course) and appears to be dose dependent based on my quick search just now. It seems it would take a lot of this drug to cause ototoxicity, kidney damage, etc. Virtually 100% of this drug is excreted from the body when taken orally and even if some did absorb from your one dose, it probably wouldn't be enough to cause damage. That being said, anything can happen and everyone is different.

You said you were hesitant to take the drug and waited a couple weeks? Did you know ototoxicity was a possible side effect before you took it? Were you anxious about taking the medication at the time of taking it? Did you feel scared after taking it and sort of anticipate side effects?

https://www.hindawi.com/journals/jtm/2011/645203/ In this study, paromoycin was INJECTED into the muscle everyday for 21 days, not taken orally, but injected systemically. 5% of participants had side effects but no one reported problems with their hearing. And of the people who had some reactions, they had a lot more drug than you took and for a long period of time.

I have terrible severe health anxiety and am very nervous about medications. Sometimes I will take something and get so many side effects and I think many times I psyched myself out and brought them on myself because I was so worried something terrible would happen.

I perforated my ear drum recently and used one dose of neomycin ear drops (Neomycin is the most toxic of this family of antibiotics). I had a cut in my ear canal when I used it (I used 3 drops total), read how ototoxic Neomycin is, panicked, and for the next 24 hours worried, worried, worried and was looking for the ringing, waiting for it to happen, because I had read so many horror stories after I put the drops in. Later that night I noticed ringing in both ears and I've been so worried that those 3 drops (which was only 0.5mg of neomycin total) absorbed into my system through my cut and is causing damage to both of my ears. BUT.. the amount I used it probably similar to a dose or two of Neosporin and people use that all the time without hearing damage. And I can't find one single case of someone suffering ototoxicity from that tiny amount of neomycin anywhere. I see cases of people who were given multiple grams of drug for days to weeks to months either orally or as an irrigant on surgical wounds who developed damage, but that was much much more than I used.

So.. my point here, and I'm not saying this is happening to YOU, but for ME I'm starting to wonder if my severe anxiety about the drug caused me to realize a tinnitus I already had in the background? So much attention was brought to my ears due to the injury and then the worry and I looked for that ringing and then sure enough it appeared. So I don't know.. our minds are very powerful in the face of anxiety.

If you have bad anxiety already, only took one pill, and have good hearing tests maybe it would be wise to focus on your anxiety and see how you feel?

I hope you don't think I'm saying "it's all in your head!" because I do believe the ringing is there but perhaps the situation/anxiety made you aware of the T and not the drug itself? A large dose over a long period of time would be more worrisome for sure. But again, anything can happen and I'm not unsupportive of your concern. One of my doctors said "There are no absolutes in medicine. Anything can happen but in this case the chances are very low".

Anyway, I'm no doctor but thought I would lend my perspective since I've been worried about these drugs as well. I hope your T quiets down for you!!

 

[Camkro]

Hi @tiniturtle
I am in an almost identical situation except the dizziness and bury vision is not to bad. Earlier this month I had a round of Paromomycin to treat GI parasites . The ringing in my left ear started on the evening I started the antibiotic. It was relatively mild a first and I didn't worry to much about it. I contacted my GP halfway through the 10 day treatment to discuss the side effect. She was unsure about stopping the course stating we are damned if we do damned if we don't. She advised to finish the course but to stop if it got worse or if there was any signs of hearing loss. I completed the full 10 days with the ringing staying about the same believing that it would stop when I ceased taking the Paromomycin. It has been about a week since I stopped and the ringing has persisted possibly even become louder. I saw my GP yesterday and she has referred me to an ENT specialist and gave me a vitamin B injection ( which had no effect) and suggested taking vitamin C. The ringing is constant and I am finding it hard to concentrate. It is certainly more distressing now realising that it may not be temporary. I realise it has been a while since you posted. I am just wondering how it progressed and if you found any treatments that relieved the Tinnitus?

 

[tiniturtle]

@Camkro

Definitely start taking NAC 600mg once or twice a day. Don't overdo it. Drink lots of water and get some exercise which will help flush things out. Mine got better over time but never actually went away. It will take time.