Vestibular and hearing manifestations of phenytoin toxicity: A retrospective series

Ear, Nose & Throat Journal, June, 2001 by Juan I. De Diego, Maria P. Prim, Sol Marcos, Maria J. De Sarria, Javier Arpa, Javier Gavilan

Audiometric alterations (presbyacusis) are not linked to phenytoin toxicity, and hearing does not appear to be affected by toxic phenytoin levels. Neither of these findings has been previously reported. Unlike Manlapaz, [6] we found no case of abducens nerve palsy in our patients.

Ever since the first reports of phenytoin toxicity, dialysis (peritoneal and/or hemodialysis) and bed rest have been advocated as a useful treatment)8 Although death associated with phenytoin toxicity is rare, the possibility justifies such aggressive management. [14-16]

From the Department of Otorhinolaryngology (Dr. De Diego, Dr. Prim, Dr. Marcos, Dr. De Sarria, and Dr. Gavilan) and the Department of Neurology (Dr. Arpa), La Paz Hospital, Autonomous University, Madrid.

References

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Table 1. Neurologic and neurotologic manifestations of phenytoin
toxicity 1,5-13
Ataxia                Oculogyria
Diplopia              Orofacial dyskinesia
Divergent strabismus  Total ophthalmoplegia
Dysarthria            Transient abduction paresis
Headache              Tremor
Nystagmus *           Vertigo
(*)Includes gaze-evoked horizontalnystagmus, periodic alternating
nystagmus, alternations of optokineticnystagmus, downbeat nystagmus,
and impaired smooth pursuit eyemovements.