The curious and damaging affinity of streptomycin for the eighth-nerve system was recognized by Hinshaw and Feldman (1945) soon after its introduction into clinical practice. They found that the earlier compounds, the calcium and sulphate salts, affected mainly the vestibular part of the eighth-nerve system, causing a disturbance of balance, though it was noted that sometimes deafness also followed prolonged use of the drug owing to intoxication of the cochlear system as well.The disturbance of balance caused by intoxication of the vestibular system was often so inconvenient and disabling that a search was made for a compound of streptomycin without these undesirable toxic effects. This led to the introduction of dihydrostreptomycin. Unfortunately this compound proved to have a selective and destructive action upon the cochlear system, causing deafness, though in large enough doses it also affected the vestibular system. It was soon found that deafness was even more inconvenient than giddiness from loss of vestibular sense, and in consequence there has been a retreat from the cochleo-toxic dihydrostreptomycin in favour of the vestibulo-toxic sulphate preparation of streptomycin, though some prefer to use a mixture of the two in what is believed to be subtoxic doses. Nevertheless, instances of disturbed equilibrium and of deafness have been reported after using the mixture.As we have seen a number of patients crippled by streptomycin therapy, some after small doses, we feel that the time has come to reconsider the toxic properties of streptomycin, with special reference to its effect upon the vestibular system, particularly as many of our patients have been middle-aged or elderly, when the effect of a disordered vestibular system is not easily overcome. Eighth-nerve System and StreptomycinThe eighth-nerve system consists of two sensory receptorsone for balance and the other for hearing-both of which are housed in the labyrinthine spaces of the internal ear in each temporal bone. The nerve fibres from each set of end-organs are collected within the temporal bone into two nerves-the cochlear, on which lies the spiral ganglion, and the vestibular, on which lies the ganglion of Scarpa. These two nerves leave the temporal bone together as the eighth cranial nerve and after a short course enter the brain stem, where again they separate, the vestibular fibres going to nuclei in the brain stem and cerebellum on the same side, and the cochlear to nuclei on both sides. Thence each is relayed to appropriate motor nuclei in the brain stem and spinal cord, and to higher centres in the temporal lobe. There has been much discussion about which part of the eighth-nerve system is affected by streptomycin. Earlier workers, Hinshaw and Feldman (1945), Fowler and Glorig (1947) Balance is governed by impulses received from the vestibular end-organs in the labyrinth. These are aided by visual impressions which often give advance information about a change in balance (for example, uphill, downhill, steps, uneven ground, etc.), whil...
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