Avaliação audiométrica de pacientes em tratamento para tuberculose pulmonar

Objective: To evaluate the hearing status of patients being treated for pulmonary tuberculosis at referral hospitals in Brazil. Methods: This was a descriptive study involving 97 male and female inpatients/outpatients between 18 and 60 years of age who were undergoing treatment for active pulmonary tuberculosis at one of two referral hospitals in the state of Rio de Janeiro. After being interviewed, all of the patients underwent pure tone audiometry. Results: OF the 97 patients studied, 65 (67%) were male, 52 (54%) were receiving first-line treatment, and 45 (46%) were receiving second-line treatment, which included aminoglycosides. Smoking, alcohol consumption, exposure to noise, and ototoxic medication use were identified in 65 (67%), 51 (53%), 53 (55%), and 45 (46.4%) of the patients, respectively. The most common auditory and vestibular complaints were dizziness, in 28 patients (28.8%); tinnitus, in 27 (27.8%); and hypoacusis, in 23 (23.7%). Conclusions: Due to the great number of patients with hearing loss in the present study, we recommend that all patients under tuberculosis treatment be submitted to auditory monitoring.OBJETIVO: Analisar a condição auditiva de uma população em tratamento para tuberculose pulmonar em dois hospitais de referência no Brasil. \ud MÉTODOS: Estudo descritivo envolvendo 97 pacientes de ambos os sexos, com idade entre 18 anos e 60 anos, que estivessem em tratamento para tuberculose pulmonar ativa, internados ou em acompanhamento ambulatorial em dois hospitais de referência no estado do Rio de Janeiro. Os participantes foram entrevistados e realizaram audiometria tonal liminar. \ud RESULTADOS: Na população estudada, 65 pacientes (67%) eram homens, 52 (54%) estavam em tratamento de primeira linha e 45 (46%) estavam em tratamento de segunda linha, o qual incluía aminoglicosídeos. Tabagismo, uso de bebidas alcoólicas, exposição a ruído e uso de medicamentos ototóxicos foram identificados respectivamente em 65 (67%), 51 (53%), 53 (55%) e 45 (46,4%) pacientes. As queixas auditivas e vestibulares mais frequentemente mencionadas foram tontura, em 28 (28,8%); zumbido, em 27 (27,8%); e hipoacusia, em 23 (23,7%). \ud CONCLUSÕES: Devido ao elevado número de casos de perda auditiva encontrado neste estudo, recomenda-se que todos os pacientes em tratamento para tuberculose sejam submetidos a monitoramento auditivo

Importância da educação formal dos responsáveis e renda familiar no processo de adesão ao uso de próteses auditivas em menores de 12 anos

OBJETIVO: verificar se o nível de educação formal dos responsáveis pelas crianças atendidas no serviço de Saúde Auditiva de um Hospital Universitário, assim como a suas rendas familiares e o grau das perdas auditivas das crianças, influencia na adesão ao uso de próteses auditivas. MÉTODOS: foi realizado um estudo retrospectivo por meio de um levantamento de dados secundários contidos em fichas técnicas no Laboratório de Exames Complementares do referido Hospital. Foram verificados os dados sobre o tipo e o grau das perdas auditivas, tipo de adaptação, renda familiar e escolaridade dos pais ou responsáveis. A adesão ao uso de próteses auditivas foi verificado por meio da presença em consulta anual após alta. RESULTADO: foram verificados dados de 105 pacientes. Em 35 (10,47%) casos, os entrevistados relataram até um salário mínimo como única renda familiar, 54 (51,4%) entre um e três salários mínimos, 4 (3,8%) entre três e 10 salários mínimos e em 12 (11,4%) casos esse dado não foi informado na entrevista. Em relação à escolaridade dos responsáveis pelas crianças, 51 (48,5%) responsáveis relataram ter no máximo, ensino fundamental I, 39 (37,1%) iniciaram ou completaram o ensino médio, 5 (4,7%) iniciaram ou completaram um curso superior e em 10 (9,7%) entrevistas não constava essa informação. Em 94 casos foi encontrada adesão e em 11, não adesão. Não houve significância estatística entre a renda familiar ou escolaridade dos responsáveis com o sucesso na adesão de crianças atendidas no Hospital Universitário. CONCLUSÃO: a renda familiar ou a escolaridade dos responsáveis não influencia na adesão em crianças de até 12 anos atendidas no Hospital Universitário

The importance of audiometric monitoring in patients with multidrug-resistant tuberculosis

Abstract INTRODUCTION: A total of 771 cases of multidrug-resistant tuberculosis (MDR-TB) were reported in Brazil in 2014. Treatment of MDR-TB with aminoglycosides can produce serious side effects such as permanent and irreversible hearing loss, which occurs in 5-64% of cases, and severely compromise patient quality of life. The goal of this research was to evaluate auditory and vestibular side effects in patients treated for MDR-TB and to identify associations between these complaints and the type of aminoglycoside used. METHODS: We performed a retrospective review of 599 medical records from patients with MDR-TB who were treated at the Hélio Fraga/Fiocruz Reference Center between 2006 and 2010. Cases without auditory or vestibular complaints and patients who were not treated with aminoglycoside drugs were excluded from the study. RESULTS: Of 164 eligible cases, 55 (33.5%) reported an auditory or vestibular complaint and medication was subsequently suspended, although hearing damage was not confirmed in all cases. Audiometric testing confirmed hearing loss in 11 (21.7%) of 12 cases submitted for evaluation. Hearing loss related to ototoxicity was confirmed in 15 (62.5%) cases. Tinnitus was significantly associated with the use of amikacin and streptomycin. CONCLUSIONS: Evaluations of ototoxicity symptoms were not usually reported in the routine care of patients with MDR-TB. Complaints of tinnitus were associated with amikacin and streptomycin use. These results require confirmation in future studies

Sequential analysis as a tool for detection of amikacin ototoxicity in the treatment of multidrug-resistant tuberculosis

ABSTRACT Objective: To investigate early detection of amikacin-induced ototoxicity in a population treated for multidrug-resistant tuberculosis (MDR-TB), by means of three different tests: pure-tone audiometry (PTA); high-frequency audiometry (HFA); and distortion-product otoacoustic emission (DPOAE) testing. Methods: This was a longitudinal prospective cohort study involving patients aged 18-69 years with a diagnosis of MDR-TB who had to receive amikacin for six months as part of their antituberculosis drug regimen for the first time. Hearing was assessed before treatment initiation and at two and six months after treatment initiation. Sequential statistics were used to analyze the results. Results: We included 61 patients, but the final population consisted of 10 patients (7 men and 3 women) because of sequential analysis. Comparison of the test results obtained at two and six months after treatment initiation with those obtained at baseline revealed that HFA at two months and PTA at six months detected hearing threshold shifts consistent with ototoxicity. However, DPOAE testing did not detect such shifts. Conclusions: The statistical method used in this study makes it possible to conclude that, over the six-month period, amikacin-associated hearing threshold shifts were detected by HFA and PTA, and that DPOAE testing was not efficient in detecting such shifts

The importance of audiometric monitoring in patients with multidrug-resistant tuberculosis

<div><p>Abstract INTRODUCTION: A total of 771 cases of multidrug-resistant tuberculosis (MDR-TB) were reported in Brazil in 2014. Treatment of MDR-TB with aminoglycosides can produce serious side effects such as permanent and irreversible hearing loss, which occurs in 5-64% of cases, and severely compromise patient quality of life. The goal of this research was to evaluate auditory and vestibular side effects in patients treated for MDR-TB and to identify associations between these complaints and the type of aminoglycoside used. METHODS: We performed a retrospective review of 599 medical records from patients with MDR-TB who were treated at the Hélio Fraga/Fiocruz Reference Center between 2006 and 2010. Cases without auditory or vestibular complaints and patients who were not treated with aminoglycoside drugs were excluded from the study. RESULTS: Of 164 eligible cases, 55 (33.5%) reported an auditory or vestibular complaint and medication was subsequently suspended, although hearing damage was not confirmed in all cases. Audiometric testing confirmed hearing loss in 11 (21.7%) of 12 cases submitted for evaluation. Hearing loss related to ototoxicity was confirmed in 15 (62.5%) cases. Tinnitus was significantly associated with the use of amikacin and streptomycin. CONCLUSIONS: Evaluations of ototoxicity symptoms were not usually reported in the routine care of patients with MDR-TB. Complaints of tinnitus were associated with amikacin and streptomycin use. These results require confirmation in future studies.</p></div