Hearing Disorders in HIV Positive Adult Patients

Background: This study was aimed at determining the prevalence and type of hearing disorders in HIV positive patients and any correlationship with the CD4 counts/stage of HIV/AIDS in patients attending the comprehensive care clinic (CCC).Methods: Case control study of 194 HIV positive patients attending CCC recruited into the study after informed consent. A thorough clinical examination and otoscopy done followed by tuning fork tests, Pure Tone Audiometry and tympanometric tests. This was compared with 124 HIV negative subjects matched for age and sex who were recruited from the voluntary counseling and testing centre. The world health organization staging of the HIV/AIDS disease and the CD4 positive lymphocyte cell count were carried out and correlated with any hearing disorder. Results were analyzed using statistical package for social sciences version 10.0.Results: Hearing loss (HL) was present in 33.5% of HIV positive compared to 8.1% in negative subjects. No gender bias in HL but HL worsened with advancement of age. SNHL was the most common and the higher frequencies were the most affected. Low CD4 cell count and advanced HIV disease were associated with increased chance of having a hearing loss.Conclusion: Hearing loss is more prevalent in HIV positive individuals than negative normal subjects and tends to worsen with the advancement of the HIV disease. This may negatively impact on the overall care and standard of living of HIV positive patients, hence otological care should be part of the comprehensive care

Lingual Thyrod: Case Report

A sixteen year old male presented with progressive dysphagia, dysphonia and haemoptysis over eight months. Radionuclide studies and computed tomographic scans confirmed an only functional thyroid gland at the base of tongue which was excised wholly via mandibular split transoral route and patient put on thyroxin replacement therapy.East African Medical Journal Vol. 87 No. 7 July 201

The pattern of hearing disorders in HIV positive patients on anti-retrovirals at Kenyatta National Hospital

Objectives: To determine if patients on Anti - retroviral drugs (ARVs) develop hearing impairment.Design: The comprehensive care clinic (CCC), Kenyatta National Hospital (KNH), Nairobi.Setting: Case controlled study.Subjects: Two hundred and seventy one human immunodeficiency virus (HIV) positive patients on ARVs were matched for age and sex with 273 HIV positive patients who were not on ARVs.Results: Thirty four percent of HIV positive patients not on ARVs had a hearing loss compared to only 28% in patients who were on ARVs. sensorineural hearing loss was the most frequent hearing disorder in both groups. Majority of the patients had mild hearing loss and the higher frequencies were the most affected. There was a notable worsening of hearing loss with increase in age, but this was not statistically significant.It was noted that HIV positive patients hearing level worsened on starting ARVs but this improved after six months of ARV treatment.Conclusion: Prolonged usage of ARVs is not associated with decreased hearing function. The most common hearing loss found in patients on ARVs is sensorineural hearing loss (SNHL)

Hearing Loss in Perinatally Human Immunodeficiency Virus- Infected and Human Immunodeficiency Virus -Exposed but Uninfected Children and Adolescents

This is not the published version.Background Little is known about hearing loss in children with HIV infection (HIV+). We examined the prevalence of hearing loss in perinatally HIV+ and HIV-exposed but uninfected (HEU) children, compared these to the percentage with hearing loss in the general population, and evaluated possible risk factors for hearing loss in HIV+ and HEU children. Methods Audiometric examinations were completed in children who met any pre-specified criteria for possible hearing loss. The hearing examination consisted of a tympanogram in each ear and pure-tone air-conduction threshold testing from 500 through 4000 Hz. Hearing loss was defined as the pure-tone average over these frequencies ≥20 dB hearing level (HL). The associations of demographic, parent/caregiver, HIV disease, and HIV treatment with hearing loss were evaluated with univariate and multivarible logistic regression models. Results Hearing testing was completed in 231 children (145 HIV+ and 86 HEU). Hearing loss occurred in 20.0% of HIV+ children and 10.5% of HEU children. After adjusting for caregiver education level, HIV infection was associated with increased odds of hearing loss [adjusted odds ratio (aOR)=2.13, 95% confidence interval (CI): 0.95–4.76, p=0.07]. Among HIV+ children, those with a CDC Class C diagnosis had over twice the odds of hearing loss (aOR=2.47, 95% CI: 1.04–5.87, p=0.04). The prevalence of hearing loss was higher in both HIV+ and HEU children compared with NHANES III children. Conclusions Hearing loss was more common in both HIV+ and HEU children than in healthy children. More advanced HIV illness increased the risk of hearing loss in HIV+ children

Is hearing impairment associated with HIV? A systematic review of data from low- and middle-income countries.

OBJECTIVES: To systematically review evidence on the prevalence and characteristics of hearing impairment among children and adults living with HIV in low- and middle-income countries (LMIC). METHODS: Articles were identified up to January 2016 through searching four electronic databases. Epidemiological studies conducted in LMIC that explored the association between HIV status and hearing loss, with or without an HIV-uninfected comparison group, were eligible for inclusion. Results were screened and assessed for eligibility, and data were extracted by two reviewers, with discussion in the case of disagreement. Findings were narratively synthesised. RESULTS: The search identified 638 unique references, of which 21 studies were included in the review, including 3491 people with HIV from 13 LMIC. There was lack of consistency in the definition used for hearing loss, making comparability across studies difficult. Among children with HIV, across the three studies that used a cut-off of >15 dB in either ear, the prevalence of hearing loss ranged from 22 to 37%. Among the three studies that used >25 dB in either ear, the prevalence ranged from 32 to 39%. Among adults with HIV, for the five studies that used a threshold of >25 dB for either ear, the prevalence ranged from 10 to 43%. The prevalence of hearing impairment was significantly higher among people with HIV than in controls in eight of the ten studies that assessed this comparison. Conductive hearing loss was the most common type of hearing loss in children with HIV, while sensorineural hearing loss was more common in adults with HIV. There was a lack of evidence for an association between ART use and hearing loss, although there was some suggestion that late stage of HIV disease or low CD4 count was related to hearing loss. There were concerns about the quality of the studies included in the review. CONCLUSIONS: The current evidence is suggestive of a high prevalence of hearing loss among people living with HIV compared to people without HIV, or to WHO estimates for the general population. More research is needed to better understand the aetiology of hearing loss in relation to HIV, and whether screening for and treatment of hearing loss can be effectively integrated into HIV treatment services needs further research

Hearing Disorders in HIV Positive Adult Patients

Background: This study was aimed at determining the prevalence and type of hearing disorders in HIV positive patients and any correlationship with the CD4 counts/stage of HIV/AIDS in patients attending the comprehensive care clinic (CCC). Methods: Case control study of 194 HIV positive patients attending CCC recruited into the study after informed consent. A thorough clinical examination and otoscopy done followed by tuning fork tests, Pure Tone Audiometry and tympanometric tests. This was compared with 124 HIV negative subjects matched for age and sex who were recruited from the voluntary counseling and testing centre. The world health organization staging of the HIV/AIDS disease and the CD4 positive lymphocyte cell count were carried out and correlated with any hearing disorder. Results were analyzed using statistical package for social sciences version 10.0. Results: Hearing loss (HL) was present in 33.5% of HIV positive compared to 8.1% in negative subjects. No gender bias in HL but HL worsened with advancement of age. SNHL was the most common and the higher frequencies were the most affected. Low CD4 cell count and advanced HIV disease were associated with increased chance of having a hearing loss. Conclusion: Hearing loss is more prevalent in HIV positive individuals than negative normal subjects and tends to worsen with the advancement of the HIV disease. This may negatively impact on the overall care and standard of living of HIV positive patients, hence otological care should be part of the comprehensive care

The relationship between HIV and prevalence of disabilities in sub-Saharan Africa: systematic review (FA).

OBJECTIVE: To systematically review evidence on the prevalence and risk of disabilities among children and adults living with HIV in sub-Saharan Africa. METHODS: Articles were identified from 1980 to June 2013 through searching seven electronic databases. Epidemiological studies conducted in sub-Saharan Africa that explored the association between HIV status and general disability or specific impairments, with or without an HIV-uninfected comparison group, were eligible for inclusion. RESULTS: Of 12 867 records initially identified, 61 papers were deemed eligible for inclusion. The prevalence of disability was high across age groups, impairment types and study locations. Furthermore, 73% of studies using an HIV- comparator found significantly lower levels of functioning in people living with HIV (PLHIV). By disability type, the results were as follows: (i) for studies measuring physical impairments (n = 14), median prevalence of limitations in mobility and motor function among PLHIV was 25.0% (95% CI: 21.8-28.2%). Five of eight comparator studies found significantly reduced functioning among PLHIV; for arthritis, two of three studies which used an HIV- comparison group found significantly increased prevalence among PLHIV; (ii) for sensory impairment studies (n = 17), median prevalence of visual impairment was 11.2% (95%CI: 9.5-13.1%) and hearing impairment was 24.1% (95%CI: 19.2-29.0%) in PLHIV. Significantly increased prevalence among PLHIV was found in one of four (vision) and three of three studies (hearing) with comparators; (iii) for cognitive impairment in adults (n = 30), median prevalence for dementia was 25.3% (95% CI: 22.0-28.6%) and 40.9% (95% CI: 37.7-44.1%) for general cognitive impairment. Across all types of cognitive impairment, twelve of fourteen studies found a significant detrimental effect of HIV infection; (iv) for developmental delay in children with HIV (n = 20), median prevalence of motor delay was 67.7% (95% CI: 62.2-73.2%). All nine studies that included a comparator found a significant difference between PLHIV and controls; for cognitive development and global delay, a significant detrimental effect of HIV was found in five of six and one of two studies, respectively. In the nine cohort studies comparing vertically infected and uninfected children, eight showed a significant gap in development over time in children with HIV. Finally, fifteen of thirty-one (48%) studies found a statistically significant dose-response relationship between indicators of disease progression (CD4 or WHO stage) and disability. CONCLUSIONS: HIV is widespread in sub-Saharan Africa and the evidence suggests that it is linked to disabilities, affecting a range of body structures and functions. More research is needed to better understand the implications of HIV-related disability for individuals, their families as well as those working in the fields of disability and HIV so that appropriate interventions can be developed