Audiologic monitoring of multi-drug resistant tuberculosis patients on aminoglycoside treatment with long term follow-up

<p>Abstract</p> <p>Background</p> <p>Multi-drug resistant tuberculosis has emerged as a significant problem with the resurfacing of tuberculosis and thus the need to use the second line drugs with the resultant increased incidence of adverse effects. We discuss the effect of second line aminoglycoside anti-tubercular drugs on the hearing status of MDR-TB patients.</p> <p>Methods</p> <p>Sixty four patients were put on second line aminoglycoside anti-TB drugs. These were divided into three groups: group I, 34 patients using amikacin, group II, 26 patients using kanamycin and group III, 4 patients using capreomycin.</p> <p>Results</p> <p>Of these, 18.75% of the patients developed sensorineural hearing loss involving higher frequencies while 6.25% had involvement of speech frequencies also. All patients were seen again approximately one year after aminoglycoside discontinuation and all hearing losses were permanent with no threshold improvement.</p> <p>Conclusion</p> <p>Aminoglycosides used in MDR-TB patients may result in irreversible hearing loss involving higher frequencies and can become a hearing handicap as speech frequencies are also involved in some of the patients thus underlining the need for regular audiologic evaluation in patients of MDR-TB during the treatment.</p

Practices employed by audiologists in the management of adult patients with multidrug-resistant tuberculosis in South Africa

Introduction: Aminoglycosides used for treating multidrug-resistant (MDR) tuberculosis are ototoxic, leading to a need for audiological monitoring. While audiologists monitor ototoxicity, currently there are no guidelines on monitoring in the South African context. Therefore, the findings of this study might help to motivate the establishment of a more in-depth ototoxicity monitoring policy, which facilitates uniformity among audiologists managing patients with MDR tuberculosis. Therefore, the study aimed to describe the audiological practices employed by audiologists in the management of adult patients with MDR tuberculosis in South Africa.Method: A descriptive survey design was used. A questionnaire was developed and included elements of the American Speech-Language and Hearing Association (1994) guidelines for monitoring ototoxicity. Ninety-three audiologists contributed data to this study. Descriptive statistics were used in the analysis of the data.Results: Sixty-eight percent (%) of the respondents were aware of the international guidelines, 93% provided pre-treatment counselling and 87% conducted a baseline assessment. Nineteen per cent of the respondents conducted high-frequency audiometry, while 74% carried out a monthly evaluation, 72% performed a full audiological assessment after the cessation of the MDR tuberculosis treatment, and 96% conducted post-treatment counselling. Modifications to the international guidelines include not conducting speech and immittance audiometry, as well as testing certain frequencies. The reasons for these modifications include limited specialised equipment, time constraints, large caseloads and understaffed departments.Conclusion: There are no explicit guidelines on ototoxicity monitoring in South Africa. Consequently, audiologists are having to modify the international guidelines. Thus, there is no consistency in managing patients with MDR tuberculosis. This highlights the need for South Africa to develop context-relevant ototoxicity monitoring guidelines to appropriately manage patients with MDR tuberculosis

Monitoramento auditivo na ototoxidade Auditory monitoring in ototoxicity

Algumas drogas, denominadas ototóxicas, têm a capacidade de lesar os sistemas auditivo e vestibular. O avanço tecnológico tem disponibilizado inúmeros recursos para realizar o monitoramento da audição, porém, apesar da disponibilização de protocolos de avaliação internacionais, existem controvérsias quanto à escolha do procedimento de maior sensibilidade e especificidade para este fim. OBJETIVO: Analisar os procedimentos audiológicos utilizados no monitoramento auditivo dos indivíduos expostos à medicação ototóxica. METODOLOGIA: Realizou-se busca eletrônica nas bases de dados MEDLINE e LILACS, a partir da combinação entre os descritores que caracterizaram as temáticas monitoramento auditivo, ototoxicidade e câncer. A literatura apontou dois principais procedimentos efetivos no monitoramento: a audiometria de altas freqüências e as emissões otoacústicas. Ambos permitem que a alteração no sistema auditivo seja identificada antes que haja um comprometimento dos limiares tonais na faixa de freqüências convencional, e conseqüentemente na habilidade de compreensão da fala. CONCLUSÃO: O protocolo de monitoramento auditivo foi sugerido considerando a capacidade do paciente em responder aos testes comportamentais e a etapa do monitoramento (primeira avaliação ou subseqüentes). No caso de portadores de câncer, o monitoramento auditivo deve ser disponibilizado no local de tratamento do indivíduo.<br>Some pharmaceutical products are capable of damaging the human auditory system. Technological progress has provided numerous resources to monitor hearing but there still is some controversy regarding the selection of the most sensitive and specific tests. OBJECTIVE: to analyze audiological procedures used in the auditory monitoring of individuals exposed to ototoxic medication. METHODS: we searched the MEDLINE and LILACS literature databases, using terms pertinent to audiological monitoring, ototoxicity and cancer. The pertaining literature analysis identified two procedures often used worldwide for the early detection of auditory lesions induced by ototoxic pharmaceutical drugs: high-frequency audiometry and evoked otoacoustic emissions. Both allow early identification of hearing disorders before changes are seen in conventional pure-tone audiometry and, consequently, before speech understanding is compromised. CONCLUSION: we suggest a hearing monitoring protocol, considering the patient’s capability to respond to behavioral tests and monitoring timing (first test/follow up). For cancer patients, hearing monitoring should be performed in the patient’s treatment venue