Background Aminoglycosides (AGs) and glycopeptides are antibiotics essential for treating life-threatening respiratory infections in patients with cystic fibrosis (CF). The goal of this study was to examine the effects of cumulative intravenous AG (amikacin and/or tobramycin) and/or glycopeptide (vancomycin) dosing on hearing status. Methods Hearing thresholds were measured from 0.25 to 16.0 kHz, in 81 participants with CF. Participants were categorized into two groups: normal hearing in both ears (≤25 dB HL for all frequency bands) or hearing loss (>25 dB HL for any frequency band in either ear). Participants were also characterized by their cumulative intravenous (IV)-AG (with or without vancomycin) exposure by comparing the total number of lifetime cumulative IV doses to a method that additionally accounts for the total number of doses per day (weighted method) per course of treatment. Results Participants in the hearing loss group were significantly older than those in the normal-hearing group. After adjusting for gender and age at the time of hearing test, participants in the two highest-quartile exposure groups were more likely to have permanent sensorineural hearing loss than those in the two lowest-quartile exposure groups. Conclusions Cumulative IV antibiotic dosing has a significant negative effect on hearing sensitivity in patients with CF, when controlling for age and gender effects. A trend for increasing odds of hearing loss was associated with increasing cumulative IV-antibiotic dosing.

Objectives Wideband acoustic immittance (WAI) measures such as pressure reflectance, parameterized by absorbance and group delay, equivalent admittance at the tympanic membrane (TM), and acoustic stapedius reflex threshold (ASRT) describe middle-ear function across a wide frequency range, compared to traditional tests employing a single frequency. The objective of this study was to obtain normative data using these tests for a group of normal hearing adults and investigate test-retest reliability using a longitudinal design. Design A longitudinal prospective design was used to obtain normative test and retest data on clinical and WAI measures. Subjects were 13 males and 20 females (mean age = 25 y). Inclusion criteria included normal audiometry and clinical immittance. Subjects were tested on two separate visits approximately one month apart. Reflectance and equivalent admittance at the TM were measured from 0.25 to 8.0 kHz under three conditions: at ambient pressure in the ear canal and with pressure sweeps from positive to negative pressure (downswept) and negative to positive pressure (upswept). Equivalent admittance at the TM was calculated using admittance measurements at the probe tip which were adjusted using a model of sound transmission in the ear canal and acoustic estimates of ear-canal area and length. Wideband ASRTs were measured at tympanometric peak pressure (TPP) derived from the average TPP of downswept and upswept tympanograms. Descriptive statistics were obtained for all WAI responses, and wideband and clinical ASRTs were compared. Results Mean absorbance at ambient pressure and TPP demonstrated a broad band-pass pattern typical of previous studies. Test-retest differences were lower for absorbance at TPP for the downswept method compared to ambient pressure at frequencies between 1.0 and 1.26 kHz. Mean tympanometric peak-to-tail differences for absorbance were greatest around 1.0 to 2.0 kHz and similar for positive and negative tails. Mean group delay at ambient pressure and at TPP were greatest between 0.32 and 0.6 kHz at 200 to 300 μs, reduced at frequencies between 0.8 and 1.5 kHz, and increased above 1.5 kHz to around 150 μs. Mean equivalent admittance at the TM had a lower level for the ambient method than at TPP for both sweep directions below 1.2 kHz, but the difference between methods was only statistically significant for the comparison between the ambient method and TPP for the upswept tympanogram. Mean equivalent admittance phase was positive at all frequencies. Test-retest reliability of the equivalent admittance level ranged from 1 to 3 dB at frequencies below 1.0 kHz, but increased to 8 to 9 dB at higher frequencies. The mean wideband ASRT for an ipsilateral broadband noise activator was 12 dB lower than the clinical ASRT, but had poorer reliability. Conclusions Normative data for the WAI test battery revealed minor differences for results at ambient pressure compared to tympanometric methods at TPP for reflectance, group delay, and equivalent admittance level at the TM f...

The findings support the theory that cortical mechanisms involved in listening to speech affect cochlear function through the MOC efferent system.

The most effective OMPs integrated audiological management into care pathways of the clinical specialties that prescribe ototoxic medications. More OMP guidance is needed to inform evaluation schedules, outcome reporting, and determination of actionable ototoxic changes. Guidance is also lacking on the use of hearing conservation approaches suitable for the mass testing needed to support large-scale OMP efforts. Guideline adherence might improve with formal endorsement from organizations governing the medical specialty stakeholders in OMP such as oncologists, pulmonologists, infectious disease specialists, ototolaryngologists and pharmacists.