Objective-This systematic review evaluates the impact of aspirin on audiometric outcomes with respect to: (1) doses exceeding 325 mg daily, (2) doses of 325 mg daily or less, (3) studies applicable to the general populace, and (4) studies applicable to those with inflammatory conditions. It also assesses the impact of aspirin on (a) self-reported hearing loss, (b) noiseinduced audiometric changes, and (c) the adverse otological effects of aminoglycoside therapy.Data Sources-Computerized searches of MEDLINE, PubMed, Cochrane, and EMBASE databases were performed, updated through January 2014, and supplemented by manual searches and inquiries to topic experts.Review Methods-A systematic review was performed according to an a priori protocol. Data extraction was performed by 2 independent parties and focused on relevant audiological measurements, potential confounders, and study design elements associated with risk of bias, including utilization of randomization, prospective/retrospective data collection, and incorporation of blinding. Results-The Author ContributionsMeghann Elizabeth Kyle, acquisition of data, analysis and interpretation of data, drafting and editing manuscript, final approval; James C. Wang, acquisition of data, analysis and interpretation of data, contributing to manuscript, final approval; Jennifer J. Shin, analysis and interpretation of data, acquisition of data, drafting and editing manuscript, final approval. DisclosuresCompeting interests: Jennifer J. Shin receives royalties from book publications: Evidence-based Otolaryngology (Springer International, 2008, Otolaryngology Prep and Practice (Plural Publishing, 2013). Sponsorships: None. Funding source: None. Supplemental MaterialAdditional supporting information may be found at http://otojournal.org/supplemental. Author Manuscript shift); the effect was dose dependent and reversible in the short term. There were no audiometric data that confirm that long-term doses of 81 mg or 325 mg daily have no hearing consequences. Paradoxically, aspirin (in doses shown to be detrimental in isolation) had a protective effect when co-administered with intravenous gentamicin. HHS Public AccessConclusions-With the large-scale population utilization of aspirin for cardiovascular prophylaxis, the potential risks to hearing health should be considered for future longitudinal study, particularly given that short-term effects may be reversible.
Objective To determine if the current body of evidence describes specific threshold values of concern for modifiable societal-level risk factors for pediatric hearing loss, with the overarching goal of providing actionable guidance for the prevention and screening of audiological deficits in children. Data Sources Three related systematic reviews were performed. Computerized PubMed, Embase, and Cochrane Library searches were performed from inception through October 2013 and were supplemented with manual searches. Review Methods Inclusion/exclusion criteria were designed to determine specific threshold values of societal-level risk factors on hearing loss in the pediatric population. Searches and data extraction were performed by independent reviewers. Results There were 20 criterion-meeting studies with 29,128 participants. Infants less than 2 standard deviations below standardized weight, length, or body mass index were at increased risk. Specific nutritional deficiencies related to iodine and thiamine may also increase risk, although data are limited and threshold values of concern have not been quantified. Blood lead levels above 10 μg/dL were significantly associated with pediatric sensorineural loss, and mixed findings were noted for other heavy metals. Hearing loss was also more prevalent among children of socioeconomically disadvantaged families, as measured by a poverty income ratio less than 0.3 to 1, higher deprivation category status, and head of household employment as a manual laborer. Conclusions Increasing our understanding of specific thresholds of risk associated with causative factors forms the foundation for preventive and targeted screening programs as well as future research endeavors.
Background Pediatric hearing loss is an increasingly recognized problem with significant implications. Increasing our quantitative understanding of potentially modifiable environmental risk factors for hearing loss may form the foundation for prevention and screening programs. Objective To determine whether specific threshold exposure levels of personally modifiable risk factors for hearing loss have been defined, with the overarching goal of providing actionable guidance for the prevention of pediatric hearing loss. Data Sources A systematic review was performed. Computerized searches of PubMed, EMBASE, and the Cochrane Library were completed and supplemented with manual searches. Review Methods Inclusion/exclusion criteria were designed to determine specific threshold values of personally modifiable risk factors on hearing loss in the pediatric population. Searches and data extraction were performed by independent reviewers. Results There were 38 criterion-meeting studies, including a total of 50,651 subjects. Threshold noise exposures significantly associated with hearing loss in youth included: (1) more than 4 hours per week or more than 5 years of personal headphone usage, (2) more than 4 visits per month to a discotheque, and (3) working on a mechanized farm. Quantified tobacco levels of concern included any level of in utero smoke exposure as well as secondhand exposure sufficient to elevate serum cotinine. Conclusions Specific thresholds analyses are limited. Future studies would ideally focus on stratifying risk according to clearly defined levels of exposure, in order to provide actionable guidance for children and families.
Objective To perform a systematic review evaluating the association between sensorineural hearing loss and (1) nonsteroidal anti-inflammatory drugs (NSAIDs) as a class, (2) NSAIDs available over the counter, (3) NSAIDs in short intravenous courses, (4) prescription NSAIDs utilized by patients without systemic inflammatory conditions, (5) prescription NSAIDs in patients with arthritides, and (6) acetaminophen with and without concomitant narcotic usage. Data Sources Computerized searches of PubMed, EMBASE, and the Cochrane Library were updated through May 2014, along with manual searches and inquiries to topic experts. Review Methods The systematic review was performed according to an a priori protocol. Data extraction was performed by 2 independent investigators, and it focused on relevant audiologic measurements, methodological elements related to risk of bias, and potential confounders. Results The 23 criterion-meeting studies included a total of 92,532 participants, with mixed results. Sulindac was the only specific agent to have been studied with formal audiometry in a randomized double-blind placebo-controlled trial in which hearing was the reported primary outcome: Although an effect was seen in the unadjusted analysis (pure tone threshold > 15 dB, 9.3% vs 2.9%; relative risk [RR], 3.2; confidence interval [CI], 1.09-9.55; P = .02), the effect dissipated in the adjusted analysis (P = .09). There was a significant effect on self-reported hearing loss from NSAIDs as a class (RR, 1.21; CI, 1.11-1.33), ibuprofen (RR, 1.13; CI, 1.06-1.19), and acetaminophen (RR, 1.21; CI, 1.11-1.33), but no formal audiometric data confirm or refute this suggested effect. Audiometry has demonstrated profound loss in some instances of acetaminophen-narcotic combination ingestions. Conclusions Data are varied regarding the impact of NSAIDs and acetaminophen on population hearing health.
Objective This systematic review evaluates the impact of aspirin on audiometric outcomes with respect to: (1) doses exceeding 325 mg daily, (2) doses of 325 mg daily or less, (3) studies applicable to the general populace, and (4) studies applicable to those with inflammatory conditions. It also assesses the impact of aspirin on (a) self-reported hearing loss, (b) noise-induced audiometric changes, and (c) the adverse otological effects of aminoglycoside therapy. Data Sources Computerized searches of MEDLINE, PubMed, Cochrane, and EMBASE databases were performed, updated through January 2014, and supplemented by manual searches and inquiries to topic experts. Review Methods A systematic review was performed according to an a priori protocol. Data extraction was performed by 2 independent parties and focused on relevant audiological measurements, potential confounders, and study design elements associated with risk of bias, including utilization of randomization, prospective/retrospective data collection, and incorporation of blinding. Results The 37 criterion-meeting studies included a combined total of 185,155 participants. Aspirin ingestion ≥1.95 g/d was associated with worse audiometric results (4–112 dB threshold shift); the effect was dose dependent and reversible in the short term. There were no audiometric data that confirm that long-term doses of 81 mg or 325 mg daily have no hearing consequences. Paradoxically, aspirin (in doses shown to be detrimental in isolation) had a protective effect when co-administered with intravenous gentamicin. Conclusions With the large-scale population utilization of aspirin for cardiovascular prophylaxis, the potential risks to hearing health should be considered for future longitudinal study, particularly given that short-term effects may be reversible.
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