Does amikacin treatment cause subclinical hearing loss in patients with cystic fibrosis?

Abstract

IntroductionAminoglycosides (AGs) have been widely used for potential life-threatening bacterial infections. Although AGs are well known for their ototoxic side effects, some AGs such as amikacin are considered less harmful to auditory functions; thus, auditory monitoring is mostly neglected during treatment with these drugs.ObjectiveTo reflect the potential auditory hazards of repeated amikacin use on the patients with cystic fibrosis (CF).Method32CF patients with prior exposure to at least 3 courses of amikacin (the CF group) and 35 non-CF patients visiting the outpatient clinic with any complaint other than hearing loss and no history of treatment with any AG(the control, or C group) were compared with pure-tone audiometry(PTA). The diagnosis of CF was made by Nanoduck sweat test.ResultsThe average age of the participants were 8.25 ± 2.76 years in the CF group and 8.58 ± 2.00 years in the C group (ranging from 5 to 13 years). 29 (43.28%) of the cases were female and 38 (56.71%) were male. Clinical SNHL(sensorineural hearing loss) was detected in 4 of the 32 subjects in the CF group. None of the subjects in the C group exhibited clinical SNHL. There was no statistically significant difference between the groups with regard to presence or absence of clinical SNHL (p > 0.05). However, hearing levels of the CF group were around 20 dB(decibel) HL(hearing loss), whereas hearing levels of the C group were around 5 dB. This difference was statistically significant for the pure tone averages of both all frequencies and speech frequencies (p < 0.05).ConclusionRepetitive exposure to AGs can cause permanent, although mild, sensorineural hearing loss. For prevention, hearing status of the patient should be closely monitored and treatment of choice should be precisely tailored according to the audiological evaluation. This is especially important in patients with CF who frequently experience medical conditions necessitating AGs use.

Functional Impacts of Aminoglycoside Treatment on Speech Perception and Extended High-Frequency Hearing Loss in Cystic Fibrosis

“…This study showed a very high rate of hearing loss in both the standard (38%) and extended high frequency region (47%) for children, teens and young adults with CF who have received IV-AG antibiotics to treat lung exacerbations. Estimates of hearing loss vary in part due to the criterion for normal-hearing; our study included slight hearing loss (>15 dB HL) in either the SF or EHF range, so the estimates are higher than studies that have used more conservative criteria (e.g., Stavroulaki et al, 2002; Solmaz et al, 2016). Using hearing loss criteria similar to the current study, (2011)Al-Malky et al reported clinically normal hearing (0 to 15 dB HL) from 0.25 to 12.5 kHz in children with CF (n = 45) and little to no previous exposure to IV-AGs (≤ 5 courses).…”

“…For example , Stavroulaki et al (2002) reported normal thresholds (≤ 20 dB HL) from 0.25 to 8 kHz in a pediatric CF cohort with a history of gentamicin exposure (n = 12; range = 5.2 to 14.1 yr.) at baseline and following gentamicin treatment (4mg/kg/day; mean = 14 days; range = 11 to 29). Solmaz et al (2016) reported 12% of individuals with CF (mean = 8.3 yr.; range = 5 to 13) with more than 3 courses of IV amikacin had hearing loss when using a pure-tone average (0.5, 1, 2, and 4 kHz) greater than 25 dB HL. However, when the hearing loss threshold was decreased to > 15 dB HL, 80% of ears in the CF group had hearing loss.…”