Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA)

Konrad-Martin, Dawn; Reavis, Kelly M.; McMillan, Garnett P.; Helt, Wendy J.; Dille, Marilyn F.

doi:10.1682/jrrd.2013.04.0092

Cited by 30 publications

(40 citation statements)

References 37 publications

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“…20 It is wise to consult with the attending physician to identify patients who are at risk for ototoxicity. 21,22 These include all patients who will be treated with known ototoxic agents paying particular attention to those who have other risk factors that can potentiate ototoxicity. These include poor general health with low levels of red blood cells and serum proteins, poor renal function, coadministration of multiple ototoxic agents, hereditary factors, and previous noise exposure.…”

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confidence: 99%

“…21 Having this information available ahead of treatment may allow the creation of a treatment plan that strikes a "balance between a curative approach and quality-of-life outcomes following treatment." 22 Konrad-Martin et al proposed the use of "prediction audiograms" that are formulated based on the planned treatment dosage. 22 They reported a hearing loss prediction error of 4.0 to 8.0 dB when compared with actual pure tone threshold shifts.…”

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confidence: 99%

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Monitoring Protocols for Cochlear Toxicity

Lord¹

2019

Semin Hear

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The need for monitoring hearing and auditory function during drug therapy and other treatments that have the potential to cause hearing loss is well documented. Besides the main purpose of ototoxic monitoring, which is to provide feedback to the attending physician about the effects the treatment is having on the auditory system, it is also helpful in setting expectations for the patient and his/her family about the communication issues that may result from the drug therapy. This article will review tests available to an audiologist, both subjective and objective, that can be used to effectively monitor hearing levels and auditory function during treatment. Published guidelines and various ototoxic monitoring protocols are reviewed regarding tests administered, what constitutes a significant change in test results and how these findings are reported, and the impact significant changes may have on the course of treatment. Test protocols from different institutions are compared for both similarities and contrasts. Effective scheduling and test location are key to a successful monitoring program. Finally, the need to streamline ototoxic monitoring of hearing and auditory function to reduce test time and make it less stressful and tiresome on the patient will be considered.

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confidence: 99%

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confidence: 99%

Monitoring Protocols for Cochlear Toxicity

Lord¹

2019

Semin Hear

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“…Significant amplitude reductions of 1dB in 3kHz, 1.15dB in 6kHz and 4.70 in 8kHz, in DPEOAE have also been reported [18]. Although EOAE are increasingly being considered as a key component of auditory monitoring in individuals at risk of ototoxicity, there is no precise definition of how to interpret the results [11, 13, 26, 29]. Some studies have attempted to define reference values of amplitude reductions in DPEOAE that could be clinically used to define ototoxicity.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that some of the advantages of using EOA is the early detection of ototoxicity and that they are strong predictors of the audiometry alterations determined by ASHA as indicative of cochlear toxicity. Furthermore, it is a non-invasive, simple and objective technique for identifying changes in behavioral auditory thresholds, when the patient is not capable of providing reliable results in hearing tests, due to illness or extreme fatigue, as for example, during chemotherapy treatment [13, 21, 25, 29]. But, when an EOAE alteration is detected in relation to the reference examination, the next step should be initiating a more complete battery of audiometry tests, such as audiometry [26].…”

Section: Discussionmentioning

confidence: 99%

Alterations in Evoked Otoacoustic Emissions by the Use of Meglumine Antimoniate in American Tegumentary Leishmaniasis Patients

et al. 2017

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IntroductionTegumentary Leishmaniasis (TL) is a neglected, non-contagious, infectious disease, caused by different protozoa species of the Leishmania genus that affects skin and mucous membranes. Meglumine Antimoniate (MA), the first drug of choice for TL treatment in Brazil, has already been associated with cochlear toxicity, which is defined as damages of the cochlea caused by exposure to chemical substances, resulting in reversible or irreversible hearing loss. Auditory monitoring for cochlear toxicity aims at the early detection of auditory disorders, enabling, when possible, hearing to be preserved or an early auditory rehabilitation. Although otoacoustic emissions (OAEs) are used in this monitoring, there is no consensus on the criteria that define cochlear toxicity by this examination. The objective of this study was to describe the characteristics of the OAEs in cochlear toxicity monitoring in TL patients using MA.MethodsProspective and longitudinal study of auditory monitoring of 35 patients with parasitological diagnosis of TL, with liminal tonal audiometry, high frequency audiometry, immitanciometry, distortion product evoked otoacoustic emissions (DPEOAEs) and transient evoked otoacoustic emissions (TEOAEs) before treatment, at the end of treatment, one month after the end of treatment and two months after the end of treatment.Results80% male, with median age of 44 years (IIQ: 22–59). In the pre-treatment evaluation: 11.4% complained of hearing loss and 20% of tinnitus, 48.6% presented auditory alterations in liminal tonal audiometry (LTA, 65.2% in high frequency audiometry (HFA), 26.6% in DPEOAE and 51.4% in TEOAE. No association was verified between genre and alterations in the EOAE examinations. We observed that patients that presented disorders in DPEOAE examinations were 17 years older than those without alterations and that patients that showed disorders in TEOAEO examinations were 34 years older than those without disorders. The presence of alterations in DPEOAE and TEOAE before beginning treatment was associated with each other and with the presence of alterations in LTA and HFA, and only DPEOAE was associated with hearing loss. We observed a significantly higher number of alterations of DPEOAE at the end of treatment than during pre-treatment and values of the ratio signal/noise significantly smaller at the end of treatment than during pre-treatment in the frequencies of 2 kHz (difference of 1.7dB; p = 0.016) and 4 kHz (difference of 2.45dB; p = 0.016) in DPEOAE and in the range 1.75/2.5 kHz in TEOAE (difference of 2.9dB; p = 0.039).ConclusionThe ototoxic signals observed in our study using EOAE indicated that both, DPEOAE and TEOAE are adequate and sensitive techniques for clinical monitoring of ototoxicity by MA. Their application is very simple, and their results help the physician to take the most adequate steps for each patient, thus avoiding permanent hearing damage.

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“…DPOAEs are measured using an ear-level microphone and provide information about cochlear outer hair cell function, which is the primary site of cochlear damage for initial noise-induced hearing loss and aminoglycoside-induced ototoxicity in adult populations [9, 14]. DPOAE responses are influenced by hearing loss at the eliciting stimulus frequencies, ( f 1 and f 2, where f 1< f 2), emission frequency (2 f 1- f 2) and higher frequencies coded by more basal cochlear regions [15]. This makes DPOAE responses a valuable screening tool for detecting the onset of ototoxicity that first appears at higher frequency (basal) cochlear locations.…”

Section: 1 Introductionmentioning

confidence: 99%

Effect of sepsis and systemic inflammatory response syndrome on neonatal hearing screening outcomes following gentamicin exposure

Cross

Liao

Urdang

et al. 2015

International Journal of Pediatric Otorhinolaryngology

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Rationale Hearing loss in neonatal intensive care unit (NICU) graduates range from 2–15% compared to 0.3% in full-term births, and the etiology of this discrepancy remains unknown. The majority of NICU admissions receive potentially ototoxic aminoglycoside therapy, such as gentamicin, for presumed sepsis. Endotoxemia and inflammation are associated with increased cochlear uptake of aminoglycosides and potentiated ototoxicity in mice. We tested the hypothesis that sepsis or systemic inflammatory response syndrome (SIRS) and intravenous gentamicin exposure increases the risk of hearing loss in NICU admissions. Methods The Institutional Review Board at Oregon Health & Science University (OHSU) approved this study design. Two hundred and eight infants met initial criteria, and written, informed consent were obtained from parents or guardians of 103 subjects ultimately enrolled in this study. Prospective data from 91 of the enrolled subjects at OHSU Doernbecher Children’s Hospital Neonatal Care Center were processed. Distortion product otoacoustic emissions (DPOAEs; f2 frequency range: 2,063 to 10,031 Hz) were obtained prior to discharge to assess auditory performance. To pass the DPOAE screen, normal responses in >6 of 10 frequencies in both ears were required; otherwise the subject was considered a “referral” for a diagnostic hearing evaluation after discharge. Cumulative dosing data and diagnosis of neonatal sepsis or SIRS were obtained from OHSU’s electronic health record system, and the data processed to obtain risk ratios. Results Using these DPOAE screening criteria, 36 (39.5%) subjects would be referred. Seventy-four (81%) subjects had intravenous gentamicin exposure. Twenty (22%) had ≥4 days of gentamicin, and 71 (78%) had <4 days. The risk ratio (RR) of referral with ≥4 days of gentamicin was 1.92 (p=0.01). Eighteen subjects had sepsis or met neonatal SIRS criteria, 9 of whom had ≥5 days of gentamicin and a DPOAE referral risk ratio of 2.12 (p=0.02) compared to all other subjects. Combining subjects with either vancomycin or furosemide overlap with gentamicin treatment yielded an almost significant risk ratio (RR = 1.77, p=0.05) compared to the rest of the cohort. Conclusions We report an increased risk of referral with DPOAE screening for those receiving ≥4 days of intravenous gentamicin administration that may contribute to the greater prevalence of hearing loss in NICU graduates. We propose an expanded prospective study to gather a larger cohort of subjects, identifying those with sepsis or neonatal SIRS, to increase the statistical power of this study design. Subsequent studies also need to obtain follow-up diagnostic audiological data to verify whether the outcomes of DPOAE screening, in addition to the standard AABR screen, is a reliable predictor of permanent hearing loss following gentamicin exposure in the NICU.

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Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA)

Cited by 30 publications

References 37 publications

Monitoring Protocols for Cochlear Toxicity

Monitoring Protocols for Cochlear Toxicity

Alterations in Evoked Otoacoustic Emissions by the Use of Meglumine Antimoniate in American Tegumentary Leishmaniasis Patients

Effect of sepsis and systemic inflammatory response syndrome on neonatal hearing screening outcomes following gentamicin exposure

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