The Incidence of Ototoxicity in Patients Using Iron Chelators

Derin, Serhan; Azık, Fatih Mehmet; Topal, Yaşar; Topal, Hatice; Karakuş, Volkan; Çetinkaya, Petek Uzay; Şahan, Murat; Azık, Tansel Erdem; Kocabaş, Can Naci

doi:10.5152/iao.2016.1852

Cited by 11 publications

(12 citation statements)

References 12 publications

(33 reference statements)

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“…They reported that there was a rather low incidence of ototoxicity after exposure to iron chelators [30]. In another paper by Derin et al, DFP and DFX were found to be unrelated to SNHL in β-thalassemia major patients [22]. The findings of these studies did not correlate with our study.…”

Section: Discussioncontrasting

confidence: 89%

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Sensorineural Hearing Loss and Its Relationship with Duration of Chelation Among Major β-Thalassemia Patients

Khan

Seedat

et al. 2019

Cureus

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IntroductionThalassemia is a common genetic disorder worldwide, also occurring frequently in Karachi, Pakistan. Beta (β)-thalassemia major patients need repeated transfusions which cause iron overload. Patients are treated with chelating agents to reduce the high serum ferritin level and to decrease morbidity and mortality due to increased iron levels. This combined therapy also leads to some complications. One of them is the sensorineural hearing loss (SNHL). To date, no data is available in Pakistan regarding SNHL among major β-thalassemia patients on chelating therapy. MethodsA cross-sectional study was performed in collaboration with the Thalassemia Center and Dr. Ruth Pfau at the Department of Ear, Nose, and Throat, Civil Hospital, Karachi, Pakistan. The variable to detect hearing was pure tone air and bone conduction thresholds at the frequencies of 250 - 4,000 Hz. Clinical data, such as chelating agent dose, duration, and hearing status, were recorded. Demographic characteristics, like age, gender, height, and weight, were noted. The hemoglobin and serum ferritin levels of the subjects were also included.ResultsForty-five percent of cases of thalassemia were suffering from SNHL. In the right ear, the Pearson correlation of chelating agent dose (mg) with SNHL was mildly positive and statistically significant (r = 0.261, p < 0.001), (r = 0.337, p < 0.001), (r = 0.198, p = 0.005), and (r = 0.207, p = 0.003) at the frequencies of 250, 500, 1,000, and 2,000 Hz, respectively, and the Pearson correlation of chelating agent used (in months) with SNHL was mildly positive and statistically significant (r = 0.232, p = 0.001), and (r = 0.301, p < 0.001) at frequencies 250 to 500 Hz, respectively. In the left ear, the Pearson correlation of chelating agent dose (mg) with SNHL was mildly positive and statistically significant, (r = 0.191, p = 0.007), (r = 0.202, p = 0.004), (r = 0.297, p < 0.001), (r = 0.183, p = 0.010) and (r = 0.221, p = 0.002) at frequencies 250, 500, 1,000, 2,000, and 4,000 Hz, respectively, and Pearson correlation of chelating agent used (months) with SNHL was mildly positive and statistically significant only at the frequency of 2,000 Hz (r = 140, p = 0.049). ConclusionChelation therapy and regular blood transfusions, apart from prolonging the life of thalassemic patients, also leads to some complications. With this survey, it was concluded that almost half of the patients had normal hearing, while the other half had sensorineural hearing loss after the use of deferasirox. It is inferred that the incidence of SNHL is not only dose-related but the duration of use of a chelating agent is also a contributing factor.

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Section: Discussioncontrasting

confidence: 89%

“…In their 2017 study, Derin et al highlighted the controversy regarding the ototoxicity of chelating agents [22]. Hence, it is important to identify the high-risk group of patients who are prone to develop SNHL and its relationship with the duration of use.…”

Section: Introductionmentioning

confidence: 99%

Sensorineural Hearing Loss and Its Relationship with Duration of Chelation Among Major β-Thalassemia Patients

Khan

Seedat

et al. 2019

Cureus

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“…The relationship between age and hearing loss was specifically investigated by some authors, with heterogeneous and inconclusive results; most studies reported no correlation between hearing loss and the age of patients [ 4 , 13 , 14 , 15 , 18 , 24 , 27 , 29 , 30 ], while some others reported an increased prevalence with age [ 6 , 27 , 28 , 44 ], and finally in some studies there was rather a reduction in the prevalence of hearing deficits with increasing age [ 31 , 36 ]. Olivieri et al and Albera et al confirmed the results that younger patients had a greater sensorineural hearing loss, and thus they suggested that the ototoxic effect seems to be due to a greater cochlear sensitivity in younger subjects [ 20 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

Hearing Loss in Beta-Thalassemia: Systematic Review

Tartaglione

Carfora

Brotto

et al. 2021

JCM

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In the last half century, the life expectancy of beta-thalassemia patients has strikingly increased mostly due to regular blood transfusions and chelation treatments. The improved survival, however, has allowed for the emergence of comorbidities, such as hearing loss, with a non-negligible impact on the patients’ quality of life. This thorough review analyzes the acquired knowledge regarding hearing impairment in this hereditary hemoglobinopathy, aiming at defining its prevalence, features, course, and possible disease- or treatment-related pathogenic factors. Following PRISMA criteria, we retrieved 60 studies published between 1979 and 2021. Diagnostic tools and criteria, forms of hearing impairment, correlations with beta-thalassemia phenotypes, age and sex, chelation treatment and laboratory findings including iron overload, were carefully searched, analyzed and summarized. In spite of the relatively high number of studies in the last 40 years, our knowledge is rather limited, and large prospective studies with homogeneous diagnostic tools and criteria are required to define all the aforementioned issues. According to the literature, the overall prevalence rate of hearing impairment is 32.3%; age, sex, and laboratory findings do not seem to correlate with hearing deficits, while the weak relationship with clinical phenotype and chelation treatment seems to highlight the presence of further yet to be identified pathogenic factors.

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“…Chronic transfusion therapy has many indications in the management of SCD sequelae and is something unaccounted for by the majority of the papers selected for this meta‐analysis 1 . One study conducted in Turkey using the National Cancer Institute Common Terminology Criteria for Adverse Events analyzed 55 transfusion‐dependent patients on chelation therapy and found that 15 patients taking deferoxamine had evidence of ototoxicity 39 . Another study using audiometric data in the pediatric population of thalassemia patients found that only 7 out of 100 patients were found to have SNHL and of those, 4 cases were attributable to chelation therapy 40 …”

Section: Discussionmentioning

confidence: 99%

Prevalence of Sensorineural Hearing Loss in Pediatric Patients with Sickle Cell Disease: A Meta‐analysis

et al. 2020

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Objectives To determine the prevalence of Sensorineural Hearing Loss (SNHL) attributable to Sickle Cell Disease (SCD) in the global pediatric population and to identify factors contributing to its severity. Study Design Meta‐analysis. Methods We performed a comprehensive literature search for scientific articles in PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library that reported the incidence of hearing loss in populations under 18 years of age with excluding studies analyzing patients on iron chelation therapy, adults, or those without objective audiological analysis. Results We identified 138 initial studies with 17 selected for analysis after applying the exclusion criteria. A total of 1,282 SCD patients and 553 controls were included in the meta‐analysis. There was a statistically significant increase in the prevalence of SNHL in children with SCD compared to the general population with a cumulative risk ratio of 3.33. Conclusion This is the first systematic investigation of the relationship between SCD and SNHL in pediatric patients across the globe. The increased prevalence of SNHL in the pediatric SCD population warrants future research into the predictors of SNHL severity and merits routine audiometric monitoring of SCD patients to reduce the social and developmental morbidity of hearing loss at a young age. PROSPERO Registration #: CRD42019132601. Laryngoscope, 131:1147–1156, 2021

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The Incidence of Ototoxicity in Patients Using Iron Chelators

Cited by 11 publications

References 12 publications

Sensorineural Hearing Loss and Its Relationship with Duration of Chelation Among Major β-Thalassemia Patients

Sensorineural Hearing Loss and Its Relationship with Duration of Chelation Among Major β-Thalassemia Patients

Hearing Loss in Beta-Thalassemia: Systematic Review

Prevalence of Sensorineural Hearing Loss in Pediatric Patients with Sickle Cell Disease: A Meta‐analysis

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