A case of hearing loss associated with pegylated interferon and ribavirin treatment ameliorated by prednisone

A Narrative Review of Pharmacologic Treatments for COVID-19: Safety Considerations and Ototoxicity

OBJECTIVE/HYPOTHESIS

The purpose of this review is to summarize evidence-based data regarding the ototoxic effects of potential COVID-19 therapeutics to treat patients suffering from SARS-CoV-2.

METHODS

Medications under investigation as novel therapeutics to treat COVID-19 were identified using the search term coronavirus therapeutics, COVID therapeutics, and SARS-CoV-2 therapeutics on ClinicalTrials.gov and the PubMed Database. A literature review was performed using the PubMed Database for each proposed COVID-19 therapeutic to identify relevant articles. Search criteria included Medical Subject Headings (MeSH) and key word search terms for ototoxicity, vestibulotoxicity, hearing disorders, and vertigo.

RESULTS

Six proposed COVID-19 therapeutics were identified as possessing ototoxic side effects including chloroquine and hydroxychloroquine, azithromycin, lopinavir-ritonavir, interferon, ribavirin, and ivermectin.

CONCLUSIONS

Available evidence suggests that ototoxic effects may be improved or mitigated by stopping the offending agent. Recognition of hearing loss, tinnitus, or imbalance/vertigo is therefore crucial to facilitate early intervention and prevent long-term damage. Hospitals should consider the inclusion of audiologic monitoring protocols for patients receiving COVID-19 therapeutics with known ototoxicity, especially in high-risk patient groups such as the elderly and hearing impaired. Laryngoscope, 131:1626-1632, 2021.

Cochlear Changes Caused by Peginterferon α-2b

To evaluate the effect of peginterferon α-2b on guinea pigs' hearing and its cochlea, and to determine whether these effects are permanent or reversible. This study is an experimental animal study done on the organs of Corti of 30 guinea pigs after a peginterferon α-2b injection course. The cochleae of guinea pigs were extracted and examined by scanning electron microscopy for the right side and immunohistochemistry for the left side. All guinea pigs were subjected to pinna reflex, otological examination, and distortion product otoacoustic emission (DPOAE) both before and after the receiving of interferon (IFN). Electron microscopic scanning and immunohistochemistry of the cochleae revealed that peginterferon α-2b has a harmful effect on guinea pigs' cochleae, in the form of structural changes in the hair cells and supporting cells with apoptotic changes in the organ of Corti and the stria vascularis. These changes were reversible. DPOAE showed a significant reduction in distortion product mean amplitude and signal-to-noise ratio in all frequencies after 3 days from the last dose of IFN injection except at 1,006 Hz. After 14 days, there was a significant improvement in most of the frequencies, but are still below the normal values.

Pegylated interferon/ribavirin-associated sudden hearing loss in a patient with chronic hepatitis C in Brazil

Sudden hearing loss is defined as a sensorineural hearing loss, equal to or greater than 30 dB, at three or more consecutive frequencies, which takes place within 72 hours. Both peginterferon and ribavirin are well-known to be associated with significant adverse effects, but sudden hearing loss is uncommon. We report a 65-year-old male patient who developed sudden-onset hearing loss during combination therapy with pegylated interferon-alpha and ribavirin for chronic hepatitis C. Peginterferon and ribavirin may cause sudden hearing loss that may not recover after discontinuation of therapy. Immediate treatment for all possible etiologies is essential, along with targeted investigations and early referral for an ear, nose and throat specialist. Physicians should be aware of the possible ototoxic effects of peginterferon and ribavirin combination therapy requiring appropriate surveillance.