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Buss E, Kane SG, Young KS, Gratzek CB, Bishop DM, Miller MK, Porter HL, Leibold LJ, Stecker GC, Monson BB. Effects of Stimulus Type on 16-kHz Detection Thresholds. Ear Hear 2024; 45:486-498. [PMID: 38178308 PMCID: PMC10922353 DOI: 10.1097/aud.0000000000001446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Audiometric testing typically does not include frequencies above 8 kHz. However, recent research suggests that extended high-frequency (EHF) sensitivity could affect hearing in natural communication environments. Clinical assessment of hearing often employs pure tones and frequency-modulated (FM) tones interchangeably regardless of frequency. The present study was designed to evaluate how the stimulus chosen to measure EHF thresholds affects estimates of hearing sensitivity. DESIGN The first experiment used standard audiometric procedures to measure 8- and 16-kHz thresholds for 5- to 28-year olds with normal hearing in the standard audiometric range (250 to 8000 Hz). Stimuli were steady tones, pulsed tones, and FM tones. The second experiment tested 18- to 28-year olds with normal hearing in the standard audiometric range using psychophysical procedures to evaluate how changes in sensitivity as a function of frequency affect detection of stimuli that differ with respect to bandwidth, including bands of noise. Thresholds were measured using steady tones, pulsed tones, FM tones, narrow bands of noise, and one-third-octave bands of noise at a range of center frequencies in one ear. RESULTS In experiment 1, thresholds improved with increasing age at 8 kHz and worsened with increasing age at 16 kHz. Thresholds for individual participants were relatively similar for steady, pulsed, and FM tones at 8 kHz. At 16 kHz, mean thresholds were approximately 5 dB lower for FM tones than for steady or pulsed tones. This stimulus effect did not differ as a function of age. Experiment 2 replicated this greater stimulus effect at 16 kHz than at 8 kHz and showed that the slope of the audibility curve accounted for these effects. CONCLUSIONS Contrary to prior expectations, there was no evidence that the choice of stimulus type affected school-age children more than adults. For individual participants, audiometric thresholds at 16 kHz were as much as 20 dB lower for FM tones than for steady tones. Threshold differences across stimuli at 16 kHz were predicted by differences in audibility across frequency, which can vary markedly between listeners. These results highlight the importance of considering spectral width of the stimulus used to evaluate EHF thresholds.
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Affiliation(s)
- Emily Buss
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stacey G. Kane
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn S. Young
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chloe B. Gratzek
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danielle M. Bishop
- Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Margaret K. Miller
- Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Heather L. Porter
- Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Lori J. Leibold
- Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | | | - Brian B. Monson
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, USA
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Jouret N, Van der Poel N, Verhulst S, Lammers MJW, Van Rompaey V, Jacquemin L, Van Hoorenbeeck K. Aminoglycoside-induced sensorineural hearing loss in pediatric cystic fibrosis patients: A retrospective cohort study. Heliyon 2024; 10:e25190. [PMID: 38333844 PMCID: PMC10850907 DOI: 10.1016/j.heliyon.2024.e25190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024] Open
Abstract
Background Pulmonary infections by gram-negative organisms are important in cystic fibrosis (CF). Aminoglycosides (AG) are often part of the treatment regimen. However, they are a well-known cause of ototoxicity. Even minimal hearing impairment in children could have a future impact on functional well-being.We aimed to investigate the progression of sensorineural hearing loss (SNHL) over several years in pediatric CF patients, and to identify risk factors, such as the use of AG, including both intravenous (IV) and inhaled AG. Methods Retrospective analyses of patient records from children and adolescents followed up at the CF clinic of the Antwerp University Hospital, Belgium, were performed. We collected data on age, sex, pure-tone audiometry, and the use of AG. Descriptive and binary logistic regression analyses, and if indicated generalized estimating equations (GEE) analyses were performed. Results Forty pediatric patients were enrolled in the study taking part from 2013 to 2020. Pure-tone audiometry revealed an important rate of SNHL over several years, with a prevalence of 29 % for high-frequency SNHL (i.e. 8 kHz). Increasing age was identified as a significant risk factor for the development of SNHL at 8 kHz if 5 or more IV AG courses (p = 0.01) were reported or when IV AG were combined with inhaled AG (p = 0.002). Conclusions Age combined with the use of IV AG (≥5 courses or in combination with inhaled AG) are predictive for developing high-frequency SNHL (i.e. 8 kHz). We suggest routine annual hearing screening (incl. high-frequency thresholds) in CF patients, starting from childhood.
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Affiliation(s)
- N Jouret
- Department of Pediatric Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - N Van der Poel
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - S Verhulst
- Department of Pediatric Pulmonology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - MJW Lammers
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - V Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - L Jacquemin
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - K Van Hoorenbeeck
- Department of Pediatric Pulmonology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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Nichols N, Rubenstein RC, Kelly A, Vachhani JJ, Echaluse MV, Garinis AC. Clinical Observations in Patients With Cystic Fibrosis-Related Diabetes and Self-Reported Ototoxicity Symptoms. Am J Audiol 2023; 33:1-9. [PMID: 38016170 PMCID: PMC11001426 DOI: 10.1044/2023_aja-22-00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/18/2023] [Accepted: 10/06/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Persons with cystic fibrosis (PwCF) are at high risk for ototoxicity due to the routine use of intravenous aminoglycoside (IV-AG) antibiotics in respiratory infection management. Additionally, factors that contribute to ototoxicity-related symptom development and severity in PwCF are unknown. Given the increased risk of ototoxicity in people with diabetes, we explored the association between cystic fibrosis-related diabetes (CFRD) and self-reported ototoxicity symptoms (tinnitus and vestibular problems) in PwCF treated with aminoglycosides. METHOD PwCF (N = 39; 25 females, 14 males; Mage = 30.1 years, SD = 10.3) were recruited from the Cystic Fibrosis Care Center at Oregon Health & Science University. Patients completed the validated questionnaires to ascertain their experiences with ototoxicity-related symptoms of tinnitus and balance function. The diagnosis of CFRD, including oral glucose tolerance testing (OGTT), insulin treatment, hemoglobin A1c, and cumulative IV-AG treatment history, was obtained through a medical chart review. Participants were classified into three groups based on their medical diagnoses via OGTT: normal glucose tolerance (NGT; control; n = 16), abnormal glucose tolerance (AGT; n = 9), and CFRD (n = 14). Participants in each group were further classified based on survey outcomes for ototoxicity-related symptoms. RESULTS There was a trend toward a higher proportion of patients with CFRD reporting tinnitus compared to the AGT and NGT groups, but did not meet statistical significance (X2 = 2.24, p = .13). Approximately, 43% of patients with CFRD reported experiencing clinically significant tinnitus lasting > 3 min compared to 11% in the AGT group and 13% in the NGT group (X2 = 3.751, p = .05). Cumulative IV-AG exposure tended to be higher in CFRD compared to other groups. High balance function was generally reported in all groups. CONCLUSIONS Patients with CFRD have greater ototoxicity-related symptoms. Further investigation of the relationship between CF-related comorbidities and the risk of developing ototoxicity-related symptoms is warranted to improve the detection and management of ototoxicity in PwCF.
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Affiliation(s)
- Nicole Nichols
- Department of Otolaryngology, Oregon Health & Science University, Portland
| | - Ronald C. Rubenstein
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, St. Louis, MO
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA
| | - Jay J. Vachhani
- Department of Otolaryngology, Oregon Health & Science University, Portland
- VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR
| | - Ma Vida Echaluse
- Department of Otolaryngology, Oregon Health & Science University, Portland
| | - Angela Constance Garinis
- Department of Otolaryngology, Oregon Health & Science University, Portland
- VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR
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Koerner TK, Gallun FJ. Speech understanding and extended high-frequency hearing sensitivity in blast-exposed veteransa). THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:379-387. [PMID: 37462921 DOI: 10.1121/10.0020174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023]
Abstract
Auditory difficulties reported by normal-hearing Veterans with a history of blast exposure are primarily thought to stem from processing deficits in the central nervous system. However, previous work on speech understanding in noise difficulties in this patient population have only considered peripheral hearing thresholds in the standard audiometric range. Recent research suggests that variability in extended high-frequency (EHF; >8 kHz) hearing sensitivity may contribute to speech understanding deficits in normal-hearing individuals. Therefore, this work was designed to identify the effects of blast exposure on several common clinical speech understanding measures and EHF hearing sensitivity. This work also aimed to determine whether variability in EHF hearing sensitivity contributes to speech understanding difficulties in normal-hearing blast-exposed Veterans. Data from 41 normal- or near-normal-hearing Veterans with a history of blast exposure and 31 normal- or near-normal-hearing control participants with no history of head injury were employed in this study. Analysis identified an effect of blast exposure on several speech understanding measures but showed no statistically significant differences in EHF thresholds between participant groups. Data showed that variability in EHF hearing sensitivity did not contribute to group-related differences in speech understanding, although study limitations impact interpretation of these results.
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Affiliation(s)
- Tess K Koerner
- Department of Veterans Affairs (VA) Rehabilitation Research and Development (RR & D), National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon 97239, USA
| | - Frederick J Gallun
- Department of Veterans Affairs (VA) Rehabilitation Research and Development (RR & D), National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon 97239, USA
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Blankenship CM, Hickson LM, Quigley T, Larsen E, Lin L, Hunter LL. Extended High-Frequency Audiometry using the Wireless Automated Hearing Test System Compared to Manual Audiometry in Children and Adolescents. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.22.23290339. [PMID: 37292836 PMCID: PMC10246139 DOI: 10.1101/2023.05.22.23290339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectives Reliable wireless automated audiometry that includes extended high frequencies (EHF) outside a sound booth would increase access to monitoring programs for individuals at risk for hearing loss, particularly those at risk for ototoxicity. The purpose of the study was to compare thresholds obtained with 1) standard manual audiometry to automated thresholds measured with the Wireless Automated Hearing Test System (WAHTS) inside a sound booth, and 2) automated audiometry in the sound booth to automated audiometry outside the sound booth in an office environment. Design Cross-sectional, repeated measures study. Twenty-eight typically developing children and adolescents (mean = 14.6 yrs; range = 10 to 18 yrs). Audiometric thresholds were measured from 0.25 to 16 kHz with manual audiometry in the sound booth, automated audiometry in the sound booth, and automated audiometry in a typical office environment in counterbalanced order. Ambient noise levels were measured inside the sound booth and the office environment were compared to thresholds at each test frequency. Results Automated thresholds were overall about 5 dB better compared to manual thresholds, with greater differences in the extended high frequency range (EHF;10-16 kHz). The majority of automated thresholds measured in a quiet office were within ± 10 dB of automated thresholds measured in a sound booth (84%), while only 56% of automated thresholds in the sound booth were within ± 10 dB of manual thresholds. No relationship was found between automated thresholds measured in the office environment and the average or maximum ambient noise level. Conclusions These results indicate that self-administered, automated audiometry results in slightly better thresholds overall than manually administered audiometry in children, consistent with previous studies in adults. Ambient noise levels in a typical office environment did not have an adverse effect on audiometric thresholds measured using noise attenuation headphones. Thresholds measured using an automated tablet with noise attenuating headphones could improve access to hearing assessment for children with a variety of risk factors. Additional studies of extended high frequency automated audiometry in a wider age range are needed to establish normative thresholds.
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Stevenson LJ, Biagio-de Jager L, Graham MA, Swanepoel DW. Extended High-Frequency Audiometry for Ototoxicity Monitoring: A Longitudinal Evaluation of Drug-Resistant Tuberculosis Treatment. Am J Audiol 2023; 32:70-80. [PMID: 36490390 DOI: 10.1044/2022_aja-22-00039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to describe extended high-frequency (EHF) pure-tone audiometry monitoring of ototoxicity in a longitudinal treatment program for drug-resistant tuberculosis (DRTB). METHOD This was a retrospective record review of longitudinal conventional (0.25-8 kHz) and EHF (9-16 kHz) audiometry for ototoxicity monitoring of DRTB patients undergoing treatment at community-based clinics between 2013 and 2017. Data from 69 patients with an average age of 37.9 years (SD = 11.2, range: 16.0-63.8 years) were included. Patients were assessed by primary health care audiologists (87%) or community health workers (13%) using portable audiological equipment. The average length of time between initial and exit assessments was 84.6 days (SD = 74.2, range: 2-335 days). RESULTS EHF ototoxicity of a mild or greater degree of hearing loss (> 25 dB HL in one or both ears across frequencies) was evident in 85.5% of patients' posttreatment, compared with 47.8% of patients across conventional frequencies. EHF audiometry demonstrated an ototoxic shift (American Speech-Language-Hearing Association criteria) in 56.5% of cases compared with 31.9% when only conventional audiometry was considered. Mean hearing deterioration for patients was significant across EHFs (9-16 kHz) bilaterally (p < .05). Absent EHF thresholds at the initial assessment, owing to maximum output limits, was a limitation that occurred most frequently at 16 kHz (17.4%, 24/138). CONCLUSIONS EHF audiometry is most sensitive for the early detection of ototoxicity and should be included in monitoring programs. Clinical ototoxicity monitoring protocols should consider shortened assessment approaches that target frequencies most sensitive to ototoxicity, including EHFs. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21651242.
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Affiliation(s)
- Lucia Jane Stevenson
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, South Africa
| | - Leigh Biagio-de Jager
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, South Africa
| | - Marien Alet Graham
- Department of Science, Mathematics and Technology Education, Faculty of Education, University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, South Africa.,Ear Science Institute Australia, Perth, Western Australia
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Shahnaz N, AlMakadma H, Sanford CA. The Rise and Fall of Aural Acoustic Immittance Assessment Tools. Semin Hear 2023; 44:5-16. [PMID: 36925655 PMCID: PMC10014212 DOI: 10.1055/s-0043-1764139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Clinical assessment of middle ear function has undergone multiple transformations and developments since the first acoustic impedance measurements were made in human ears nearly a century ago. The decades following the development of the first acoustic impedance bridge by Metz in 1946 witnessed a series of technological advancements leading to the widespread use of single-frequency admittance tympanometry in the 1960s. In the 1970s, multi-frequency and multi-component tympanometry (MFT) emerged for clinical use, allowing for a better understanding of the middle ear acoustic-mechanical response at frequencies between 200 and 2,000 Hz. MFT has not gained widespread clinical adoption despite its advantages over single-frequency tympanometry. More recent technological developments enabled assessment for frequencies greater than 2,000 Hz, leading to the advent of wideband acoustic immittance measures with capabilities for comprehensive assessment of middle ear acoustic mechanics, and a great potential for use of acoustic immittance testing in various diagnostic practices. This article reviews important historical markers in the development and operation of middle ear assessment tools and analysis methods. Technical and clinical factors underlying the emergence and adoption of different acoustic immittance tests as a standard of clinical practice are described. In addition, we discuss the likelihood for widespread adoption of wideband acoustic immittance and wideband tympanometry in future clinical practice.
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Affiliation(s)
- Navid Shahnaz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
- Address for correspondence Navid Shahnaz, Ph.D. School of Audiology and Speech Sciences, Faculty of Medicine, University of British Columbia2177 Wesbrook Mall, Friedman Building, Vancouver, British Columbia V6T 1Z3Canada
| | - Hammam AlMakadma
- Department of Otolaryngology and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Chris A. Sanford
- Department of Communication Sciences and Disorders, College of Health, Idaho State University, Pocatello, Idaho
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Mishra SK, Saxena U, Rodrigo H. Hearing Impairment in the Extended High Frequencies in Children Despite Clinically Normal Hearing. Ear Hear 2022; 43:1653-1660. [PMID: 35470812 DOI: 10.1097/aud.0000000000001225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Pediatric hearing impairment, regardless of degree and type, has a detrimental effect on speech perception, cognition, oral language development, academic outcomes, and literacy. Hearing assessment in the clinic is limited to 8 kHz although humans can hear up to 20 kHz. Hearing impairment in the extended high frequencies (EHFs > 8 kHz) can occur despite clinically normal hearing. However, to date, the nature and effects of EHF hearing impairment in children remain unknown. The goals of the present study were to determine the effects of EHF hearing impairment on speech-in-noise recognition in children and to examine whether hearing impairment in the EHFs is associated with altered cochlear functioning in the standard frequencies. DESIGN A volunteer sample of 542 participants (4 to 19 years) with clinically normal audiograms were tested. Participants identified with EHF impairment were assigned as cases in a subsequent case-control study. EHF loss was defined as hearing thresholds greater than 20 dB in at least one EHFs (10, 12.5, or 16 kHz). Speech recognition thresholds in multi-talker babble were measured using the digit triplet test. Distortion product otoacoustic emissions ( f2 = 2, 3, 4, and 5 kHz) were measured to assess cochlear functioning. RESULTS Thresholds in the EHFs were as reliable as those in the standard frequency range. Thirty-eight children had EHF hearing impairment regardless of a clinically normal audiogram. A linear mixed-effects model revealed that children with EHF hearing impairment had higher (poorer) mean speech recognition threshold than children with normal EHF sensitivity ( estimate = 2.14 dB, 95% CI: 1.36 to 3.92; effect size = small). The overall magnitude of distortion product otoacoustic emissions was lower for children with EHF impairment ( estimate = -2.47 dB, 95% CI: -4.60 to -0.73; effect size = medium). In addition, the pure-tone average for standard audiometric frequencies was relatively higher for EHF-impaired children ( estimate = 3.68 dB, 95% CI: 2.56 to 4.80; effect size = small). CONCLUSIONS Hearing impairment in the EHFs is common in children despite clinically normal hearing and can occur without a history of otitis media. EHF impairment is associated with poorer speech-in-noise recognition and preclinical cochlear deficits in the lower frequencies where hearing thresholds are normal. This study highlights the clinical need to identify EHF impairments in children.
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Affiliation(s)
- Srikanta K Mishra
- Department of Communication Sciences & Disorders, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Udit Saxena
- MAA Institute of Speech & Hearing, Hyderabad, India
| | - Hansapani Rodrigo
- School of Mathematical and Statistical Sciences, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
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9
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Diepstraten FA, Hoetink AE, van Grotel M, Huitema ADR, Stokroos RJ, van den Heuvel-Eibrink MM, Meijer AJM. Aminoglycoside- and glycopeptide-induced ototoxicity in children: a systematic review. JAC Antimicrob Resist 2021; 3:dlab184. [PMID: 34917943 PMCID: PMC8669239 DOI: 10.1093/jacamr/dlab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Ototoxicity has been reported after administration of aminoglycosides and glycopeptides. Objectives To identify available evidence for the occurrence and determinants of aminoglycoside- and glycopeptide-related ototoxicity in children. Materials and methods Systematic electronic literature searches that combined ototoxicity (hearing loss, tinnitus and/or vertigo) with intravenous aminoglycoside and/or glycopeptide administration in children were performed in PubMed, EMBASE and Cochrane Library databases. Studies with sample sizes of ≥50 children were included. The QUIPS tool and Cochrane criteria were used to assess the quality and risk of bias of included studies. Results Twenty-nine aminoglycoside-ototoxicity studies met the selection criteria (including 7 randomized controlled trials). Overall study quality was medium/low. The frequency of hearing loss within these studies ranged from 0%–57%, whereas the frequency of tinnitus and vertigo ranged between 0%–53% and 0%–79%, respectively. Two studies met the criteria on glycopeptide-induced ototoxicity and reported hearing loss frequencies of 54% and 55%. Hearing loss frequencies were higher in gentamicin-treated children compared to those treated with other aminoglycosides. In available studies aminoglycosides had most often been administered concomitantly with platinum agents, diuretics and other co-medication. Conclusions In children the reported occurrence of aminoglycoside/glycopeptide ototoxicity highly varies and seems to depend on the diagnosis, aminoglycoside subtype and use of co-administered medication. More research is needed to investigate the prevalence and determinants of aminoglycoside/glycopeptide ototoxicity. Our results indicate that age-dependent audiological examination may be considered for children frequently treated with aminoglycosides/glycopeptides especially if combined with other ototoxic medication.
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Affiliation(s)
- F A Diepstraten
- Princess Máxima Center for pediatric oncology, Utrecht, The Netherlands
| | - A E Hoetink
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, UMC Brain Centre, Utrecht, The Netherlands
| | - M van Grotel
- Princess Máxima Center for pediatric oncology, Utrecht, The Netherlands
| | - A D R Huitema
- Princess Máxima Center for pediatric oncology, Utrecht, The Netherlands.,Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R J Stokroos
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, UMC Brain Centre, Utrecht, The Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for pediatric oncology, Utrecht, The Netherlands.,Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A J M Meijer
- Princess Máxima Center for pediatric oncology, Utrecht, The Netherlands
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10
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Garinis AC, Poling GL, Rubenstein RC, Konrad-Martin D, Hullar TE, Baguley DM, Burrows HL, Chisholm JA, Custer A, Hawe LD, Hunter LL, Marras TK, Ortiz CE, Petersen L, Steyger PS, Winthrop K, Zettner EM, Clark K, Hungerford M, Vachhani JJ, Brewer CC. Clinical Considerations for Routine Auditory and Vestibular Monitoring in Patients With Cystic Fibrosis. Am J Audiol 2021; 30:800-809. [PMID: 34549989 PMCID: PMC9126110 DOI: 10.1044/2021_aja-21-00031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/09/2021] [Accepted: 05/24/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Specific classes of antibiotics, such as aminoglycosides, have well-established adverse events producing permanent hearing loss, tinnitus, and balance and/or vestibular problems (i.e., ototoxicity). Although these antibiotics are frequently used to treat pseudomonas and other bacterial infections in patients with cystic fibrosis (CF), there are no formalized recommendations describing approaches to implementation of guideline adherent ototoxicity monitoring as part of CF clinical care. Method This consensus statement was developed by the International Ototoxicity Management Working Group (IOMG) Ad Hoc Committee on Aminoglycoside Antibiotics to address the clinical need for ototoxicity management in CF patients treated with known ototoxic medications. These clinical protocol considerations were created using consensus opinion from a community of international experts and available evidence specific to patients with CF, as well as published national and international guidelines on ototoxicity monitoring. Results The IOMG advocates four clinical recommendations for implementing routine and guideline adherent ototoxicity management in patients with CF. These are (a) including questions about hearing, tinnitus, and balance/vestibular problems as part of the routine CF case history for all patients; (b) utilizing timely point-of-care measures; (c) establishing a baseline and conducting posttreatment evaluations for each course of intravenous ototoxic drug treatment; and (d) repeating annual hearing and vestibular evaluations for all patients with a history of ototoxic antibiotic exposure. Conclusion Increased efforts for implementation of an ototoxicity management program in the CF care team model will improve identification of ototoxicity signs and symptoms, allow for timely therapeutic follow-up, and provide the clinician and patient an opportunity to make an informed decision about potential treatment modifications to minimize adverse events. Supplemental Material https://doi.org/10.23641/asha.16624366.
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Affiliation(s)
- Angela C. Garinis
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
- Oregon Hearing Research Center, Oregon Health & Science University, Portland
| | - Gayla L. Poling
- Department of Otolaryngology — Head and Neck Surgery, Division of Audiology, Mayo Clinic, Rochester, MN
| | - Ronald C. Rubenstein
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO
| | - Dawn Konrad-Martin
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Timothy E. Hullar
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
| | - David M. Baguley
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University of Nottingham, United Kingdom
| | - Holly L. Burrows
- Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jennifer A. Chisholm
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD
| | - Amy Custer
- Department of Audiology, The Ohio State University Comprehensive Cancer Hospital–Arthur G. James Cancer Hospital and Richard J. Solve Research Institute, Columbus
| | - Laura Dreisbach Hawe
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Lisa L. Hunter
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
| | - Theodore K. Marras
- Division of Respiratory Medicine, Toronto Western Hospital, University Health Network and University of Toronto, Canada
| | - Candice E. Ortiz
- Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Lucretia Petersen
- Department of Health and Rehabilitation Sciences, University of Cape Town, South Africa
| | - Peter S. Steyger
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Translational Hearing Center, Biomedical Sciences, Creighton University, Omaha, NE
| | - Kevin Winthrop
- School of Public Health, Oregon Health & Science University, Portland
| | - Erika M. Zettner
- Department of Otolaryngology-Head & Neck Surgery, Division of Audiology, University of California, San Diego
| | - Khaya Clark
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Hearing Center of Excellence, Department of Defense, San Antonio, TX
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Michelle Hungerford
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
| | - Jay J. Vachhani
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
| | - Carmen C. Brewer
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD
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11
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Westman MR, Putterman DB, Garinis AC, Hunter LL, Feeney MP. Wideband Acoustic Reflex Growth in Adults With Cystic Fibrosis. Am J Audiol 2021; 30:825-833. [PMID: 33661027 PMCID: PMC9126118 DOI: 10.1044/2020_aja-20-00117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/25/2020] [Accepted: 11/05/2020] [Indexed: 11/09/2022] Open
Abstract
Purpose Individuals with cystic fibrosis (CF) are often treated with intravenous (IV) aminoglycoside (AG) antibiotics to manage life-threatening bacterial infections. Preclinical animal data suggest that, in addition to damaging cochlear hair cells, this class of antibiotics may cause cochlear synaptopathy and/or damage to higher auditory structures. The acoustic reflex growth function (ARGF) is a noninvasive, objective measure of neural function in the auditory system. A shallow ARGF (small reflex-induced changes in middle ear function with increasing elicitor level) has been associated with synaptopathy due to noise exposure in rodent and human studies. In this study, the ARGF was obtained in CF patients with normal hearing, some of whom have been treated with IV AGs, and a control group without CF. The hypothesis was that patients with IV-AG exposure would have a shallow ARGF due to cochlear synaptopathy caused by ototoxicity. Method Wideband ARGFs were examined in four groups of normal-hearing participants: a control group of 29 individuals without CF; and in 57 individuals with CF grouped by lifetime IV-AG exposure: 15 participants with no exposure, 21 with low exposure, and 21 with high exposure. Procedures included pure-tone audiometry, clinical immittance, wideband acoustic immittance battery, including ARGFs, and transient evoked otoacoustic emissions. Results CF subjects with normal pure-tone thresholds and either high or low lifetime IV-AG exposure had enhanced ARGFs compared to controls and CF participants without IV-AG exposure. The groups did not differ in transient evoked otoacoustic emission signal-to-noise ratio. Conclusion These results diverge from the shallow ARGF pattern observed in studies of noise-induced cochlear synaptopathy and are suggestive of a central mechanism of auditory dysfunction in patients with AG-induced ototoxicity.
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Affiliation(s)
- Martha R. Westman
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis
| | - Daniel B. Putterman
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Angela C. Garinis
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
- Oregon Hearing Research Center, Oregon Health & Science University, Portland
| | | | - M. Patrick Feeney
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
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12
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Garinis A, Konrad-Martin D, Bramhall N. Ototoxicity and Noise Damage: From Preclinical Findings to Audiological Management. Am J Audiol 2021; 30:797-799. [PMID: 34606329 DOI: 10.1044/2021_aja-21-00153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
[Figure: see text].
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Affiliation(s)
- Angela Garinis
- Oregon Health & Science University, West Campus, Beaverton
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13
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Dong M, Rodriguez AV, Blankenship CA, McPhail G, Vinks AA, Hunter LL. Pharmacokinetic modelling to predict risk of ototoxicity with intravenous tobramycin treatment in cystic fibrosis. J Antimicrob Chemother 2021; 76:2923-2931. [PMID: 34379758 PMCID: PMC8677449 DOI: 10.1093/jac/dkab288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Further optimization of therapeutic drug monitoring (TDM) for aminoglycosides (AGs) is urgently needed, especially in special populations such as those with cystic fibrosis (CF), >50% of whom develop ototoxicity if treated with multiple courses of IV AGs. This study aimed to empirically test a pharmacokinetic (PK) model using Bayesian estimation of drug exposure in the deeper body tissues to determine feasibility for prediction of ototoxicity. MATERIALS AND METHODS IV doses (n = 3645) of tobramycin and vancomycin were documented with precise timing from 38 patients with CF (aged 8-21 years), including total doses given and total exposure (cumulative AUC). Concentration results were obtained at 3 and 10 h for the central (C1) compartment. These variables were used in Bayesian estimation to predict trough levels in the secondary tissue compartments (C2 trough) and maximum concentrations (C2max). The C1 and C2 measures were then correlated with hearing levels in the extended high-frequency range. RESULTS Patients with more severe hearing loss were older and had a higher number of tobramycin C2max concentrations >2 mg/L than patients with normal or lesser degrees of hearing loss. These two factors together significantly predicted average high-frequency hearing level (r = 0.618, P < 0.001). Traditional metrics such as C1 trough concentrations were not predictive. The relative risk for hearing loss was 5.8 times greater with six or more tobramycin courses that exceeded C2max concentrations of 3 mg/L or higher, with sensitivity of 83% and specificity of 86%. CONCLUSIONS Advanced PK model-informed analysis predicted ototoxicity risk in patients with CF treated with tobramycin and demonstrated high test prediction.
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Affiliation(s)
- Min Dong
- Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Anna V Rodriguez
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Chelsea A Blankenship
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Gary McPhail
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Alexander A Vinks
- Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Lisa L Hunter
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology, University of Cincinnati Academic Medical Center, Cincinnati, OH, USA
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