Sudden hearing loss in chronic hepatitis C patient suffering from Turner syndrome, treated with pegylated interferon and ribavirin

Assessment of auditory function in hepatitis “C” patients managed by combination of sofosbuvir and daclatsavir

Background

To evaluate the effect of daclatasvir and sofosbuvir on auditory function in hepatitis C patients. Thirty hepatitis C virus (HCV) patients were included in this study with age ranged from 22 to 55 years. All patients underwent full audiological evaluation before beginning and after completion of their treatment with combination of daclatasvir and sofosbuvir.

Result

When the results of audiological data were compared before and after treatment, we found that; there were statistically significant differences in the pure tone audiometry (PTA) threshold and ART bilaterally mainly in the high frequency region. Transient evoked otoacoustic emission (TEOAE) reproducibility showed a statistically significant difference bilateral. However, there was no statistically significant difference in the Auditory Brainstem Response (ABR) findings.

Conclusion and recommendations

The combination therapy of daclatasvir and sofosbuvir used in patients with HCV led to deterioration in the hearing threshold in the basic audiological tests (PTA and immitancemetry). In addition, it had an adverse effect on the cochlear OHCs, with no affection on auditory nerve, brain stem functions or in sub-thalamic function, it seems that it had no effect, we cannot confirm. The study evaluate hearing at the end of treatment immediately. We recommend performing a routine monitoring of auditory functions in HCV patients treated with daclatasvir and sofosbuvir combination by specialist for early detection of auditory changes to avoid further damage to auditory system.

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.

Herpes zoster does not increase the risk of sudden sensory neural hearing loss: a longitudinal follow-up study using a national sample cohort

Objective: This study aimed to investigate the risk of sudden sensorineural hearing loss (SSNHL) in Herpes zoster patients from a representative population cohort.Design: A longitudinal follow-up studyStudy sample: Data were obtained from the Korean National Health Insurance Service-National Sample Cohort for the period from 2002 to 2013. We matched 61,702 subjects in the Herpes zoster group with subjects in a control group (246,808 subjects with no history of Herpes zoster) based on demographic factors (age, sex, income, and region of residence) and medical history (diabetes, dyslipidemia, and hypertension). The crude (simple) and adjusted hazard ratios (HRs) for Herpes zoster with SSNHL were analysed using the Cox-proportional hazard model.Results: Only 0.5% (338/61,364) of the Herpes zoster group and 0.7% (1664/245,144) of the control group showed SSNHL. The Herpes zoster group did not exhibit a higher rate of SSNHL (adjusted HR = 0.81, 95% CI = 0.72-0.91, p < 0.001) than the control group. In subgroup analyses, no age subgroups showed a significant risk of SSNHL in the Herpes zoster group.Conclusions: After adjusting for confounding factors, the risk of SSNHL did not increase in the Herpes zoster group compared with the control group.

Assessment of auditory functions in chronic hepatitis C patients treated by sofosbuvir

OBJECTIVE

Evaluating the auditory function in patients with chronic hepatitis C treated with sofosbuvir and ribavirin.

METHODS

This study involved 80 patients with chronic hepatitis C who agreed to receive sofosbuvir and ribavirin. All participants were subjected to baseline otological and audiological assessment just before treatment. The audiological assessment included standard pure tone audiometry, extended high-frequency audiometry, immitancemetry and otoacoustic emissions (OAEs) (transient and distortion product). According to baseline hearing threshold measurements, the study population was divided into 2 groups. Group 1 included 42 patients with normal hearing sensitivity (250-8000 Hz), and Group 2 included 38 patients with sensorineural hearing loss. After 24 weeks of therapy, otological and audiological assessments were repeated and compared between the two groups and before and after therapy.

RESULTS

Post-treatment hearing threshold evaluation showed no significant difference from pretreatment evaluation at all tested frequencies. There was no statistically significant difference between pre and post-treatment otoacoustic emissions results.

CONCLUSION

Therapy with sofosbuvir and ribavirin in chronic hepatitis C has no noticeable effects on cochlear functions.

Bilateral sudden sensorineural hearing loss: review

Introduction:

Unilateral and bilateral sudden sensorineural hearing loss represent different disease entities. The unilateral condition is more common and predominantly idiopathic, and up to 65 per cent of patients spontaneously recover hearing. Conversely, the bilateral condition is rare, mostly associated with serious systemic conditions, and has a higher prevalence of morbidity and mortality.

Methods:

A literature search using the PubMed database was conducted using the MeSH terms ‘sudden’, ‘bilateral’ and ‘sensorineural hearing loss’.

Results:

One hundred and three reported cases of bilateral sudden sensorineural hearing loss were identified. The condition is most often associated with toxic, autoimmune, neoplastic and vascular conditions. A younger age of onset, with a bimodal age distribution, was seen for bilateral sudden sensorineural hearing loss, compared with the unilateral condition. Patients with the bilateral condition had more profound hearing loss, with poorer recovery and a 35 per cent mortality rate. Vestibular symptoms were also less common than in the unilateral condition.

Conclusion:

The presentation of bilateral sudden onset sensorineural hearing loss is a medical emergency requiring thorough and urgent investigation to exclude life-threatening and reversible conditions.

The effects of pegylated interferon/lamivudine therapy on auditory functions in patients with chronic hepatitis B

OBJECTIVES

The aim of this study was to assess the effects of pegylated interferon monotherapy and pegylated interferon+lamivudine combination therapy on auditory functions in patients with chronic hepatitis B (CHB) infection.

METHODS

A total of 54 patients with a diagnosis of CHB were grouped into four treatment groups: patients in Group 1 received pegylated interferon-alpha 2a; patients in Group 2 received pegylated interferon-alpha 2a+lamivudine; patients in Group 3 received pegylated interferon-alpha 2b, and patients in Group 4 received pegylated interferon-alpha 2b+lamivudine treatment. The auditory system (using standard and high frequency audiometry) and the vestibulocochlear adverse effects including otalgia, tinnitus, vertigo and imbalance were assessed immediately before the onset of the study, and at the 12th, 24th, and 48th weeks of the study.

RESULTS

A mean elevation of auditory threshold of 1-10dB was found in all treatment groups when the thresholds at the onset of the study and the thresholds at the 12th, 24th, and 48th weeks were compared. However, the elevations were not significant. The elevations were mostly at high frequencies (10,000, 12,000 and 16,000Hz). The most common vestibulocochlear adverse effects related to treatment were tinnitus, vertigo, imbalance, and otalgia, respectively. Tinnitus was the most common adverse effect in Group 2, vertigo was the most common in Group 3, imbalance was at equal frequency in Group 2 and 3, and otalgia was the most common adverse effect in Group 2 (p>0.05).

CONCLUSION

There were no significant auditory adverse effects in the treatment groups. We think that it may be beneficial to monitor the auditory functions in patients receiving PEG-IFN treatment because of the mild elevation in the auditory thresholds (although not significant).