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Janky K, Steyger PS. Mechanisms and Impact of Aminoglycoside-Induced Vestibular Deficits. Am J Audiol 2023; 32:746-760. [PMID: 37319406 PMCID: PMC10721243 DOI: 10.1044/2023_aja-22-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/26/2023] [Accepted: 03/06/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Acquired vestibulotoxicity from hospital-prescribed medications such as aminoglycoside antibiotics affects as many as 40,000 people each year in North America. However, there are no current federally approved drugs to prevent or treat the debilitating and permanent loss of vestibular function caused by bactericidal aminoglycoside antibiotics. This review will cover our current understanding of the impact of, and mechanisms underlying, aminoglycoside-induced vestibulotoxicity and highlight the gaps in our knowledge that remain. CONCLUSIONS Aminoglycoside-induced vestibular deficits have long-term impacts on patients across the lifespan. Additionally, the prevalence of aminoglycoside-induced vestibulotoxicity appears to be greater than cochleotoxicity. Thus, monitoring for vestibulotoxicity should be independent of auditory monitoring and encompass patients of all ages from young children to older adults before, during, and after aminoglycoside therapy.
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Affiliation(s)
- Kristen Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE
| | - Peter S. Steyger
- Bellucci Translational Hearing Center, Creighton University, Omaha, NE
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2
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Schlemmer E, Nicholson N. Vestibular Rehabilitation Effectiveness for Adults With Mild Traumatic Brain Injury/Concussion: A Mini-Systematic Review. Am J Audiol 2022; 31:228-242. [PMID: 35077655 DOI: 10.1044/2021_aja-21-00165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Millions of people suffer from traumatic brain injuries every year with common sequelae, including dizziness, disequilibrium, compromised vision, and gait abnormalities. Individuals suffering a mild traumatic brain injury (mTBI) or concussion may be prescribed bed rest, but for some, symptoms may persist and require different treatment options. The aim of this mini-systematic review was to synthesize the best available evidence regarding the effectiveness of vestibular rehabilitation therapy (VRT) as a treatment option for adults with mTBIs. METHOD A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search term concepts were VRT and mTBI. Records meeting the inclusion criteria were extracted from the following databases: PubMed and CINAHL. A manual search of reference lists identified additional studies. Inclusion criteria were (a) participants with mTBI/concussion characterized by dizziness, balance, and/or other vestibular symptoms; (b) VRT as the primary treatment; and (c) self-reported and/or performance-based outcome measures. Data were extracted using a standardized tool, and studies were critically appraised. RESULTS Five studies were included in the systematic review: one randomized controlled trial, two retrospective chart reviews, one pre-/post-intervention study, and one case series. Four of the five studies found VRT to be effective at reducing postconcussion symptoms after head injury. Self-reported measures were included in all studies; performance-based measures were included in four out of five studies. None of the studies reported adverse effects of intervention. CONCLUSIONS Results suggest VRT is an effective treatment option for patients with persistent/lingering symptoms after concussion/mTBI, as demonstrated by self-reported and performance-based outcome measures. Results of this study emphasize the need for audiologists to be thoroughly familiar with VRT as an effective treatment for patients with persistent symptoms following mTBI.
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Affiliation(s)
- Erica Schlemmer
- Department of Audiology, Nova Southeastern University, Fort Lauderdale, FL
| | - Nannette Nicholson
- Department of Audiology, Nova Southeastern University, Fort Lauderdale, FL
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Ferreira-Cendon S, Martinez-Carranza R, Fernandez-Nava MJ, Villaoslada-Fuente R, Sanchez-Gomez H, Santa Cruz-Ruiz S, Sanchez-Ledesma M, Batuecas-Caletrio A. Prevention of Severe Vestibular Hypofunction after Systemic Gentamicin. J Clin Med 2022; 11:jcm11030586. [PMID: 35160038 PMCID: PMC8836904 DOI: 10.3390/jcm11030586] [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: 01/03/2022] [Revised: 01/16/2022] [Accepted: 01/23/2022] [Indexed: 01/25/2023] Open
Abstract
The importance of early evaluation by a neurotologist in patients with infective endocarditis treated with systemic gentamicin and its impact on the patients’ quality of life was evaluated. This is a longitudinal retrospective cohort study of 29 patients who received intravenous gentamicin for the treatment of infective endocarditis. Patients were classified into two groups: group A, before a neurotologist was included in the treatment protocol, and group B, after the inclusion of a neurotologist. The frequency of the different symptoms in each group was measured, and the gain of the vestibulo-ocular reflex (VOR) and its relationship with the presence of oscillopsia. In total, 13 and 16 patients were assigned to groups A and B, respectively. The mean gain of the VOR measured using the video head impulse test in group A was 0.44 in the best side and 0.39 in the worst side. In group B, the mean gain was 0.71 (best side) and 0.64 (worst side) (p < 0.0001). The patients who complained about oscillopsia had a main gain of 0.41 in the best side and 0.35 in the worst side. Evaluation of vestibular function should be included in the infective endocarditis treatment protocol, including the adverse effects of systemic gentamicin.
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Affiliation(s)
- Sofía Ferreira-Cendon
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain; (S.F.-C.); (R.M.-C.); (M.J.F.-N.); (R.V.-F.); (H.S.-G.); (S.S.C.-R.)
- Neurotology Unit, ENT Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Ramon Martinez-Carranza
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain; (S.F.-C.); (R.M.-C.); (M.J.F.-N.); (R.V.-F.); (H.S.-G.); (S.S.C.-R.)
- Neurotology Unit, ENT Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Maria José Fernandez-Nava
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain; (S.F.-C.); (R.M.-C.); (M.J.F.-N.); (R.V.-F.); (H.S.-G.); (S.S.C.-R.)
- Neurotology Unit, ENT Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Rosana Villaoslada-Fuente
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain; (S.F.-C.); (R.M.-C.); (M.J.F.-N.); (R.V.-F.); (H.S.-G.); (S.S.C.-R.)
- Neurotology Unit, ENT Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Hortensia Sanchez-Gomez
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain; (S.F.-C.); (R.M.-C.); (M.J.F.-N.); (R.V.-F.); (H.S.-G.); (S.S.C.-R.)
- Neurotology Unit, ENT Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Santiago Santa Cruz-Ruiz
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain; (S.F.-C.); (R.M.-C.); (M.J.F.-N.); (R.V.-F.); (H.S.-G.); (S.S.C.-R.)
- Neurotology Unit, ENT Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - María Sanchez-Ledesma
- Department of Internal Medicine, Infectious Diseases, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain;
| | - Angel Batuecas-Caletrio
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain; (S.F.-C.); (R.M.-C.); (M.J.F.-N.); (R.V.-F.); (H.S.-G.); (S.S.C.-R.)
- Neurotology Unit, ENT Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-923-291-430
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4
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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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Progressive and Degenerative Peripheral Vestibular Disorders. Otolaryngol Clin North Am 2021; 54:959-971. [PMID: 34301401 DOI: 10.1016/j.otc.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Initial diagnosis of peripheral vestibulopathy requires a detailed history, physical examination, and, in some cases, audiovestibular testing, radiographic imaging, or serology. Differentiation of a peripheral vestibulopathy as progressive or degenerative is often nuanced and influenced by a characterization of a patient's symptoms or natural history over time. A diverse group of vestibular pathology may fit into this category, including Ménière's disease, autoimmune conditions, congenital pathologies, ototoxic medications, radiation therapy, and perilymphatic fistula. Differentiation among these entities may be guided by initial or subsequent symptomatology, with various combinations of audiovestibular testing, serology, and imaging. Treatment options are disparate and disease-specific, ranging from observation to medical management or surgical intervention, underscoring the need for astute investigation and diagnosis.
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Prospective cohort study of ototoxicity in persons with cystic fibrosis following a single course of intravenous tobramycin. J Cyst Fibros 2020; 20:278-283. [PMID: 32713806 DOI: 10.1016/j.jcf.2020.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/02/2020] [Accepted: 07/04/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Aminoglycoside (AG) antibiotics, such as tobramycin, are known to be ototoxic but important clinically due to their bactericidal efficacy. Persons with cystic fibrosis (CF) are at risk for AG-induced ototoxicity due to the repeated use of intravenous (IV) tobramycin for the treatment of pulmonary exacerbations. While it is well-established that ototoxic hearing loss is highly prevalent in this clinical population, the progression of hearing loss over time remains unclear. Cumulative IV-AG dosing has been associated with a higher risk of ototoxic hearing loss, yet some individuals lose substantial hearing after a single IV-AG treatment, while others never seem to lose hearing. METHODS 31 persons with CF (18 on IV tobramycin, 13 controls) were enrolled in an observational study. Pure-tone hearing thresholds (0.25-16 kHz) were measured at baseline (pre-treatment) and at follow-up for each subject. A hearing shift was determined using various metrics, and outcomes were compared to characterize changes in hearing bilaterally for both study groups. RESULTS Comparison of pure-tone threshold shifts between baseline and follow-up audiograms following either a course of IV tobramycin (n = 18) or no intervening therapy (n = 13) demonstrated significant (p < 0.05) threshold shifts in all continuous metrics tested. CONCLUSION A single course of IV tobramycin causes ototoxic hearing loss in some people with CF, which supports the need for routine ototoxicity monitoring and management in this clinical population. These findings also suggest that people with CF are a suitable population for clinical trials examining ototherapeutics in single IV-tobramycin treatment episodes.
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Prayuenyong P, Kasbekar AV, Hall DA, Baguley DM. Audiovestibular clinician experiences and opinions about cisplatin vestibulotoxicity. Eur Arch Otorhinolaryngol 2020; 277:3283-3293. [PMID: 32430772 PMCID: PMC7648001 DOI: 10.1007/s00405-020-06033-4] [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: 01/10/2020] [Accepted: 05/01/2020] [Indexed: 11/05/2022]
Abstract
Purpose Vestibulotoxicity associated with cisplatin chemotherapy is known to exist, but the extent, severity, and impact is unclear from the literature. This study explored knowledge, experiences, and opinions of audiovestibular professionals about cisplatin vestibulotoxicity. Methods An online survey was disseminated to clinicians working in the audiovestibular field. Results Ninety-three respondents participated in the survey. Most professionals were aware of potential vestibulotoxicity associated with cisplatin chemotherapy. Thirty-three percent of the respondents reported that they had seen patients with cisplatin vestibulotoxicity. Forty percent of them were confident in making the diagnosis and in managing the patient in this situation. The prevalence and impact of vestibulotoxicity including practicality of the assessment should be considered when designing an effective vestibulotoxicity screening protocol. Conclusion This study provides a better understanding of cisplatin vestibulotoxicity from the perspectives of audiovestibular clinicians, which will underpin appropriate detection and management of the condition.
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Affiliation(s)
- Pattarawadee Prayuenyong
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK. .,NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, UK. .,Nottingham University Hospitals NHS Trust, Nottingham, UK. .,Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Anand V Kasbekar
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Deborah A Hall
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK.,University of Nottingham Malaysia, Semenyih, Malaysia
| | - David M Baguley
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abstract
Ototoxicity refers to the damage to structures and function of the auditory-vestibular system caused by exogenous agents such as pharmaceuticals, chemicals, and ionizing radiation. There are many potentially ototoxic substances. For example, depending on how ototoxicity is defined, there are 200 to 600 medications that can cause damage to hearing and/or balance. Ototoxicity encompasses cochleotoxicity, vestibulotoxicity, and neurotoxicity. A variety of professional disciplines are involved in determining causation, prevention, and management of ototoxic effects. Research to identify and develop otoprotectants and otorescue agents is emerging and will translate basic scientific discovery into applications for use in hearing conservation programs, safety operations, and clinical care. Original concept maps are presented here to visually represent knowledge pathways, domains, and relationships essential to the understanding of ototoxicity.
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Affiliation(s)
- Kelly L. Watts
- US Department of Defense Hearing Center of Excellence, San Antonio, Texas
- Naval Submarine Medical Research Laboratory (NSMRL), Naval Submarine Base New London, Groton, Connecticut
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Konrad-Martin D, Poling GL, Garinis AC, Ortiz CE, Hopper J, Bennett KO, Dille MF. Applying U.S. national guidelines for ototoxicity monitoring in adult patients: perspectives on patient populations, service gaps, barriers and solutions. Int J Audiol 2018; 57:S3-S18. [PMID: 29157038 PMCID: PMC6450095 DOI: 10.1080/14992027.2017.1398421] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To promote establishment of effective ototoxicity monitoring programs (OMPs), this report reviews the U.S. national audiology guidelines in relation to "real world" OMP application. Background is provided on the mechanisms, risks and clinical presentation of hearing loss associated with major classes of ototoxic medications. DESIGN This is a non-systematic review using PubMed, national and international agency websites, personal communications between ototoxicity experts, and results of unpublished research. Examples are provided of OMPs in various healthcare settings within the U.S. civilian sector, Department of Defense (DoD), and Department of Veterans Affairs (VA). STUDY SAMPLE The five OMPs compared in this report represent a convenience sample of the programs with which the authors are affiliated. Their opinions were elicited via two semi-structured teleconferences on barriers and facilitators of OMP, followed by a self-administered questionnaire on OMP characteristics and practices, with responses synthesized herein. Preliminary results are provided from an ongoing VA clinical trial at one of these OMP sites. Participants were 40 VA patients who received cisplatin chemotherapy in 2014-2017. The study arms contrast access to care for OMP delivered on the treatment unit versus usual care as provided in the audiology clinic. RESULTS Protocols of the OMPs examined varied, reflecting their diverse settings. Service delivery concerns included baseline tests missed or completed after the initial treatment, and monitoring tests done infrequently or only after cessation of treatment. Perceived barriers involved logistics related to accessing and testing patients, such as a lack of processes to help patients enter programs, patients' time and scheduling constraints, and inconvenient audiology clinic locations. Use of abbreviated or screening methods facilitated monitoring. CONCLUSIONS The most effective OMPs integrated audiological management into care pathways of the clinical specialties that prescribe ototoxic medications. More OMP guidance is needed to inform evaluation schedules, outcome reporting, and determination of actionable ototoxic changes. Guidance is also lacking on the use of hearing conservation approaches suitable for the mass testing needed to support large-scale OMP efforts. Guideline adherence might improve with formal endorsement from organizations governing the medical specialty stakeholders in OMP such as oncologists, pulmonologists, infectious disease specialists, ototolaryngologists and pharmacists.
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Affiliation(s)
- Dawn Konrad-Martin
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Gayla L. Poling
- Mayo Clinic, Department of Otorhinolaryngology, Division of Audiology, Rochester, MN
| | - Angela C. Garinis
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Candice E. Ortiz
- Walter Reed National Military Medical Center, National Military Audiology and Speech Pathology Center, Bethesda, MD
| | - Jennifer Hopper
- Department of Otolaryngology, Yale University School of Medicine, New Haven, CT
| | - Keri O’Connell Bennett
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Marilyn F. Dille
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
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