Pharmaco-Audiology Vigilance in the Treatment of Adult Patients with HIV/Aids: Ototoxicity Monitoring Protocol Recommendation

An Analysis of Risk Factors for Hearing Function in Adults Living with Human Immunodeficiency Virus in Gauteng, South Africa

The aim of this study was to explore risk factors for hearing loss or affecting hearing function in adults living with HIV. A quantitative cross-sectional design was employed. A non-probability purposive sampling method was used to select and recruit 132 participants aged 18 years and above from an HIV clinic within the Academic Hospital in Gauteng Province, South Africa. Participants' hearing were tested using, video otoscopy, tympanometry, pure tones, and speech audiometry. Of the 22.73% prevalence of hearing loss in the sample, the multiple logistic regression, controlling for other variables, indicated that age (AOR) = 1.049; 95%CI: 1.0005 to 1.0978) (p-value = 0.048) and extended use of antiretroviral therapy (AOR) = 1.0073; 95%CI: 0.9312 to 1.0896)) (p-value = 0.856) were strongly associated with the development of hearing loss. Although the odds of male participants to have hearing loss was 2.3572 (95%CI: 0.9394 to 5.915) compared to females, this association was marginal (p-value = 0.068). Current findings provide evidence for the risk factors for hearing loss in adults living with HIV. Given that an extended use of ART and a higher number of CD4 are strongly associated with hearing loss, these findings raise important implications for a focused monitoring for this population in order to identify early signs of hearing loss and implement timeous intervention to reduce the potential impact of hearing loss.

Investigating Hearing Function in Pediatric Patients with Renal Dysfunction: In Pursuit of Preventive Audiology Outcomes

Chronic kidney is being increasingly recognized as a global health problem with effects that have implications for both mortality and morbidity; with hearing loss being one of the effects that has an impact on quality of life. This study aimed to describe hearing function in a group of children with chronic renal dysfunction receiving treatment in an academic hospital in Johannesburg, South Africa. One hundred children between the ages 5 and 18 years (mean age 11.68) were included in the study. A cross-sectional, descriptive, quantitative research design was employed. All participants underwent a case history interview and an audiological examination which included otoscopy, immittance testing, pure tone audiometry including extended high frequency testing up to 16 kHz as well as diagnostic distortion product otoacoustic emission testing. A medical record review was also done. Both descriptive and inferential statistics were used to analyze the collected data. Results revealed that there was a high prevalence of hearing loss in this group. The most common hearing loss was a low and high to ultrahigh frequency mild sensorineural hearing loss. No relationship between the severity of hearing loss and the severity of renal dysfunction, or the duration of renal dysfunction and the duration of treatment was found. However, a relationship between the severity of hearing loss and certain treatments was found. These were v hemodialysis and the use of ototoxic medication such as loop diuretics, tuberculosis medication, and antimalarial medication. Current findings highlight the importance of extended high frequency audiometry as well as diagnostic distortion product otoacoustic emission testing for early detection of hearing impairment, in pursuit of preventive audiology outcomes, in ototoxic monitoring in this population.

Investigation of the Interaction between Hearing Function and Comorbidities in Adults Living with Human Immunodeficiency Virus

Adults living with the human immunodeficiency virus (HIV) have a high prevalence of co-existing comorbidities. While research indicates that adults living with HIV are at risk of developing hearing impairment, limited research exists on the interaction between hearing function and comorbidities in this population. The objective of this study was to determine and compare the hearing function of a group of adults living with HIV and comorbidities and those without comorbidities. A sample of 132 adults living with HIV underwent a basic audiological test battery to assess their hearing function. Participants with comorbidities were 1.23 times more likely to develop hearing loss, with crude odds of 1.236 (95%CI 0.5467 to 2.795), while those with three comorbidities were 2.52 times more likely to develop hearing loss. Participants with hypertension were 93% more likely to develop hearing loss when compared to nonhypertensive participants (OR = 1.928; 95%CI: 0.7856 to 4.7345). There was only a marginal association between hypercholesterolemia and sensorineural hearing loss (SNHL), with no association between other comorbidities and the type of hearing loss. The current findings raise a need for prioritizing patients with comorbidities in audiological assessment and monitoring in resource-constrained contexts, where capacity versus demand challenges might prevent the provision of audiological services to all adults living with HIV. These findings also highlight the importance of preventive care in this population with regard to the burden of the disease, as it may lead to worse ear and hearing outcomes for affected individuals.

Impact of drug-resistant tuberculosis treatment on hearing function in South African adults: Bedaquiline versus kanamycin

Background

Ototoxicity linked to medications used to treat tuberculosis (TB) remains a global challenge.

Objectives

The aim was to describe the audiological function in a group of adults with drug-resistant tuberculosis (DR-TB) on bedaquiline (G-BDQ) treatment attending a TB hospital in South Africa and compare this with patients on kanamycin (G-KCIN).

Methods

A quantitative paradigm was adopted within a non-experimental retrospective record review design. The sample consisted of 30 records of adults with DR-TB between the ages of 18 and 50 years, recruited from a Tropical Diseases Hospital in South Africa. Data were analysed through both descriptive and inferential statistical measures.

Results

Clear and statistically significant differences in the audiological function were found between the two groups. The group receiving G-KCIN presented with ototoxicity that was clearly demonstrated by sensorineural hearing loss of high-frequency worsening of thresholds in over 73% of the records, which was statistically (p < 0.05) and clinically significant, over the three testing sessions, demonstrating the cumulative effects of dosage. Increased evidence of tinnitus was also found in this group. The group receiving G-BDQ presented with neither statistically (p > 0.05) nor clinically significant changes in hearing thresholds across all frequencies over the same monitoring timeframe. Additionally, only one report (7%) of tinnitus was found in this group.

Conclusion

The results indicating that bedaquiline does not cause hearing loss when compared with G-KCIN highlight the need for increased availability of bedaquiline for the treatment of DR-TB within the South African context, to preserve both the quantity and quality of life of those infected.

In Pursuit of Preventive Audiology in South Africa: Scoping the Context for Ototoxicity Assessment and Management

Aim

The study explored the South African healthcare context for ototoxicity assessment and management from the audiologists' perspectives.

Materials and Methods

This was done through a survey research methodology that adopted a cross-sectional research design. South African audiologists were recruited from professional associations databases using specific inclusion criteria; and 31 audiologists from across the country participated. The study used an 18-item web-based survey guided by the Health Professions Council of South Africa (HPCSA) (2018) guidelines. Data were analyzed through both descriptive and inferential statistics.

Results

Findings revealed serious contextual challenges influencing the implementation of assessment and management programs within the South African context. Over two-thirds of the participants engage with ototoxicity monitoring and management, but the practices adopted are not aligned to international standards nor the national HPCSA guidelines on assessment and management of patients on ototoxic medications. Findings speak to the frequency of practice; the referral pathways audiologists use; prevention and promotion methods used; availability of resources for the implementation of ototoxicity assessment and management; barriers to ototoxicity assessment and management; the influence of language and culture in ototoxicity assessment and management; as well as information management practices within this context. No relationship could be established between knowledge regarding ototoxicity, communication, caseload, and ototoxicity assessment and management on the chi-square.

Conclusion

Implications for strategic planning, budget allocation, collaborative multidisciplinary within the same institution approaches; training; policy formulation; and translation of policies and guidelines into practice are raised by these findings.

Middle ear Pathologies in Adults Living with Human Immunodeficiency Virus: A Systematic Review

INTRODUCTION

Middle ear pathologies have been linked with HIV. The onset and development of these pathologies in individuals with HIV have not been categorized; and clarity has not been gained regarding whether their presentation is any different in this population when compared to HIV negative control group.

PURPOSE

The aim of this study was to explore and document published evidence reflecting trends in middle ear pathologies in adults living with HIV.

METHODS

A systematic review of literature from January 1982 to December 2018 was conducted using Medline, CINAHL, PubMed, and Psych Info. Studies that reported the occurrence rate of middle ear pathologies in adults with HIV and published in English were included.

RESULTS

Twelve articles met the inclusion criteria. Evidence suggests that the reported occurrence rates of middle ear pathologies ranges from 2.5% to 58% in this population. The variability in assessment measures as well as the different cut-off criteria used in studies seem to have an influence in the findings, with pure tone audiometry identifying more middle ear pathologies in the current review than tympanometry with 226 Hz probe tone and clinical examination. Otitis media, conductive hearing loss, and type B tympanogram were common findings reported in this study. No evidence of an association between the use of antiretroviral therapy (ART) and the rates of middle ear pathologies was found.

CONCLUSION

Although there are very few studies that have reported on middle ear pathologies in adults living with HIV, the available studies have sufficiently established a link between HIV and middle ear disease in this population, and have revealed that the rate of occurrence is influenced by a number of factors. Key amongst these is the type of assessment measure used. Careful analysis of middle ear pathologies in this population through well controlled research designs that include different assessment measures. The use of case-control and longitudinal designs to determine differences between groups and to establish the time of onset and development of middle ear pathologies is required.

Burden of disease: A scoping review of HIV/AIDS and TB in occupational noise-induced hearing loss

BACKGROUND

Occupational noise-induced hearing loss (ONIHL) does not occur in isolation from other influencing factors such as health conditions and illnesses like human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS), as well as tuberculosis (TB). How the burden of disease influences the occurrence and/or management of ONIHL becomes a key if the goal of hearing conservation programmes (HCPs) is to be achieved within these contexts.

OBJECTIVES

The purpose of this scoping review was to conduct an investigation on how the burden of disease's influence on ONIHL is reported in literature, with a specific focus on the most prevalent diseases in South African mines - HIV and AIDS and TB.

METHOD

A scoping review was conducted using the Arksey and O'Malley's framework. A search was conducted in five electronic bibliographic databases and the grey literature.

RESULTS

The search procured 10 publications, with two specific to ONIHL within the South African context. In addition to the two publications specific to TB and ONIHL, findings revealed a serious gap in the evidence around the scoping review question globally. This obvious lack of investigations into the influence of these two conditions in the South African mining context raises serious implications about the responsiveness, and proactive nature of HCPs within this population.

CONCLUSION

Considering the burden of diseases on otology and audiology is critical as certain diseases cause hearing impairment either as a primary effect, as a secondary/opportunistic effect or as a side effect of treatment options for that disease. An employee suffering from any such disease with concomitant exposure to hazardous noise levels presents an even bigger challenge to HCPs if such is not taken into consideration in the conception, implementation and monitoring of HCPs.