Audiological Changes Associated with HIV Infection

Bankaitis, Aukse E.; Keith, Robert W.

doi:10.1177/014556139507400511

Cited by 37 publications

(36 citation statements)

References 42 publications

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“…The fact that the ART groups did not differ in measures of peripheral hearing ability (DPOAEs, thresholds), or in the rate of abnormal tympanograms, but that the ART+ group reported significant more trouble understanding speech and had higher gap detection thresholds point to a reduction in central processing abilities as a cause of the findings. These data are consistent with findings from other studies showing longer ABR latencies in HIV+ adults, and difficulty in localizing sound in infants born to HIV+ mothers (Pagano, Cahn et al 1992; Bankaitis and Keith 1995; Castello, Baroni et al 1998; Matas, Leite et al 2006; Matas, Iorio et al 2008). …”

Section: Discussionsupporting

confidence: 92%

Auditory Impairments in HIV-Infected Individuals in Tanzania

et al. 2014

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Objectives Abnormal hearing tests have been noted in HIV-infected patients in several studies, but the nature of the hearing deficit has not been clearly defined. We performed a cross-sectional study of both HIV+ and HIV− individuals in Tanzania using an audiological test battery. We hypothesized that HIV+ adults would have a higher prevalence of abnormal central and peripheral hearing test results compared to HIV− controls. Additionally, we anticipated that the prevalence of abnormal hearing assessments would increase with anti-retroviral therapy (ART) use, and treatment for tuberculosis (TB). Design Pure-tone thresholds, distortion product otoacoustic emissions (DPOAEs), tympanometry, and a gap detection test were performed using a laptop-based hearing testing system on 751 subjects (100 HIV− in the U.S., plus 651 in Dar es Salaam Tanzania including 449 HIV+ [130 ART− and 319 ART+], and 202 HIV−, subjects. No U.S. subjects had a history of TB treatment. In Tanzania, 204 of the HIV+, and 23 of the HIV−, subjects had a history of TB treatment. Subjects completed a video and audio questionnaire about their hearing as well as a health history questionnaire. Results HIV+ subjects had reduced DPOAE levels compared to HIV− subjects, but their hearing thresholds, tympanometry results, and gap detection thresholds were similar. Within the HIV+ group, those on ART reported significantly greater difficulties understanding speech-in-noise, and were significantly more likely to report that they had difficulty understanding speech than the ART− group. The ART+ group had a significantly higher mean gap detection threshold compared to the ART− group. No effects of TB treatment were seen. Conclusions The fact that the ART+/ART− groups did not differ in measures of peripheral hearing ability (DPOAEs, thresholds), or middle ear measures (tympanometry), but that the ART+ group had significantly more trouble understanding speech and higher gap detection thresholds, indicates a central processing deficit. These data suggest that: (a) hearing deficits in HIV+ individuals could be a central nervous system (CNS) side effect of HIV infection, (b) certain ART regimens might produce CNS side effects that manifest themselves as hearing difficulties, and/or (c) some ART regimens may treat CNS HIV inadequately, perhaps due to insufficient CNS drug levels, which is reflected as a central hearing deficit. Monitoring of central hearing parameters could be used to track central effects of either HIV or ART.

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Section: Discussionsupporting

confidence: 92%

Auditory Impairments in HIV-Infected Individuals in Tanzania

et al. 2014

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“…These results were consistent with the reports that have associated iatrogenic hearing loss with many of the drugs used to treat HIV / AIDS. [1114]…”

Section: Resultsmentioning

confidence: 99%

“…Antineoplastic medications such as vincristine, antifungal agents, including amphotericin B, flucytosine and ketoconazole, immune modulators, aminoglycoside antibiotics, erythromycin, and azidothymidine (AZT) are all widely used in the management of HIV and are all reported to be associated with significant ototoxicity or decreased hearing. [7811–14] These medications are associated with hearing loss, tinnitus, and vertigo. Frequently administered medications for Pneumocystis pneumonia (PCP) (Pentamidine, TMP / SMX, Primaquine) may cause tinnitus, vertigo, dizziness, auditory disturbances, deafness, decreased hearing, hearing loss, and otalgia.…”

mentioning

confidence: 99%

Highly active antiretroviral therapy: Does it Sound toxic?

Khoza-Shangase

2011

J Pharm Bioall Sci

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ObjectiveThe main objective of the current study is to monitor the auditory status in a group of adults with AIDS, receiving Highly Active Antiretroviral Therapy (HAART) (3TC -lamivudine, D4T – stavudine, and efavirenz) in a hospital outpatient clinic in Gauteng. A total sample of 54 adults (between the ages of 18 and 50 years) in the experimental group and 16 in the control group were assessed prospectively following a repeated measures design. All participants were assessed at baseline at three months, and at six months into the treatment.Materials and MethodsThe participants underwent case history interviews and medical record reviews, otoscopy, and tympanometry, as well as conventional pure tone audiometry and distortion product otoacoustic emission testing. Both descriptive and inferential statistics were used to analyze the data.ResultsOn audiological monitoring, statistically significant changes (P<0.05) were established, only in the experimental group, for pure tone audiometry — with clinically significant changes found at high frequencies. Statistically significant changes with clinically significant changes were obtained for distortion product otoacoustic emissions (DPOAEs) in the experimental group, particularly at high frequencies — implying subclinical hearing function changes; while lack of statistically significant changes with no clinically significant changes were found in the control group. The subclinical hearing changes in the experimental group were also evident in the findings of the subclinical hearing loss group, who, although they had normal pure tone function after six months of follow up, presented with clinical changes on DPOAEs at 6 and 8 kHz.ConclusionsFindings highlight the need for closer monitoring of the effects of antiretroviral drugs (ARVs) on hearing, through the use of more sensitive tools of assessment when conducting drug trials.

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“…Studies where ABRs have been measured in HIV+ subjects have shown abnormalities in auditory evoked potentials consistent with a higher rate of central processing defects compared to HIV-negative subjects (Bankaitis et al 1995; Pagano et al 1992; Reyes-Contreras et al 2002). In an early ABR study, Pagano et al showed prolonged ABR latencies in a group of 35 HIV+ individuals, which they attributed to effects of the HIV virus on the central nervous system.…”

Section: Discussionmentioning

confidence: 98%

Auditory Impairments in HIV-Infected Children

et al. 2016

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Objectives In our cross-sectional study of human immunodeficiency virus (HIV)-infected adults, we showed lower distortion product otoacoustic emissions (DPOAEs) in HIV+ individuals compared to controls as well as findings consistent with a central auditory processing deficit in HIV+ adults on anti-retroviral therapy. We hypothesized that HIV+ children would also have a higher prevalence of abnormal central and peripheral hearing test results compared to HIV− controls. Design Pure-tone thresholds, DPOAEs, and tympanometry were performed on 244 subjects (131 HIV+, and 113 HIV−, subjects). Thirty-five of the HIV+, and 3 of the HIV−, subjects had a history of tuberculosis treatment. Gap detection results were available for 18 HIV− and 44 HIV+ children. Auditory brainstem response (ABR) results were available for 72 HIV− and 72 HIV+ children. Data from ears with abnormal tympanograms were excluded. Results HIV+ subjects were significantly more likely to have abnormal tympanograms, histories of ear drainage, tuberculosis, or dizziness. All audiometric results were compared between groups using a two-way ANOVA with HIV status and ear drainage history as grouping variables. Mean audiometric thresholds, gap detection thresholds, and ABR latencies did not differ between groups, although the HIV+ group had a higher proportion of individuals with a hearing loss >25 dB HL in the better ear. The HIV+ group had reduced DPOAE levels (p<0.05) at multiple frequencies compared to HIV− subjects. No relationships were found between treatment regimens or delay in starting treatment and audiological parameters. Conclusions As expected, children with HIV+ were more likely to have a history of ear drainage, and to have abnormal tympanograms. Similar to the adult findings, the HIV+ group did not show significantly reduced audiometric thresholds, but did have significantly lower DPOAE magnitudes. These data suggest that: (a) HIV+ children often have middle ear damage which complicates understanding the direct effects of HIV on the hearing system, and (b) even when corrected for confounders DPOAEs were lower in the HIV+ group. Previous studies suggest ototoxicity from anti-retroviral drugs is an unlikely cause of the reduced DPOAE magnitudes. Other possibilities include effects on efferent pathways connecting to outer hair cells or a direct effect of HIV on the cochlea.

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Audiological Changes Associated with HIV Infection

Cited by 37 publications

References 42 publications

Auditory Impairments in HIV-Infected Individuals in Tanzania

Auditory Impairments in HIV-Infected Individuals in Tanzania

Highly active antiretroviral therapy: Does it Sound toxic?

Auditory Impairments in HIV-Infected Children

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