Audiological monitoring of patients undergoing multidrug resistant tuberculosis treatment at Jigme Dorji Wangchuk National Referral Hospital and Gidakom Hospital, Bhutan

Abstract

Background Hearing impairment due to ototoxicity is one common cause adding to global burden of disability. Amikacin and kanamycin are two common Aminoglycosides used to treat multidrug resistant tuberculosis which results in ototoxicity. The mean prevalence rate of multidrug resistant tuberculosis in Bhutan stood at 16%. Objective The study is aimed to establish prevalence rate of hearing impairment due to ototoxicity and secondary side effects which may ascertain specific early intervention. Method A total of 42 Patients undergoing multidrug resistant tuberculosis treatment participated in the study conducted at Jigme Dorji Wangchuk National Referral Hospital and Gidakom Hospital over a period of one year. Audiological tests were conducted once every month. The severity of ototoxicity was being graded using Brock's hearing loss grades. Result The study found 45.23% participants with some degree of hearing loss consequent to multidrug resistant tuberculosis treatment. Around 9.5% of the total participants developed potential disabling hearing loss. Around 30.09% of participants had experienced subjective tinnitus during the course of treatment. Study found no significant association (p-value 0.88, 95%CI 0.93–1.00) between referred test result of DPOAE (distortion product Otoacoustic emission) screener and the ototoxicity. Conclusion Study showed with significant prevalence of ototoxicity. Since hearing impairment have negative impact on psychosocial wellbeing and communication abilities, it is paramount importance to put in place the various preventative measures. With current guidelines by World Health Organisation on replacement of second-line injectable by oral regimens while treating patients with MDR-TB, it is expected to address ototoxicity and related issues.

Ototoxicity in Multidrug-Resistant Tuberculosis: A Scoping Review of the Indonesian Studies

“…All articles were observational studies, both prospective and retrospective assessing the ototoxicity during the treatment. Five studies are written in Indonesia and two studies are written in EnglishPatients who do not take their TB treatment properly or fail in TB category I are at risk of developing MDR-TB (Wangchuk et al, 2021). Genetic predisposition, history of TB treatment, and other factors such as diabetes mellitus, and co-infection HIV may lead to the mechanism of drug resistance.…”