Clinical Considerations for Routine Auditory and Vestibular Monitoring in Patients With Cystic Fibrosis

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

Cystic Fibrosis Foundation otolaryngology care multidisciplinary consensus recommendations

“…In individuals who already have documented sensorineural hearing loss, the CFF recommends monitoring for ototoxic effects after each course of ototoxic medications. In contrast to the broader recommendations in 24, this recommendation focuses on and includes only those individuals who already have documented hearing loss and aligns with the International Ototoxicity Management Working Group statement recommending posttreatment audiologic monitoring within 3 months of completing intravenous ototoxic treatment for individuals with CF 66 . This statement also supports that individuals with CF receive annual audiological evaluation (recommendation #9) to ensure their auditory function data are up‐to‐date before each new course of treatment. 11.…”

“…This committee did not formally recommend a time frame for ototoxic monitoring; however, the International Ototoxicity Management Working Group recommends posttreatment audiologic monitoring within 3 months of completing an intravenous ototoxic treatment for individuals with CF. 66 Coordinating point of care options with your local audiology team may help alleviate this burden. As noted above in statements 8, 9, and 10, there are no published data showing that screening for ototoxicity will change or improve outcomes, but the knowledge that an individual is developing ototoxicity symptoms associated with treatments may potentially result in using alternative antibiotics.…”

“…The CFF recommends, as an option, to monitor for these ototoxic effects after each course of ototoxic systemic medications in all individuals, while recognizing that this may place a significant burden on some individuals with CF and health care resources. This committee did not formally recommend a time frame for ototoxic monitoring; however, the International Ototoxicity Management Working Group recommends posttreatment audiologic monitoring within 3 months of completing an intravenous ototoxic treatment for individuals with CF 66 . Coordinating point of care options with your local audiology team may help alleviate this burden.…”

Ototoxicity: a high risk to auditory function that needs to be monitored in drug development

“…In September 2019, the International Ototoxicity Management Working Group (IOMG) was formed in response to health care gaps in ototoxicity management worldwide at the 9th Biennial Conference of the NCRAR held in Portland, Oregon ( Garinis et al, 2021 ). The IOMG is a global consortium of international stakeholders from universities, task forces, health foundations, professional societies, government agencies and patients created to address healthcare gaps in the clinical management of individuals who experiencing hearing loss, tinnitus, and/or balance difficulties following medical, occupational or environmental exposures to ototoxicants.…”

A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape

“…Extended high-frequency audiometry, http://www.sajcd.org.za Open Access which assesses air conduction hearing thresholds above 8 kHz, is considered to be the most sensitive behavioural method for detecting early cochlear outer hair cell damage (Campbell & Le Prell, 2018;Harris, Peer, & Fagan, 2012;Petersen & Rogers, 2015) before it affects hearing functionality, and is therefore recommended for the monitoring of ototoxicity (HPCSA, 2018). There have been significant advances in point of care testing and mobile health technologies in hearing assessment (Garinis et al, 2021), which should be considered for ototoxicity monitoring in South Africa. In particular, the use of smartphone technology with automated EHF audiometry hearing assessment applications and cloud-based capabilities for integrated data management should be considered for community-based ototoxicity monitoring (Bornman, Swanepoel, De Jager, & Eikelboom, 2019;Eksteen et al, 2019;WHO, 2021b;Yousuf Hussein, Swanepoel, Mahomed, & Biagio de Jager, 2018).…”