Ototoxicity: The Hidden Menace

Abstract

Otolaryngology, although considered a surgical specialty, also covers many diseases that are not cured by surgery. These are treated medically and thus the otolaryngologist should have a good knowledge of drug treatments. It also entails ability to recognize, when an ENT symptom may be caused by one of the patient's medications, particularly as this is easily remedied by changing the drug. Although most of us know the common drugs that can cause otological side effects, there are many others that we may not be aware of. Here we have tried to consolidate a list of some commonly used drugs having otological side effects.

Unusual discovery of a vestibular schwannoma following eradication therapy forMycobacterium abscessus

“…However, it has also been reported with imipenem (stopped at day 8) and minocycline 2. Ototoxicity is believed to occur as a result of susceptibility of the injured tissue to the drug and/or accumulation of the drug within the organ 3. The mechanism is poorly understood and numerous actions have been described, including but not limited to: inhibition of endolymph production—resulting in degeneration of the tissue, direct hair cell toxicity, retrograde auditory nerve damage, central brainstem effects and reactive oxygen species 3 4.…”

“…The mechanism is poorly understood and numerous actions have been described, including but not limited to: inhibition of endolymph production—resulting in degeneration of the tissue, direct hair cell toxicity, retrograde auditory nerve damage, central brainstem effects and reactive oxygen species 3 4. The precise incidence of ototoxic side effects is not known, but is estimated to be up to 63% with aminoglycosides,5 causing varying symptoms from tinnitus to total hearing loss3 and both acute and delayed presentations 6…”

Prevention of treatment-induced ototoxicity: An update for clinicians

“…[1] It is therefore as important for clinicians to recognise adverse drug reactions (ADRs) as it is to diagnose serious diseases if effective clinical management is to be realised. [2] Ototoxicity is an adverse reaction resulting from the pharmacological treatment of many life-threatening illnesses, such as cancer, multidrug-resistant tuberculosis and congestive heart failure, [2] and it is increasingly becoming a problem in low-and middle-income countries (LMICs) such as South Africa (SA). Some ototoxic medicines primarily affect the auditory system (cochleotoxic), while others primarily affect the vestibular system (vestibulotoxic), and some classes, e.g.…”

“…from daily dosage to 3 times per week) to reduce the concentration in the inner ear. [2] The success of ototoxicity monitoring depends on effective communication between all health professionals involved in the management of patients who are being treated with ototoxic medicines (the clinical pharmacist, audiologist and doctor). Patients benefit the most if the information from these professionals regarding ototoxicity monitoring is communicated coherently and consistently.…”

Comorbidity: Reconsidering the Unit of Analysis

“…Several examples come to mind, such as the significant number of older adults hospitalized with gastrointestinal bleeding and ulcers as a result of taking nonsteroidal anti-inflammatory drugs for arthritis, or the ototoxic (harmful for hearing) effect of both antibiotics like erythromycin and gentamycin and commonly used over-the-counter pain medication drugs such as ibuprofen, acetaminophen, and aspirin (Bisht and Bist 2011). The common problem of poorly monitored polypharmacy for older patients ( Wolff et al 2002) is the tip of the iceberg of a much larger comorbidity problem related to drug interactions.…”