Prevention and management of hearing loss in patients receiving ototoxic medications

Abstract

Following the efforts of patient advocates, the World Health Organization published updated guidelines for management of multidrug-resistant tuberculosis in 2018 that advised against the routine use of ototoxic second-line injectable drugs (amikacin, capreomycin and kanamycin). Although hearing loss is no longer considered an unavoidable harm for patients with multidrug-resistant tuberculosis, ototoxic medications continue to be used for several infectious and oncological disorders around the world. These drugs contribute to more than a half a million cases of hearing loss worldwide annually. Currently, there are no international standards for preventing and managing hearing loss associated with ototoxic medications. We present recent data on the prevention and management of hearing loss related to these drugs and highlight the variability in care across settings. More importantly, we aim to provide an evidence-based framework for evaluating, screening and preventing ototoxicity. Finally, we identify avenues for future research so that patients no longer have to choose between hearing loss and a disease cure. There remain significant gaps in our understanding about optimal screening and treatment of ototoxic hearing loss. Here we aim to inspire future international guidelines to address gaps in ototoxicity care and establish research agendas for eliminating ototoxic medications.

N-Acetyl-L-cysteine Affects Ototoxicity Evoked by Amikacin and Furosemide Either Alone or in Combination in a Mouse Model of Hearing Threshold Decrease

“…In this study, we evaluated the hearing threshold by 20% and 50% after acute (single) administration of the drugs in combination. Acute vs. chronic administration of the ototoxic drugs are very important in relation to the fact that loop diuretics usually evoke reversible hearing loss due to their influence on sodium, chloride and potassium cotransporters in the cochlea and temporal induction of ions imbalance in the endolymphatic fluid of the inner ears [44]. By contrast, aminoglycoside antibiotics, due to their destructive effects on outer hair cells, induce irreversible hearing loss in individuals receiving aminoglycosides [44].…”

“…Acute vs. chronic administration of the ototoxic drugs are very important in relation to the fact that loop diuretics usually evoke reversible hearing loss due to their influence on sodium, chloride and potassium cotransporters in the cochlea and temporal induction of ions imbalance in the endolymphatic fluid of the inner ears [44]. By contrast, aminoglycoside antibiotics, due to their destructive effects on outer hair cells, induce irreversible hearing loss in individuals receiving aminoglycosides [44]. On the other hand, the effects of both groups of drugs when used together were not tested experimentally, and little is known about the effects exerted by the drugs used concomitantly and chronically.…”

Presbycusis: A Coordinated and Personalized Approach According to Different Frailty Phenotypes

“…There are guidelines for the etiological assessment of bilateral sensorineural hearing loss and comprehensive audiological management in children [22,23]; and for the screening and management of ototoxic hearing loss [24]. There are also some protocols or proposals for the etiological assessment and management of presbyastasis [8,21,25] and tinnitus [26,27].…”

“…Other etiologically differential diagnosis of tinnitus symptoms includes pulsatile or objective (pulsatile synchronous or vascular and asynchronous or mechanical) tinnitus, and more common subjective tinnitus accompanying unilateral or bilateral hearing loss [26,27]. The screening also includes tinnitus-related systemic morbidities, such as cardiometabolic diseases, mental health disorders, neurological diseases (e.g., multiple sclerosis and head injury), tinnitus-related otological diseases, such as Meniere's disease, middle ear infection, noise exposure, and tinnitus-related polypharmacy, such as diuretics for hypertension therapy [39], aspirin [40,41], and other ototoxic medications [24]. Visual analog scales and questionnaires (e.g., Tinnitus handicap inventory and Tinnitus functional index) usually are used to assess tinnitus annoyance, distress, and severity [42].…”

“…Other non-invasive subjective tinnitus interventions include sound therapy, psychological therapies, neuromodulation, and combined therapy of these interventions [26,27,49,58]. Psychological therapies, such as cognitive behavioral therapy, have been shown to improve quality of life and decrease depression for these with persistent and bothersome tinnitus, or tinnitus disorder [24,59].…”