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Antibiotics increase risk for hearing loss in patients with cystic fibrosis
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Recent study findings showed that aminoglycosides and glycopeptides, which are commonly used to treat life-threatening respiratory infections, were associated with permanent hearing loss in patients with cystic fibrosis.
The results build on previous research that also demonstrated a link between the antibiotics and impaired hearing, according to Angela Garinis, PhD, senior research associate in the Oregon Hearing Research Center at Oregon Health and Science University, and colleagues. The researchers reported that aminoglycosides (AG) and glycopeptides can damage auditory function in the inner ear, which can result in permanent high-frequency sensorineural hearing loss (SNHL).
“It has been well-established in both clinical and preclinical studies that AG antibiotics induce cochleotoxicity,” the researchers wrote the Journal of Cystic Fibrosis. “However, the incidence of hearing loss from intravenous (IV-)AG exposure in patients with [cystic fibrosis (CF)] remains unclear, likely contributing to the lack of ototoxic monitoring in many CF clinics.”
For their study, Garinis and colleagues measured hearing thresholds and assessed cumulative IV-AG exposure in 81 participants (mean age, 26 years) with CF. The researchers also examined data on vancomycin dosing, which can help increase the cochleotoxicity of AGs. Each participant completed one hearing test, and his or her personal health records were used to determine IV-AG and vancomycin exposure.
More than half of participants (56%) had SNHL in at least one ear, the researchers reported.
Those with SNHL tended to be older at the time of their hearing test (median age, 26 years) compared with their normal-hearing counterparts (median age, 21 years). Further analysis showed that for each 1-year increase in age, the odds of developing SNHL were 1.16 (95% CI, 1.06-1.26).
According to the researchers, the overall rates of SNHL were larger than expected, with greater degrees of hearing loss in the high-frequency range compared with an age-matched cohort of controls without CF or a history of AG treatments.
Cumulative lifetime dosing of IV-AG (with or without vancomycin) was divided into four quartiles, which ranged from two to 15 doses in the first quartile, 16 to 52 doses in the second quartile, 57 to 146 doses in the third quartile and 152 to 647 doses in the fourth quartile. In the third and fourth quartiles, the number of ears with SNHL (12 and 14, respectively) was much higher than the number of ears with normal hearing (seven and six ears, respectively).
After adjusting for age at the time of the hearing test and gender, participants in the third quartile were 2.03 (95% CI, 0.47-8.72) times more likely, and those in the fourth quartile 4.53 (95% CI, 1.03-20.02) times more likely, to have SNHL compared with participants in the two lowest quartile exposure groups. Overall, those in the two highest exposure groups were 4.79 times more likely to have SNHL than those in the two lowest exposure groups (P = .005).
The researchers observed a significant trend of increased SNHL risks with increasing dosing quartiles (P = .01). Further analyses showed that age was significantly associated with SNHL after adjusting for dosage (P <. 05) and gender. For each 1-year increase in age, the odds of developing SNHL were 1.16 (95% CI, 1.06-1.26).
The researchers concluded that their findings suggest the need for ongoing clinical monitoring of cumulative lifetime IV-AG dosing in CF patients. In addition, there is “strong evidence” to support routine hearing evaluations with extended high-frequency testing in patients with CF before and after IV-AG treatments, they wrote.
“This allows for identification of hearing damage before it reaches frequencies important for speech discrimination (e.g., 0.5-8.0 kHz),” Garinis and colleagues wrote. “This information will allow both the patient and the physician to discuss possible modifications to the treatment regimen, particularly if an alternative approach is or becomes available, or at a minimum provides a basis for recommendation for rehabilitation.”
Garinis and colleagues further noted that close cochleotoxicity monitoring is particularly recommended among patients at a greater risk for SNHL, including those who are older and have a higher number of IV-AG courses.
According to a press release, people with CF are living longer, underscoring the importance of maintaining their quality of life over a longer time period.
“People don’t realize the trauma of hearing loss until after they’ve lost it,” senior author Peter Steyger, PhD, professor of otolaryngology/head and neck surgery in the Oregon Health and Science University School of Medicine, said in the release. “Helen Keller said, ‘Blindness separates people from things; deafness separates people from people.’ It can lead to isolation, depression and cognitive decline.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
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