High-frequency audiometry reveals high prevalence of aminoglycoside ototoxicity in children with cystic fibrosis
High-frequency audiometry reveals high prevalence of aminoglycoside ototoxicity in children with cystic fibrosis
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DOI：
10.1016/j.jcf.2014.07.009
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发表时间：
2015-03-01
影响因子：
5.2
通讯作者：
Suri, Ranjan
中科院分区：
文献类型：
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作者：
Al-Malky, Ghada;Dawson, Sally J.;Suri, Ranjan
背景：静脉注射氨基糖苷(IV AG)抗生素被广泛用于囊性纤维化(CF)患者，已知有耳毒性并发症。尽管如此，听力监测并不常见，如果进行，也只使用标准的纯音测听(PTA)。方法：采用标准纯音测听(PTA)、扩展高频(EHF)测听和失真产物耳声发射(DPOAE)对CF儿童进行听力评估。结果：共纳入70名CF儿童，平均年龄10.7(3.5)岁。在63名接受静脉注射AG的儿童中，15名(24%)儿童通过流行性出血热测听和DPOAE检测到耳毒性。标准PTA仅在13名儿童中检测到耳毒性。其中11名儿童接受了至少10个课程的IV AG课程。所有EHF频率的听力损失均为25-85dBHL(平均标准差：57.5+/-25.7dBHL)，DPOAE在4-8 kHz处的波幅显著下降。然而，标准的PTA在这15名儿童中只有5名在8 kHz处检测到显著的听力损失(>；20dBHL)，而在显著提高ETU阈值的2名受试者中没有发现听力损失。接受静脉注射AG的疗程数、年龄和低肺功能是耳毒性的危险因素。结论：接受静脉注射AG至少10个疗程的CF儿童发生耳毒性的风险较高。流行性出血热听力测试发现，与标准的PTA相比，多了2名儿童耳毒性，并且根据可用的设施，应该是检测接受静脉注射AG的CF型儿童耳毒性的首选测试。(C)2014年欧洲囊性纤维化协会。爱思唯尔出版，版权所有。
Background: Intravenous aminoglycoside (IV AG) antibiotics, widely used in patients with cystic fibrosis (CF), are known to have ototoxic complications. Despite this, audiological monitoring is not commonly performed and if performed, uses only standard pure-tone audiometry (PTA). The aim of this study was to investigate ototoxicity in CF children, to determine the most appropriate audiological tests and to identify possible risk factors.Methods: Auditory assessment was performed in CF children using standard pure tone audiometry (PTA), extended high-frequency (EHF) audiometry and distortion-product otoacoustic emissions (DPOAE).Results: 70 CF children, mean (SD) age 10.7 (3.5) years, were recruited. Of the 63 children who received IV AG, 15 (24%) children had ototoxicity detected by EHF audiometry and DPOAE. Standard PTA only detected ototoxicity in 13 children. Eleven of these children had received at least 10 courses of IV AG courses. A 25 to 85 dB HL hearing loss (mean SD: 57.5 +/- 25.7 dB HL) across all EHF frequencies and a significant drop in DPOAE amplitudes at frequencies 4 to 8 kHz were detected. However, standard PTA detected a significant hearing loss (>20 dB HL) only at 8 kHz in 5 of these 15 children and none in 2 subjects who had significantly elevated ETU thresholds. The number of courses of IV AG received, age and lower lung function were shown to be risk factors for ototoxicity.Conclusions: CF children who had received at least 10 courses of IV AG had a higher risk of ototoxicity. EHF audiometry identified 2 more children with ototoxicity than standard PTA and depending on facilities available, should be the test of choice for detecting ototoxicity in children with CF receiving IV AG. (C) 2014 European Cystic Fibrosis' Society. Published by Elsevier B.V. All rights reserved.