Sensorineural hearing loss associated with intrathecal vancomycin

OBJECTIVE: To report a case of nonreversible bilateral sensorineural hearing loss resulting from administration of intrathecal vancomycin. CASE SUMMARY: A 63-year-old white man with newly diagnosed pre-B-cell acute lymphocytic leukemia developed Corynebacterium jeikeium meningitis associated with an Ommaya reservoir. The patient was treated with intravenous vancomycin for several days without symptomatic improvement, and intrathecal vancomycin was added to the treatment regimen. Difficulty in the patient's hearing was noted after the first intrathecal dose and he experienced complete hearing loss after the second intrathecal dose. An audiogram was performed and the patient was diagnosed with cranial nerve VIII bilateral sensorineural hearing loss. The Ommaya reservoir was removed and the patient was successfully treated with linezolid. DISCUSSION: Ototoxicity with intravenous vancomycin has been documented in multiple case reports, but this adverse effect has not been reported with intrathecal vancomycin. Cerebrospinal fluid vancomycin concentrations were not measured in our patient, but there was 1 documented occurrence of supratherapeutic serum vancomycin concentrations. Other drug-related causes of ototoxicity were evaluated and intrathecal vancomycin-induced ototoxicity was considered to be possible according to the Naranjo probability scale. CONCLUSIONS: The strong temporal relationship that was seen in this case suggests the possibility of an association between administration of intrathecal vancomycin and hearing loss. Healthcare providers should consider the potential for this adverse reaction with the intrathecal route of vancomycin administration.     

Sensorineural hearing loss after select procedures.

Hearing is one of the most significant senses; therefore, any loss can be frightening. Previous studies have found that certain surgical and medical procedures can result in hearing loss. Cardiac surgical procedures are most commonly associated with hearing loss owing to the use of the cardiopulmonary bypass pump. Other noncardiac, nonotologic surgical procedures also may result in hearing loss. Additionally, medical procedures such as myelogram and lumbar puncture have been associated with hearing loss. Studies suggest that hearing loss can result any time cerebrospinal fluid is leaked. This report highlights the effect of dural puncture on hearing loss. The implication that any dural puncture procedure may result in a cerebrospinal fluid leak and subsequent hearing loss is a significant clinical topic. Perianesthesia nurses are advised to educate themselves and their patients regarding this complication.     

Sensorineural hearing changes after myelogram.

Dire consequences can occur after any medical or surgical procedure. Certain procedures may even cause sensorineural hearing loss (SNHL). Previous studies have demonstrated that certain surgical and medical procedures may result in hearing losses of varying degrees. Although hearing loss is a well-known phenomenon, little consistent information exists about hearing loss after medical or surgical procedures. This one-tailed, directional study compared the effect of myelogram procedures on hearing in selected outpatients. A pre/posttest design was used to measure audiograms in 27 myelogram subjects. Pre- and postprocedure hearing tests were measured by audiometry and compared for differences. Results did not support previous studies that low-frequency hearing loss can occur within 24 hours after myelogram procedure. Clinically relevant information was found in one subject 53 hours post myelogram.     

Atorvastatin is associated with reduced cisplatin-induced hearing loss

BACKGROUNDCisplatin is widely used to treat adult and pediatric cancers. It is the most ototoxic drug in clinical use, resulting in permanent hearing loss in approximately 50% of treated patients. There is a major need for therapies that prevent cisplatin-induced hearing loss. Studies in mice suggest that concurrent use of statins reduces cisplatin-induced hearing loss.METHODSWe examined hearing thresholds from 277 adults treated with cisplatin for head and neck cancer. Pretreatment and posttreatment audiograms were collected within 90 days of initiation and completion of cisplatin therapy. The primary outcome measure was a change in hearing as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE).RESULTSAmong patients on concurrent atorvastatin, 9.7% experienced a CTCAE grade 2 or higher cisplatin-induced hearing loss compared with 29.4% in nonstatin users (P < 0.0001). A mixed-effect model analysis showed that atorvastatin use was significantly associated with reduced cisplatin-induced hearing loss (P ≤ 0.01). An adjusted odds ratio (OR) analysis indicated that an atorvastatin user is 53% less likely to acquire a cisplatin-induced hearing loss than a nonstatin user (OR = 0.47; 95% CI, 0.30–0.78). Three-year survival rates were not different between atorvastatin users and nonstatin users (P > 0.05).CONCLUSIONSOur data indicate that atorvastatin use is associated with reduced incidence and severity of cisplatin-induced hearing loss in adults being treated for head and neck cancer.TRIAL REGISTRATIONClinicalTrials.gov identifier {"type":"clinical-trial","attrs":{"text":"NCT03225157","term_id":"NCT03225157"}}NCT03225157.FUNDINGFunding was provided by the Division of Intramural Research at the National Institute on Deafness and Other Communication Disorders (1 ZIA DC000079, ZIA DC000090).     

Sensorineural hearing loss owing to deficient G proteins in patients with pseudohypoparathyroidism: results of a multicentre study

Pseudohypoparathyroidism (PHP) is a rare disorder that might be caused by an hereditary defect in the G protein system. These membrane-bound proteins are responsible for the transduction of biological signals through the outer cell membrane. The investigation of 22 patients with PHP showed a symmetric sensorineural hearing loss in 63.6% of the subjects. In erythrocyte membrane preparations from blood samples of 15 of these patients, we measured the concentration of the stimulatory Gs protein and the inhibitory Gi protein by means of the Western blot analysis using selective antibodies against alpha-subunits of G proteins. In nine of the 15 cases (60%), we found a distinct decrease in the amount of the Gs protein with a partial preponderance of the Gi protein. These patients had a considerable symmetric sensorineural hearing loss. Pathophysiological mechanisms and the possible role of G proteins in the inner ear are discussed.     

伪聋及夸大性耳聋患者听力检查的护理

目的 针对伪聋及夸大性耳聋患者心理特点进行护理，最终对其听力作出正确评估。方法 对初次检查结果可疑者，分析其行为动机，进行正确有效的思想疏导工作，使患者以积极的态度接受检查。结果 经说服教育和心理护理。所有病例均获得满意检查结果。确定初诊为伪聋者58例，夸大性耳聋者67例。动机包括为获取经济赔偿或诉讼优势；工伤评残或老兵退役评残；逃避工作或训练；医疗纠纷等。结论 伪聋和夸大性耳聋有其复杂的主观动机，通过正确引导和心理护理，最终均能获得真实听力结果。     

Genetics of hearing loss.

Advances in genetic technology have increased the knowledge of hereditary hearing loss in all age groups. A basic understanding of the multiple types and causes of hearing loss can advance nurses' ability to provide better education and referral services for their patients.     

Detection of mutations in genes associated with hearing loss using a microarray-based approach

Knowing the etiology of hearing loss in a person has implications for counseling and management of the condition. More than 50% of cases of early onset, nonsyndromic sensorineural hearing loss are attributable to genetic factors. However, deafness is a genetically heterogeneous condition and it is therefore currently not economically and practically feasible to screen for mutations in all known deafness genes. We have developed a microarray-based hybridization biochip assay for the detection of known mutations. The current version of the hearing loss biochip detects nine common mutations in the connexin 26 gene, four mutations in the pendrin gene, one mutation in the usherin gene, and one mutation in mitochondrial DNA. The biochip was validated using DNA from 250 people with apparent nonsyndromic, moderate to profound sensorineural hearing loss. The hearing loss biochip detected with 100% accuracy the mutations it was designed for. No false-positives or false-negative results were seen. The biochip can easily be expanded to test for additional mutations in genes associated with hearing impairment or other genetic conditions.     

MT-45, a new psychoactive substance associated with hearing loss and unconsciousness

Background. MT-45 (1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) is an opioid analgesic drug candidate developed in the 1970s that has recently been introduced as a new psychoactive substance (NPS) on the “recreational” drug market. We describe a case series of non-fatal intoxications associated with MT-45 within the Swedish STRIDA project. Study design. Observational case series of consecutive patients with admitted or suspected intake of NPS presenting to hospitals in Sweden from November 2013 to February 2014. Patients and methods. Blood and urine samples were collected from intoxicated patients presenting to emergency departments and intensive care units over the country. NPS analysis was performed by an LC–MS/MS multi-component method. Clinical data were collected when caregivers consulted the Poisons Information Centre and also retrieved from medical records. Case series. Among nine intoxications where MT-45 was detected in the biological samples, four cases were indicated to only involve MT-45, while one or several psychoactive substances were found along with MT-45 in the others. All patients were men aged 17–32 years and they commonly presented with opioid-like adverse symptoms, such as unconsciousness and respiratory depression. Naloxone appeared to have utility in the treatment of MT-45 intoxication in several cases. Three patients complained of bilateral hearing loss that in one case persisted after two weeks. Conclusion. MT-45 should be added to the growing list of harmful NPS causing life-threatening poisonings, and rapid actions taken to make it a controlled substance.     

Understanding hearing loss in children.

At some point in their career, nurses will care for a child with a hearing loss. Understanding how to work best with these children necessitates an in-depth knowledge of how the hearing loss impacts both the child and family. Each component is interrelated. Knowing, for example, that the child has a profound sensorineural hearing loss tells the nurse much about the child's potential prognosis for improvement, use of amplification, communication style, and parental and family stress. While many variables impact on these basic features, they set the foundation for a deeper understanding and the formation of a stronger, trusting bond between the nurse and patient. As in all professional fields, issues related to deafness continue to change. There are new and improved forms of amplification as well as various effective communication methodologies. Most importantly, there is a change in attitude. The deaf do not view themselves as disabled. Instead they have a sense of pride in sharing a culture and a common language. Through this understanding, respect for one another can be achieved.     

Noise-induced hearing loss

Hearing loss caused by exposure to recreational and occupational noise results in devastating disability that is virtually 100 percent preventable. Noise-induced hearing loss is the second most common form of sensorineural hearing deficit, after presbycusis (age-related hearing loss). Shearing forces caused by any sound have an impact on the stereocilia of the hair cells of the basilar membrane of the cochlea; when excessive, these forces can cause cell death. Avoiding noise exposure stops further progression of the damage. Noise-induced hearing loss can be prevented by avoiding excessive noise and using hearing protection such as earplugs and earmuffs. Patients who have been exposed to excessive noise should be screened. When hearing loss is suspected, a thorough history, physical examination and audiometry should be performed. If these examinations disclose evidence of hearing loss, referral for full audiologic evaluation is recommended.