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Author Details
Srabanti Khemka
Ex-Lecturer (Speech & Hearing)
AYJNIHH(ERC), BONHOOGHLY
B.T.ROAD, KOLKATA-700090
*Mrs.Pamela Samaddar Sardar
Audiologist and Speech Language Pathologist
AYJNIHH(ERC), BONHOOGHLY
B.T.ROAD,KOLKATA-700090
[email protected]
Mob No-9830024303
Fax-033-25311427
Corresponding author
Mrs.Mita Sarkar
Lecturer (Speech & Hearing)
AYJNIHH(ERC), BONHOOGHLY
B.T.ROAD, KOLKATA-700090
[email protected]
Mob No-9830713110
Fax-033-25311427
DRUG INDUCED HEARING LOSS: A CASE STUDY
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Srabanti Khemka1,*Pamela Samaddar Sardar2, Mita Sarkar3
Ex-Lecturer, Speech and Hearing, AYJNIHH, ERC1
Audiologist & Speech Language Pathologist, AYJNIHH, ERC2
Lecturer, Speech and Hearing, AYJNIHH, ERC3
*Corresponding author: Pamela Samaddar Sardar, email id:[email protected]
Mob No-9830024303
ABSTRACT
Introduction: Hearing impairment occasionally accompanies medications such as
aspirin, non-steroidal anti-inflammatory drugs, and cis-platin (Seligmann et al. 1996). Use of
these medications, alone or in combination with exposure to hazardous noise, can result in highfrequency sensorineural hearing loss. The reactions of these drugs may affect all structures of
the hearing organ, and result in sensorineural or mixed hearing loss.
Aim of the study: This study investigates the configuration, type and degree of hearing
loss of a 12 year old boy who had taken drugs which were prescribed to him after he met with an
accident 3 years ago. The drugs which were prescribed to him were Coenflex, Niacin(Amikacin)
Injection and SN10. In addition, audiologic management is discussed with reference to
audiologic assessment, counseling, and use of amplification.
Method: Audiological assessment included clinical examination and otoscopy. Pure tone
audiometry was undertaken using Audiometer MAICO MA 53, including bone conduction
testing, impedance testing using GSI 38 Impedance Audiometer. Speech and Language
Assesssment was done for the case using various Speech Assessment Tools. Linguistic Profile
Test and Articulation Test in Bengali was administered.
Results: The patient revealed a profound sensorineural hearing loss in Right ear and a
severe high frequency sensorineural hearing loss in Left ear with impaired speech discrimination
ability bilaterally as well as misarticulated speech. The child was diagnosed as Age Appropriate
Language with misarticulation.
Discussion: In this study a subject who had been taking certain drugs namely SN10,
Niacin and Coenflex developed hearing loss with misarticulated speech. These had been
prescribed to the patient as antitoxins after the boy had met with an accident. Audiological tests
revealed a profound sensorineural hearing loss in Right ear and a severe high frequency
sensorineural hearing loss in Left ear with impaired speech discrimination ability bilaterally.
When a hearing loss has been documented, aural rehabilitation should be initiated. Counseling
the patient and his family regarding the hearing loss provides an opportunity to explain the use
of amplification as a rehabilitative approach.
Conclusion: The prevention and rehabilitation is an essential measure of such cases. In
selected cases with bilateral profound hearing loss or total deafness, cochlear implants may
prove effective. Further improvements in otologic diagnostics and therapy may allow better
prevention and management of drug induced-related hearing changes.
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INTRODUCTION
Clinically used drugs and chemical agents may potentially cause adverse effects to the
human auditory and vestibular systems. Many of them, such as aminoglycosides, quinine and
cisplatin, can play a critical role in the treatment of serious or life-threatening diseases; others,
like loop diuretics or salycilates, offer such important therapeutical effects compared to the
ototoxic side effects that the ototoxicity risk can be considered to be of minor importance. The
problem of ototoxicity is more acute in developing countries, where highly effective and lowcost drugs are more easily prescribed without adequate monitoring.
Medical awareness of doses, forms of administration, populations at risk, and possible synergism
is necessary in order to develop appropriate care in the prescription of drugs with ototoxic side
effects. Relatively recent issues such as risk-benefit analysis, patient-informed consent, and
quality-of-life considerations, particularly when life expectancy can be low, are also to be
considered. More than 230 drugs are known to cause hearing loss. Hearing loss ranges from mild
to profound and is temporary or permanent. It destroys hearing in very high frequencies
(Bauman, 2016)
NEED OF THE STUDY
This investigation was aimed at characterizing degree and the type of hearing loss as a
side effect to certain drugs which were given after an accident at the age of nine years. It was
also aimed at providing proper rehabilitative measures to the patients having such problems.
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OBJECTIVE OF THE STUDY
To investigate hearing impairment in a child after taking high doses of medication
(Coenflex, Niacin Injection and SN10) post-morbidly.
METHOD
A boy aged 12 years was taken as a subject for the study. A thorough case history of the
patient was taken. Audiological assessment included clinical examination and otoscopy. Pure
tone audiometry was done using Audiometer MAICO MA 53, including bone conduction testing
and impedance testing using GSI 38 Impedance Audiometer. The degree of hearing loss was
classified using the average of hearing thresholds at 0.5, 1, and 2 KHz frequencies. Hearing Aid
Trial comprised of both aided and unaided responses using verbal and non-verbal stimuli and this
was done using Audiometer AD229.
Speech and Language Assesssment was done for the case using various Speech
Assessment Tools. Linguistic Profile Test (LPT, Suchitra and Karanth, 1993) and Articulation
Test in Bengali (Banik and Karanth,1988) was administered. The child was diagnosed as Age
Appropriate Language with misarticulation.
RESULTS
Audiologic assessment as it is revealed in Table 1a, profound sensorineural hearing loss in Right
ear and a severe high frequency sensorineural hearing loss in Left ear with impaired speech
discrimination ability bilaterally as depicted in Table 1b.
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Table 1a: Air (AC) and bone (BC) conduction thresholds of right and left ear.
Frequency (Hz)
AC of Right Ear (dB)
AC of Left Ear (dB)
BC
250
80
80
40
500
90
85
60
1000
100
90
65
2000
110
95
75
4000
100
100
80 NR
6000
100
100
8000
115
110
Table 1b: Speech reception threshold(SRT), Speech discrimination Score(SDS), Uncomfortable
level(UCL), Most Comfortable level(MCL).
SpeechReceptionParameters
SRT (dB)
SDS (%)
UCL (dB)
MCL (dB)
Right Ear
120
Could not be done
115
90
Left Ear
115
Could not be done
115
85
Impedance audiometry revealed A type tympanogram with reflexes absent bilaterally except at
500Hz as depicted in Table 2.
Table 2: Tympanometric findings of right and left ears. ECV- external canal volume
Immittance parameters
ECV
Compliance (cm3)
Pressure (dapa)
Gradient
Tympanogram type
Right Ear
1.1
0.7
-20
65
A
Left Ear
0.9
0.6
-25
75
A
Hearing aid trial was also performed and the child was recommended a strong class body level
hearing aid.
Speech and Language Assessment: No misarticulation in vowels. Misarticulation in consonants
mostly in word middle and final positions of substitution and omission types. The Speech and
Language Assessment revealed that the child misarticulated in the following speech sounds.
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Substitution in the following phonemes |p|, |ph|, |bh| , |d͎|, |͎t|, |tʃ|, |tʃh |, |j|, |jh|, |g|, |gh|, |r|, |l|.
Omission in |tʃh|.
DISCUSSION
Of the various drug effects, neurological complications and hearing impairment are of
particular importance. Despite relatively high number of both animal and human studies, clearcut data on the incidence, type and severity of drug-induced ear toxicity are scarce. Drug-induced
damage can affect the hearing organ, especially the middle and inner ear up to the central
auditory pathways. It may result in, sensorineural or mixed (i.e., with both conductive and
sensorineural component) hearing loss. Sensorineural hearing loss (SNHL) can have sudden or
progressive character. SNHL typically appears several months or years after completion of
treatment.
It develops slowly after the intake of drugs. Damage to the cochlear nerve is
common. Studies reporting clinical data on use of drugs which had caused sensorineural hearing
deficit can occur gradually and progressively with the use of drugs over a span of 2-3 years
(Moretti, 1976; Leach, 1965). Niacin (Amikacin) is an injectable antibiotic. It is indicated in
short term treatment of serious infections to susceptible strain. Amikacin is given for infections
of organisms which are gram –ve or staphylococci. It is prescribed for serious cases of
pneumonia, meningitis, urinary tract infection and tuberculosis. Its side effect is hearing loss and
vertigo. (Johnson 2016).
In this study a subject who had been taking certain drugs namely SN10,Niacin and
Coenflex after the accident developed hearing loss with misarticulated speech. These had been
prescribed to the patient as antitoxins after the boy had met with an accident. Audiological tests
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revealed a profound sensorineural hearing loss in Right ear and a severe high frequency
sensorineural hearing loss in Left ear with impaired speech discrimination ability bilaterally.
Toxic substances are widely used in industry, agriculture, and transportation. Some are
ototoxins and some neurotoxins. These materials can cause a variety of insults to the
auditory mechanism, such as sensorineural hearing loss (Barregard and Axelsson 1984),
retrocochlear hearing loss (Hormes, Filley et al. 1986), and lesions in the higher auditory
pathways (Moshe et al. 2002). When a hearing loss has been documented, aural rehabilitation
should be initiated. Counseling the patient and his family regarding the hearing loss provides an
opportunity to explain the use of amplification as a rehabilitative approach. The possibility of a
progressive loss and speech problems suggests the need for periodic re-evaluations after the
initial assessment is completed.
CONCLUSION
Hearing loss may occur in patients due to administration of certain drugs caused by either
the disease process or the treatment method. Appropriate audiologic and speech-language
therapeutic services include hearing assessment ( regular hearing monitoring), speech-language
assessment, counseling, hearing aid trial and fitting and speech-language therapy. Effective
audiological management is essential to ensure adequate communication ability, psychological
adjustment, and general case management for the patient with hearing loss due to these drugs.
Due to its relatively high frequency, and serious implications, this should attract more attention.
And an attempt should be undertaken to prevent the hearing loss.
Uniform method of monitoring for all potentially ototoxic therapeutic drugs, does not
seem reasonable or practical. It is recommended, however, that the individual’s auditory function
be assessed for a particular drug being employed. Protocols and exams should be easy, quick,
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sensitive, reliable, and as objective as possible. Benefits of audiological monitoring include the
opportunity to change the patient's treatment course, improvement of patient and family
awareness of the impact of hearing impairment, timely prescription of amplification devices and
commencement of speech-language therapy. Finally, particular attention should be paid to highrisk populations such as neonatal intensive care unit patients.
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