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Otoacoustic Emissions for Monitoring Aminoglycoside-Induced Ototoxicity in Children With Cystic Fibrosis
Pelagia Stavroulaki, MD;
Ioannis C. Vossinakis, MD;
Dimitra Dinopoulou, MD;
Spiros Doudounakis, PhD;
George Adamopoulos, PhD;
Nikolaos Apostolopoulos, PhD
Arch Otolaryngol Head Neck Surg. 2002;128:150-155.
Objective To investigate whether transient-evoked and distortion-product (DP)
otoacoustic emissions (OAEs) are more sensitive than pure-tone audiometry
(PTA) in revealing gentamicin-induced ototoxicity in children with cystic
fibrosis (CF).
Design Prospective case-control study.
Setting Tertiary referral audiologic center in conjunction with an academic
pediatric CF unit.
Participants The study group consisted of a consecutive sample of 12 audiologically
normal children with CF and a history of gentamicin exposure (CF-gentamicin
group). The control groups consisted of 8 age-matched children with CF and
11 age-matched healthy volunteers. No member of the control groups had a history
of aminoglycoside exposure.
Intervention Members of the CF-gentamicin study group received 4 mg/kg of gentamicin
per day for a mean of 14.2 days (range, 11-29 days).
Outcome Measures The PTA thresholds (250-8000 Hz) were the criterion standard. Transient-evoked
OAEs' reproducibility at 5 frequency bands (800, 1600, 2400, 3200, and 4000
Hz) and total emission level were measured, as were DP-audiogram (DP-gram)
amplitude (1001-6299 Hz), input-output function dynamic range, and detection
thresholds at 4004, 6006, and 7996 Hz. Baseline measurements were compared
between groups examining the effect of CF and previous gentamicin exposure
(2-way analysis of variance). For the CF-gentamicin group, baseline measurements
were compared with those at the end of the last gentamicin treatment (paired t test).
Results The PTA findings were normal for all groups at baseline and remained
normal in the CF-gentamicin group after treatment. The CF-gentamicin group
had significantly lower transient-evoked OAEs total emission level, DP-gram
amplitude at 5042 Hz, and input-output dynamic ranges with higher detection
thresholds in all frequencies compared with both control groups, which was
attributed completely to previous gentamicin exposure (P<.05). After treatment, further decreases in total emission levels,
DP-gram amplitudes (>3000 Hz), and dynamic ranges were noted, with increased
detection thresholds (P<.05).
Conclusions Otoacoustic emissions measurement (especially of DP OAEs) proved more
sensitive than PTA in revealing minor cochlear dysfunction after gentamicin
exposure. They should be used for monitoring patients receiving ototoxic factors
such as aminoglycosides.
From the University Department of Otolaryngology–Head and Neck
Surgery, Southmead Hospital, Bristol, England (Dr Stavroulaki); Department
of Orthopedic Surgery, Weston General Hospital, Weston-Super-Mare, England
(Dr Vossinakis); and the Ear, Nose and Throat Department, Faculty of Medicine,
University of Athens (Drs Dinopoulou and Adamopoulos), Department of Cystic
Fibrosis, Children's Hospital Agia Sofia (Dr Doudounakis), and Department
of Otorhinolaryngology –Head and Neck Surgery, Children's Hospital Panagiotis
& Aglaia Kyriakou (Dr Apostolopoulos), Athens, Greece.
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