title: High-frequency audiometry reveals high prevalence of aminoglycoside ototoxicity in children with cystic fibrosis.
abstract: 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 dBHL hearing loss (mean±SD: 57.5±25.7 dBHL) 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 dBHL) only at 8 kHz in 5 of these 15 children and none in 2 subjects who had significantly elevated EHF 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.
authors.affiliation: University College London Ear Institute, 332 Gray's Inn Road, London WC1X 8EE, UK. Electronic address: g.al-malky@ucl.ac.uk.
authors.forename: Ghada
authors.initials: G
authors.lastname: Al-Malky
authors.affiliation: University College London Ear Institute, 332 Gray's Inn Road, London WC1X 8EE, UK.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Dawson
authors.affiliation: Department of Audiology & Audiological Medicine, Great Ormond Street Hospital, London WC1N 3JH, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Sirimanna
authors.affiliation: MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London WC1N 1EH, UK.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Bagkeris
authors.affiliation: Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London WC1N 3JH, UK.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Suri
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects; D001301:Audiometry, Pure-Tone / Q000379:methods; D002648:Child; D003550:Cystic Fibrosis / Q000188:drug therapy*; D005260:Female; D034381:Hearing Loss / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D017084:Otoacoustic Emissions, Spontaneous; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom
chemical_list: D000617:Aminoglycosides
keywords: Aminoglycoside; Audiometry; Cystic fibrosis; Ototoxicity