Effectiveness of medical interventions implemented during ototoxicity monitoring to prevent further deterioration of hearing thresholds


  • Hlupheka M. Maluleka
  • Silva Kuschke http://orcid.org/0000-0002-1046-7435
  • Lebogang Ramma Health & Rehabilitation Sciences
  • Smangele Mashele
  • Matsie M. Ntatamala
  • Tracy A. Frosler
  • Ezethu B. Potelwa
  • Dylan G. Walker




Background: MDR-TB patients are often treated with aminoglycosides which may lead to irreversible ototoxic hearing impairment. Early identification of changes in the hearing thresholds of patient is critical in facilitating treatment modifications that can minimise communication impairment.

Design: A retrospective review of medical records of all patients who underwent ototoxicity monitoring from 2012-2014 was conducted. Patients treated with aminoglycosides and with normal hearing thresholds at baseline were included.

Results: 26 of 509 patient records met inclusion criteria.  There were 9 males and 17 females. The mean age was 36.81±11.48. Half of the participants were on treatment for ≤160 days, whereas the rest were on treatment for ≥161 days. The greatest deterioration in hearing thresholds (post-treatment initiation) occurred in the high frequencies (4-8 kHz). Participants on treatment for >160 days had the greatest deterioration in hearing thresholds. Modifying the frequency of drug administration led to a lesser degree of deterioration of hearing thresholds.

Conclusion: Early detection of deterioration in hearing thresholds can potentially minimise ototoxicity in patients who are being treated with aminoglycosides. More research is needed regarding the effectiveness of these strategies.


Download data is not yet available.

Author Biography

Lebogang Ramma, Health & Rehabilitation Sciences



American Academy of Audiology. 2009. Position statement and clinical practice guidelines: ototoxicity monitoring [homepage on the Internet]. Available from: http://www.audiology.org/publications-resources/document-library/ototoxicity-monitoring [2015, November 18].

American Speech-Language-Hearing Association. 1994. Guidelines for the audiologic management of individuals receiving cochleotoxic drug therapy [Guidelines]. Asha, 36 (Suppl. 12), 11-19. Available: http://www.asha.org/policy/GL1994-00003.htm#AP1 [2015, November 18].

Bardien, S., Jong, G.D., Schaaf, H. S., Harris, T., Fagan, J., & Petersen, L. 2009. Aminoglycoside-induced hearing loss: South Africans at risk. South African Medical Journal, 99(6): 440-441.

Bates, D. E., Beaumont, S. J., & Baylis, B. W. 2002. Ototoxicity induced by gentamicin and furosemide. Annals of Pharmacotherapy, 36(3):446-451.

Brown, R. F., Hullar, T. E., Cadieux, J. H., & Chole, R. A. 2010. Residual hearing preservation after paediatric cochlear implantation. Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 31(8): 1221-1226. http://doi.org/10.1097/MAO.0b013e3181f0c649

Ciorba, A., Bianchini, C., Pelucchi, S., & Pastore, A. 2012. The impact of hearing loss on the quality of life of elderly adults. Clinical Intervention Aging, 7, 159-163. DOI: 10.2147/CIA.S26059

Chang, K.W., & Chinosornvatana, N. 2010. Practical grading system for evaluating cisplatin ototoxicity in children. Journal of Clinical Oncology, 28(10): 1788-1795.

De Jager, P., & Van Altena, R. 2002. Hearing loss and nephrotoxicity in long-term aminoglycoside treatment in patients with tuberculosis. The International Journal of Tuberculosis and Lung Disease, 6(7): 622-627.

Duggal, P., & Sarkar, M. 2007. Audiologic monitoring of multi-drug resistant tuberculosis patients on aminoglycoside treatment with long term follow-up. BMC Ear, Nose and Throat Disorders, 7(1):5. Available: http://www.biomedcentral.com/1472-6815/7/5 [2015, July 22].

Durrheim, K. L. 2002. Factorial analysis of variance. In Numbers, hypotheses and conclusions. C.G. Tredoux & K.L. Durrheim ,Eds. Cape Town: Juta Publishers. 289-307.

Elfenbein, J. L., Hardin-Jones, M. A., & Davis, J. M. 1994. Oral communication skills of children who are hard of hearing. Journal of Speech, Language, and Hearing Research, 37(1): 216.Available: EBSCOHost Communication & Mass Media Complete [2015, July 22].

Fausti, S. A., Larson, V. D., Noffsinger, D., Wilson, R. H., Phillips, D. S., & Fowler, C. G. 1994. High-frequency audiometric monitoring strategies for early detection of ototoxicity. Ear and Hearing, 15(3): 232-239.

Fischel-Ghodsian, N., Prezant, T. R., Chaltraw, W. E., Wendt, K. A., Nelson, R. A., Arnos, K. S., & Falk, R. E. 1997. Mitochondrial gene mutation is a significant predisposing factor in aminoglycoside ototoxicity. American Journal of Otolaryngology, 18(3):173-178.

Frymark, T., Leech, H., Mullen, R., Schooling, T., Venediktov, R., & Wang, B. 2010. Evidence-Based Systematic Review: Drug-Induced Hearing Loss-Amikacin. ASHA’s National Center for Evidence-Based Practice in Communication Disorders.

Harris, T., Bardien, S., Schaaf, H. S., Petersen, L., De Jong, G., & Fagan, J.J. 2012. Aminoglycoside: induced hearing loss in HIV-positive and HIV-negative multidrug-resistant tuberculosis patients. South African Medical Journal, 102(6):363-365.

Human, H., Hagen, C. M., Jong, G. D., Harris, T., Lombard, D., Christiansen, M., & Bardien, S. 2010. Investigation of mitochondrial sequence variants associated with aminoglycoside-induced ototoxicity in South African TB patients on aminoglycosides. Biochemical and Biophysical Research Communications, 393(4):751-756.

Khoza-Shangase, K., Mupawose, A., & Mlangeni, N.P. 2009. Ototoxic effects of tuberculosis treatments: How aware are patients? African Journal of Pharmacy and Pharmacology, 3: 391-399.

Konrad-Martin, D., Gordon, J., Reavis, K., Wilmington, D., Helt, W., & Fausti, S. 2005. Audiological monitoring of patients receiving ototoxic drugs. Perspectives on Hearing and Hearing Disorders: Research and Diagnostics. 1: 17-22. DOI:10.1044/hhd9.1.17.

Leon, A. C., Davis, L. L., & Kraemer, H. C. 2011. The role and interpretation of pilot studies in clinical research. Journal of Psychiatric Research, 45(5): 626-629.

Mann, C. J. 2003. Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emergency Medicine Journal, 20(1): 54-60. DOI: 10.1136/emj.20.1.54

Michel, P. 2003. Strengths and weaknesses of available methods for assessing the nature and scale of harm caused by the health system: Literature review. World Health Organization.

Moore, R. D., Smith, C. R., & Lietman, P. S. 1984. Risk factors for the development of auditory toxicity in patients receiving aminoglycosides. Journal of Infectious Diseases, 149(1): 23-30.

Peloquin, C. A., Berning, S. E., Nitta, A. T., Simone, P. M., Goble, M., Huitt, G. A., & Curran-Everett, D. 2004. Aminoglycoside toxicity: daily versus thrice-weekly dosing for treatment of mycobacterial diseases. Clinical Infectious Diseases, 38(11):1538-1544.

Pooran, A., Pieterson, E., Davids, M., Theron, G., & Dheda, K. 2013. What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa. Public Library of Science One, 8, e54587.

Schacht, J., Talaska, A. E., & Rybak, L. P. 2012. Cisplatin and Aminoglycoside Antibiotics: Hearing Loss and Its Prevention. Anatomical Record (Hoboken), 295, 1837-1850. DOI:10.1002/ar.22578

Schellack, N., & Naude, A. 2012. An overview of pharmacotherapy-induced ototoxicity. South African Family Practice, 55(4):357-366.

Selimoglu, E. (2007). Aminoglycoside-induced ototoxicity. Current Pharmaceutical Design. 13(1): 119-26.

Silman, S. & Silverman, C. A. 1991. Auditory diagnosis: principles and applications. Academic Press.

Song, J. W., & Chung, K. C. 2010. Observational studies: cohort and case-control studies. Plastic and Reconstructive Surgery, 126(6): 2234. DOI:10.1097/PRS.0b013e3181f44abc.

Suen, L. J., Huang, H. M., & Lee, H. H. 2014. A comparison of convenience sampling and purposive sampling [Abstract]. Hu Li Za Zhi, 61(3): 105. DOI: 10.6224/JN.61.3.105

Theunissen, E. A., Dreschler, W. A., Latenstein, M. N., Rasch, C. R., van der Baan, S., de Boer, J. P., & Zuur, C. L. 2014. A New Grading System for Ototoxicity in Adults. Annals of Otology, Rhinology & Laryngology, 123(10):711-718.

Wang, S., Bian, Q., Liu, Z., Feng, Y., Lian, N., Chen, H., Hu, C., Dong, Y., & Cai, Z. 1999. Capability of serum to convert streptomycin to cytotoxin in patients with aminoglycoside-induced hearing loss. Hearing Research, 137(1): 1-7.

Whitehorn, H., Sibanda, M., Lacerda, M., Spracklen, T., Ramma, L., Dalvie, S., & Ramesar, R. 2014. High prevalence of cisplatin-induced ototoxicity in Cape Town, South Africa. SAMJ: South African Medical Journal, 104(4):288-291.

World Health Organization. 2006. Guidelines for management of drug resistant tuberculosis. Geneva, (WHO/TB/2006.361).

World Health Organization. 2014. Global tuberculosis Report. Geneva, (WHO/HTM/TB/2014.08).

World Medical Association. 2013. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. Jama, 310(20): 2191.

Xie, J., Talaska, A. E., & Schacht, J. 2011. New developments in aminoglycoside

therapy and ototoxicity. Hearing Research, 281(1):28-37. DOI:10.1016/j.heares.2011.05.00