An audiological profile of patients infected with multi-drug resistant tuberculosis at a district hospital in KwaZulu-Natal

• Published in: South African journal of communication disorders Vol. 63; no. 1; pp. 1 - 12
• Main Authors: Appana, Delicia, Joseph, Lavanithum, Paken, Jessica
• Format: Journal Article
• Language: English
• Published: South Africa Health and Medical Publishing Group (HMPG) 25.11.2016; AOSIS (Pty) Ltd; AOSIS; South African Speech-Language-Hearing Association (SASLHA)
• Subjects: Adolescent; Adult; Aminoglycosides - adverse effects; Aminoglycosides - therapeutic use; audiological monitoring; Audiological profiles; Audiology; Audiometry; Audiometry, Pure-Tone; aural rehabilitation; Communication; Drug dosages; Evaluation Studies as Topic; Female; Hearing disorders; Hearing loss; Hearing Loss - chemically induced; Hearing Loss, Bilateral - chemically induced; Hearing protection; Hospitals; Hospitals, District; Humans; Infectious diseases; Longitudinal Studies; Male; Middle Aged; multi-drug resistant tuberculosis, ototoxic hearing loss; Original Research; Otoacoustic Emissions, Spontaneous - drug effects; Otolaryngology; Patients; Quality of life; Research methodology; Sampling techniques; Sensorineural hearing loss; South Africa; Speech perception; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Young Adult; South Africa; KwaZulu-Natal Province South Africa
• ISSN: 0379-8046; 2225-4765; 2225-4765
• DOI: 10.4102/sajcd.v63i1.154

Background: The increased incidence of multi-drug-resistant tuberculosis (MDR-TB) and the consequent use of aminoglycosides with their ototoxic potential necessitate a better understanding of the audiological pattern of infected patients.Objective: To describe the occurrence and nature of hearing loss in patients with MDR-TB receiving aminoglycosides over a period of 6 months.Methods: Baseline and five consecutive monthly audiological assessments were conducted on 52 adults at a hospital in KwaZulu-Natal. A longitudinal descriptive study was implemented. A conventional audiological test battery, extended high frequency audiometry and otoacoustic emission testing were conducted. Data were analysed using SPSS version 19 statistical software package.Results: Decreased hearing was the most common audiological symptom experienced. Bilateral sensorineural hearing loss was predominant. Ototoxic hearing loss was noted in 27 participants (52%) in 1 month post-treatment. Hearing loss progressed from mild to moderate at post-treatment one, to moderate to severe at post-treatment three and severe to profound at post-treatment five. Changes in hearing function were noted in 52 participants (100%) by post-treatment five. High and ultra-high frequencies were most affected. Speech discrimination scores deteriorated over time. The number of patients with absent distortion product otoacoustic emissions increased over treatment duration.Conclusion: The greatest effects were observed in the high frequencies before manifesting in the lower frequencies. This highlights the importance of inclusion of high frequency audiometry in the early detection of ototoxicity which can go undiagnosed with traditional audiometry. The high prevalence of hearing loss has implications for the provision of audiological service to this patient population.