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Ototoxicity management and cystic fibrosis (Garinis et al., 2021)

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posted on 22.09.2021, 15:37 by Angela C. Garinis, Gayla L. Poling, Ronald C. Rubenstein, Dawn Konrad-Martin, Timothy E. Hullar, David M. Baguley, Holly L. Burrows, Jennifer A. Chisholm, Amy Custer, Laura Dreisbach Hawe, Lisa L. Hunter, Theodore K. Marras, Candice E. Ortiz, Lucretia Petersen, Peter S. Steyger, Kevin Winthrop, Erika M. Zettner, Khaya Clark, Michelle Hungerford, Jay J. Vachhani, Carmen C. Brewer
Purpose: Specific classes of antibiotics, such as aminoglycosides, have well-established adverse events producing permanent hearing loss, tinnitus, and balance and/or vestibular problems (i.e., ototoxicity). Although these antibiotics are frequently used to treat pseudomonas and other bacterial infections in patients with cystic fibrosis (CF), there are no formalized recommendations describing approaches to implementation of guideline adherent ototoxicity monitoring as part of CF clinical care.
Method: This consensus statement was developed by the International Ototoxicity Management Working Group (IOMG) Ad Hoc Committee on Aminoglycoside Antibiotics to address the clinical need for ototoxicity management in CF patients treated with known ototoxic medications. These clinical protocol considerations were created using consensus opinion from a community of international experts and available evidence specific to patients with CF, as well as published national and international guidelines on ototoxicity monitoring.
Results: The IOMG advocates four clinical recommendations for implementing routine and guideline adherent ototoxicity management in patients with CF. These are (a) including questions about hearing, tinnitus, and balance/vestibular problems as part of the routine CF case history for all patients; (b) utilizing timely point-of-care measures; (c) establishing a baseline and conducting posttreatment evaluations for each course of intravenous ototoxic drug treatment; and (d) repeating annual hearing and vestibular evaluations for all patients with a history of ototoxic antibiotic exposure.
Conclusion: Increased efforts for implementation of an ototoxicity management program in the CF care team model will improve identification of ototoxicity signs and symptoms, allow for timely therapeutic follow-up, and provide the clinician and patient an opportunity to make an informed decision about potential treatment modifications to minimize adverse events.

Supplemental Material S1. Selected publications of CF-specific evidence-based outcomes for ototoxicity.

Garinis, A. C., Poling, G. L., Rubenstein, R. C., Konrad-Martin, D., Hullar, T. E., Baguley, D. M., Burrows, H. L., Chisholm, J. A., Custer, A., Dreisbach Hawe, L., Hunter, L. L., Marras, T. K., Ortiz, C. E., Petersen, L., Steyger, P. S., Winthrop, K., Zettner, E. M., Clark, K., Hungerford, M., … Brewer, C. C. (2021). Clinical considerations for routine auditory and vestibular monitoring in patients with cystic fibrosis. American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2021_AJA-21-00031

Publisher Note: This article is part of the Special Issue: Selected Papers From the 9th Biennial National Center for Rehabilitative Auditory Research Conference.

Funding

Funding for this work was supported in part by the National Institute on Deafness and Other Communication Disorders (Grant ZIA-DC000064, awarded to C. C. B.; Grant 1R21DC016128-01A1, awarded to A. C. G.; Grants DC004555 and DC016680, awarded to P. S. S.; Grant 1R01DC017867, awarded to L. L. H.; Grant 1R01DC017425, awarded to T. E. H.), as well as the Cystic Fibrosis Foundation (Grant GARINI1A90, awarded to A. C. G, P. S. S., and R. C. R.). D. M. B is supported by the UK National Institute for Health Research (NIHR): his views herein are his own and do not represent those of NIHR nor the UK Department of Health and Social Care. We would like to acknowledge the National Center for Rehabilitative Auditory Research at the Portland VA Health Care System for providing their support and resources to hold our first in-person IOMG meeting (VA Rehabilitation Research and Development Services Center Award-C2361C).

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