ADR: Hearing Loss/ Ototoxicity

• A common cause of hearing loss is due to aminoglycosides if wax build-up and middle ear infections are ruled out.

Suggested Management Strategies​​ ​

• Documentation of the hearing loss should be done and compared with a baseline audiogram, if available (some degree of hearing loss occurs with most patients starting with a high-frequency loss). ​
• If early symptoms of hearing loss are documented, change the dosing of the injectable agent to twice/ thrice a week. ​
• Discontinue injectable agent if hearing loss continues despite dose adjustment and add additional drugs to reinforce the regimen. ​
• Even when additional drugs are not available, stopping the injectable agent can be considered based on the patient’s desire to maintain hearing.

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Points to Note​

• Patients with previous exposure to aminoglycosides may have baseline hearing loss. ​In such patients, audiometry may be helpful at the start of the Drug-resistant TB (DR-TB) treatment. ​
• Hearing loss is almost always permanent. Continuing the injectable agent despite hearing loss almost always results in irreversible deafness. ​
• While the benefit of hearing aids is minimal to moderate in auditory toxicity, consider a trial use to determine if a patient with hearing loss can benefit from its use.​
• A cochlear transplant can also be considered. 

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Ready Reckoner for Medical Officer - Adverse Drug Reactions Associated with Anti-TB Drugs Identification and Management, 2019.  ​
• Technical and Operational Guidelines for TB in India, 2016.