Hearing loss and vestibular dysfunction among children with cancer after receiving aminoglycosides.

Abstract

BACKGROUND:

Children undergoing cancer therapy often receive aminoglycosides to treat febrile neutropenia or gram-negative infections. The magnitude of the risk of developing aminoglycoside-induced ototoxicity and the dose threshold at which that risk significantly increases are unknown.

PROCEDURE:

Eligible cancer patients received the aminoglycoside amikacin at Children's Medical Center between 2004 and 2007. They were aged 3-8 years; were without prior hearing loss; had no platinum-based chemotherapy, cranial radiation, nor bone marrow transplant; and received no loop diuretics within 6 weeks of testing. Consenting patients underwent complete hearing and vestibular testing.

RESULTS:

We tested 23 patients who had significant amikacin exposure. Three (13%) had abnormal hearing tests, and four (17%) had subclinical vestibular dysfunction; none had both. Of those with hearing loss, two were known to have developed hearing loss after aminoglycoside exposure, but the third had moderate to severe high-frequency sensorineural hearing loss bilaterally that had been undiagnosed. We observed clear dose-dependent ototoxicity; of the eight patients who received amikacin for a cumulative total of more than 50 days, five (68%) developed toxicity. Similarly, of the seven who received a cumulative total of more than 1,200 mg/kg, five developed toxicity.

CONCLUSIONS:

These data highlight the risks of prolonged aminoglycoside administration and warrant further validation in a larger group of patients. Patients to be treated with prolonged aminoglycoside therapy may benefit from prospective hearing screening.

• Authors: Kenneth S Chen, Alicia Bach, Angela Shoup, Naomi J Winick
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 60 Issue 11 Pg. 1772-7 (Nov 2013) ISSN: 1545-5017 [Electronic] United States
• PMID: 23788258 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Wiley Periodicals, Inc.

Chemical References

• Aminoglycosides
• Antineoplastic Agents
• Amikacin

Topics

• Amikacin (adverse effects)
• Aminoglycosides (adverse effects)
• Antineoplastic Agents (adverse effects)
• Child
• Child, Preschool
• Female
• Hearing Loss (chemically induced)
• Humans
• Male
• Neoplasms (drug therapy)
• Vestibular Diseases (chemically induced)
• Vestibular Evoked Myogenic Potentials (drug effects)