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. 2021 Oct 11;30(3S):800-809.
doi: 10.1044/2021_AJA-21-00031. Epub 2021 Sep 22.

Clinical Considerations for Routine Auditory and Vestibular Monitoring in Patients With Cystic Fibrosis

Angela C Garinis  1   2   3 , Gayla L Poling  4 , Ronald C Rubenstein  5 , Dawn Konrad-Martin  1   2 , Timothy E Hullar  1   2 , David M Baguley  6   7 , Holly L Burrows  8 , Jennifer A Chisholm  9 , Amy Custer  10 , Laura Dreisbach Hawe  11 , Lisa L Hunter  12 , Theodore K Marras  13 , Candice E Ortiz  8 , Lucretia Petersen  14 , Peter S Steyger  1   15 , Kevin Winthrop  16 , Erika M Zettner  17 , Khaya Clark  1   18   19 , Michelle Hungerford  1 , Jay J Vachhani  1 , Carmen C Brewer  9
Affiliations

Clinical Considerations for Routine Auditory and Vestibular Monitoring in Patients With Cystic Fibrosis

Angela C Garinis et al. Am J Audiol. .

Abstract

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 https://doi.org/10.23641/asha.16624366.

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Figures

Figure 1.
Figure 1.
Audiology referral flowchart for adult and pediatric patients with cystic fibrosis (CF). POC = point-of-care.
Figure 2.
Figure 2.
CF-specific case history questions and referral pathway for POC testing and audiological management by a trained CF care team member or audiologist. CF = cystic fibrosis; POC = point-of-care.
Figure 3.
Figure 3.
Audiology referral recommendations for patients receiving new IV-ototoxic treatment. IV = intravenous.
See this image and copyright information in PMC

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