Ototoxicity

Hearing loss (hearing impairment) is an illness which significantly affects the quality of life and sometimes can be also a signalling symptom of a life threatening diseases. The cause can be often a result of several influences such as aging, various internal illnesses, noise impact and also ototoxicity, which we wouldlike to explain in this article.

CLPraskyDid you know that drug overdose can result in a hearing problem? Children are often affected by this issue, but it’s not a rule. Ototoxicity or “ear poisoning” is a gained disease caused by side effects of strong drugs which are intended for treating serious diagnosis such as cancer, strong inflammation or chronic conditions. It is a damage of a part of the inner ear (cochlea) or the vestibulocochlear nerve which was affected by allochthonous substance. Ototoxicity is usually gained by bigger intake of the normal dose of drugs, that’s when the excess of the effective substances damages the vestibular system in the inner ear or the vestibulocochlear nerve. That creates a disorder of leading the signal to the brain which subsequently results in hearing impairment.

CAUSES OF THE ILLNESS

Drug cause:

  • Antibiotics - Streptomycin, Gentamicin, Neomycin, Erythromycin
  • Cytotoxic agents - Cisplatin, Carboplatin, Bleomycin, Vincristine
  • Diuretics - Furosemide, Ethacrynic Acid, Acetazolamide
  • Other drugs - Acetylsalicylic acid, nicotine

More:

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  • Styrene
  • Toluene
  • Mercury
  • Carbon Monoxide

SYMPTOMS AND HOW DOES OTOTOXICITY MANIFEST

Among main symptoms is:

  • Impaired hearing
  • Tinnitus (ringing in the ears)
  • Stuffy ears

Other symptoms mas be:

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  • Change in the hearing in one or both ears
  • Sudden change in the sound perception in a certain high tone
  • Worsened or absent speech, communication disorders
  • Taking longer time to form answers
  • Balance disorders in a sitting position, standing and walking
  • Blurred vision after fast head turn
  • Often headaches

Less common symptoms:

  • Vertigo (sensation of spinning motion)
  • Nausea (sensation of unease and discomfort in the upper stomach)
  • Pressure or pain in the ear
  • Dizziness
  • Diarrhea

DIAGNOSIS, THERAPY AND PREVENTION

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In case you observe occurrence of one of the mentioned symptoms, it is optional if you don’t delay and search immediately for a doctor. Diagnosis by pediatricians is usually based on removing the anamnesis and re-evaluation of the prescribed drugs and the dosage. That is followed by general examination and detection of the damaged area, then you will be most likely sent to visit Otorhinolaryngology - ENT, which is a subspecialty within medicine that deals with conditions of the ear, nose, and throat (ENT). Thanks to special tests the extent of the damage will be found. Examination on the ENT can look like this:

  • Behavioral hearing test: observing the behavior of the child during specific sounds in form of calibration of speech and various tones.
  • Examining the brainstem: inserting small hearing aids into the ear canal and studying the reactions of the vestibulocochlear nerve to various types of sounds.
  • Otoacoustic emission: (OAE) observing the feedback of the cells in the inner ear by placing a small device into the ear canal.
  • Electronystagmography: observing the movement of the eyes during visual stimulation
  • Posturography: standing on a stable and unstable platform in order to examine the balance

The treatment is depending especially on removing the initiating causes. So far there is no verified effective therapy. Therefore there is only one option left: preventing any further damage by stopping to take toxic medications. The most important thing is an early elimination of the substances that are causing the problems, except when the general benefit from the treatment of the ototoxic drug is bigger than the manifestation of the ototoxicity. In case you can’t eliminate the drugs completely, the intake will significantly reduce until the problem is under control. Early detection can prevent further damage, and help to completely recover the lost functions. Changes in the ear can be reversible or permanent. Hearing loss is compensated by hearing aids.


The basis for non existent therapy treating the ototoxicity is therefore prevention, which is depending on the doctor and consistent examination of the patient along with weighing the potential risk of undesired effects before prescribing the medications with a possible ototoxic effect. You can prevent these health problems by consistent observation. If you or your child suffers from ototoxicity, don’t despair and deal with the situation in time.

HOW CAN PHYSIOTHERAPIST HELP YOU

It’s not unusual that roaring or ringing in ears, vertigo, or nausea may be connected to disbalance in the neck muscles, along with blockage in the cervical spine and ribs. So if the drugs and other unwanted substances have been eliminated as the primary cause along with the pathological conditions, which is in competency of the doctor, it wouldn’t do any harm to visit a physiotherapist, who should be able to tell you based on the complexive kinesiologic examination whether there is effective solution in form of rehabilitation for your problems.



Author:
 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

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