Speech
Understanding Ototoxicity
Characteristics
The disease stems from toxic reactions to structures of the ear, including the cochlea, vestibule, semicircular canals and otoliths. Drug-induced damage to these structures of the auditory and balance system can result in hearing loss, tinnitus, disequilibrium or dizziness (Ryback 2007).
Etiology
The propensity of specific classes of drugs to cause ototoxicity has been well established and over 100 classes of drugs have been associated with ototoxicity. Hearing loss can be temporary but is usually irreversible with most agents. Generally, antibiotic-induced ototoxicity is bilaterally symmetrical, but it can be asymmetrical. The usual time of onset is often unpredictable, and marked hearing loss can occur even after a single dose (Ishiyama 2006). Additionally, hearing loss may not manifest until several weeks or months after completion of antibiotic or anti-neoplastic therapy (Dille 2003). Vestibular injury is also a notable adverse effect of aminoglycoside antibiotics and may appear early on with positional nystagmus. If severe, vestibular toxicity can lead to disequilibrium and oscillopsia (Fausti et al. 2009). Permanent hearing loss or balance disorders caused by ototoxic drugs may have serious communication, educational, and social consequences. Therefore, the benefits of ototoxic drugs must be weighed against the potential risks and alternative medications should be considered when appropriate. Management emphasis is on prevention, as most hearing loss is irreversible. No therapy is currently available to reverse ototoxic damage (Fausti et al. 2009).
Assessment of Ototoxicity
The definition and criteria for ototoxicity has been well established by the American Speech-Language-Hearing Association (ASHA). The ASHA defines ototoxicity as: (a) 20db or greater decrease in pure-tone threshold...
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