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Reduction of the hearing as a consequence of an antibiotic therapy

Question
My son is 4 years old and has CF (diagnosed after birth with meconium ileus). I had already the impression from the beginning, that he does not hear properly, which has been denied by the doctors mostly. Now, with increasing age it strikes even more to me again. At an online platform I heard from older CF patients, which do alike and who bring it in connection with their intake of antibiotics. My son has had in the first year some i.v. with diverse antbiotics, afterwards however almost exclusivley inhalation with Tobramycin, for a short period of time he takes in additon Azithromycin. At the latter, hardness of hearing is listed as a rare side-effect, at Tobramycin, as far as I do remember, at least effects on the ear canal (tinnitus, impairment of the balance). Are there any studies or number of cases, which do confirm an accumulation of problems with the hearing in CF patients, caused by antibiotics? If yes, are there any experiences to minimize these via changing of therapy respectively to avoid these (composition, dosage, etc.)? Is the damage irreversible or does the condition normalize itself after termination of the antibiotic therapy?
In other words: Can it be that the reduction of the hearing has been caused by the i.v. courses in the first year of life and is permanent?
Many thanks for your help
Answer
Dear questioner,
You ask, whethere there is any experience with impairment of the hearing in CF patients in connection with antibiotic therapy.

First of all it has to be clarified, if your child indeed has a reduction of the hearing. This can today be clarified easily with modern investigation methods. Furhtermore it has to be clarified, on which level the reduction of the hearing is (conductive component or inner ear impairment). Due to this, it has to be discussed with your doctors in charge what might be the possible causes.

You report, that your child received several antibiotic drugs i.v. in the first year of life. In general, today the drugs, which might potentially cause a reduction of the hearing, are dosed according to the blood level in such a way, that such a damage should not happen. Even under an inhalative therapy with Tobramycin, controls of the blood level should be conducted at the age of your child, in order to avoid this problem. The necessity of a permanent therapy with Azithromycin should be discussed with the doctors of your CF-center in case there is a reduction of the hearing.

Over all there are many publications dealing with reduction of the hearing in CF patients. These could be caused by a chronic effusion in the middle ear, which can lead to an impariment of the conductive component. With such a chronic effusion in the middle ear, the insert of a tube could be possibly necessary.

Reduction of the hearing due to drugs are especially known to be caused by Aminoglycosides (Tobramycin belongs to this group). They have been seen mostly in older patients, which received very often Aminoglycosides intravenously and per inhalation. Such impariments are in general hardly reversible. In case an impairment of the hearing can be stated, in general an extreme caution should be present at the usage of potentially hearing-damaging drugs in the future. It should be clarified urgently, if there is no other alternative drug available for treatment.
Yours sincerely,
Dr. H.-G. Posselt
30.06.2009