Aminoglycoside and Hearing Loss in Children with Cystic Fibrosis - Thesis Example

? early detection of signs of aminoglycoside-induced hearing loss in children with cystic fibrosis [Type the document sub Aminoglycoside based antibiotics are being considered as one of the primary sources of auditory disorders among human beings, and especially in children. Cystic fibrosis also accompanies the hearing disorders and they can severely cause damage of lungs and pancreas. Similarly, ototoxicity can ruin and blemish the vestibular system in the children. There are two primary reasons behind these discrepancies. The Aminoglycoside antibiotic contains special kind of organic materials which target the high frequency hearing instead of low frequency hearing. So, the early detection mechanisms can deploy this factor in a very productive way because during the process of hearing, we normally deploy 0.3 up to 3 kHz; whereas, in high frequency hearing which is an exception in the daily life, the frequency range is around 20 to 25 kHz, at max. Therefore, the doctors and medics can detect and respond timely, based on the abnormal responses of the patient on low level frequencies. The dilemma, in the early detection of auditory damage, is that in most of the cases, the patients do not complaint about any problems with the hearing system and this is because of the fact that the detectable loss of hearing comes to feel in the frequency range of around 25 to 30 dB; whereas, the normal audiometer can detect from 8kHz and above. Due to this factor, around 77% of the reported cases of auditory damage are very problematic as the patient has usually reached the low frequency hearing losses (Asha.org, 2013). Literature Review There are numerous works done both in the past and present about the aminoglycoside-induced hearing loss in children and how this disease can be detected in early stages in order to avoid permanent deafness. The present works are mostly presented by American speech language and hearing association. Most of the present works focus on the importance of the fact that the symptoms of this disease must be detected and indentified timely, for example, Tobi Frymark says in his “Evidence based systematic review” of this disease that the cochlear defects are easily corrigible if detected and identified in time. Similarly, the importance of the drug induced effects on human ear and auditory systems are presented in one of the most useful works of the classical time named as the ‘aminoglycosides’, written by Bailey, in whom he predicted that with the advent of modern medicines that come with both cures and aftereffects. The same issues are discussed in Profound bilateral sensorineural hearing loss during gentamicin therapy written by Moffat DA and this book is also counted in standard textbook for hearing loss diseases. It has been reflected that nearly 90% of the checked for the hearing loss problems before they are discharged from the hospital. (Ross et al., 2008). Despite these measures the hearing loss in children is not diminished completely. According to study, nearly 30% of children were suffering hearing losses due to aminoglycoside based antibiotics. (Stredler Brown et al.., 2008) Modern experts are focusing their efforts to aware the parents because the hearing loss diseases among children can only be tracked if the parents can inform timely. Doctors are educating the parents about the basic signs through which they can detect the start of the disease, for example the problems in otitis media with effusion and white fluid in the middle side of the ear. Classical medics and experts of ear problems gave a very little heed on the relationship of unilateral hearing loss (UHL) and its comparative educational effects on child (Lieu, 2004). A study, that was conducted in order to evaluate the effects of hearing loss on children’s grades, depicted that around 62.5% of students who failed, had some degree of hearing loss or hearing issues and due to lack of hearing, their learning capabilities were adversely affected. Explanation Ototoxicity, which is an alias in the medical sciences for the damage to the ear in which the auditory nerves are afflicted, is caused by biotic medicines; for example, aminoglycoside gentamicin, loop diuretics and furosemide. These medicines and toxins are the importunate substances that cause the damage to the ears of children. As the ears of the children are not very resistant to the chemicals produced by these toxins and antibiotics, many a times the early detection of hearing loss is avoided. Such harmful medicines are also known as nonsteroidal anti-inflammatory drugs (NSAIDS). Such kind of medicines can cause disequilibrium in hearing among the children as they directly affect the ear barriers inside the human ear structure. Sensirunieural disease caused by these antibiotics, are the main cases of hearing losses which can be either temporary or permanent, if not detected or diagnosed timely. These medicines containing ototoxicity effects can harm the cochlea and ear vessels in a very detrimental way though the speed of the damage is very slow; because of this, the patient cannot detect the harm at early stages. Other examples of such medicines are gentamicin and tobramycin. When such kinds of antibiotic medicines are taken by the patient, they get bind with the inner structures of the ear vessels and the binding effect rises. The ototoxicity materials are also bound with NMDA receptors, which speed up the process of lack of hearing.  Chemotherapeutic agents and platinum containing antibiotic medicines are also very important causes of cochleotoxicity in the auditory systems inside the ear of children. The harmful effects of tinnitus which is a kind of ringing inside the ears are also cause by such chemotherapeutic agents. This process starts when these Cisplatin materials and other detrimental agents are collided with the cochlear skin hair vessels and produce oxygen reactive substances. This causes intense pain the ears of children as the inside substance, when reacts with the oxygen of the environment produce many harmful liquids inside the structural body of cochlea. The after effects of cisplatin-induced ototoxicity are also caused by aminoglycoside medicines. Such kinds of medicines must not be taken in excess to avoid the dangerous reactions inside the human ear. The decrease in these hearing losses can be achieved by decreasing the collision of the byproducts of these medicines with the cochlear barriers and avoidance of mixture of oxaliplatin ototoxicity and cochlear cells (Medscape.com, 2000). Ototoxic chemicals and antibiotic medicines are harmful for the human ear in many different ways. The mixture of different substances like Toluene, styrene or xylene is open for reaction with the walls of the ear and the results of such reaction are mutilating. Different metal substances in these medicines are also proving to be the agents of chemical processes having a key role in auditory damages. The following figure depicts the effect of aminoglycosides on hearing. Sciencedirect.com, 2010 The human ear is the sensory organ which has the sole qualities of hearing. The human ear comprises three main parts, the inner ear, the external ear and the middle ear. The inner ear has two main parts, the cochlea and vestibules. The other important part is named semicircular canals, and they have paramount importance in maintaining the balance in different hearing processes. There are numerous canals and tunnels in the inner ear of the human brain. Across these canals, there lies a very important part of the human hearing organ named membranous sacs, a very thin membrane material important in the listening process. The complex structure of epithelium is also housed in this membrane and that’s why its overall importance increases in the auditory processes. The labyrinth of this membrane is filled with endolymph and within this structure there is another fluid whose name is perilymph. The structure of cochlea covers the inner structure of the ear by making around three to four turns and thus protecting the whole body of ear with exposure to harmful chemicals. The bony structure of cochlea is further divided into three parts namely scala vestibule, upper chamber and he lower chamber. The first part is also known as cochlear duct. Single row o hair cells are situated at basilar membrane. The outer hair cells are situated above this structure. Synapsing is coming from the base of the ear line and form dendrites of the overall structure of the ear. The auditory nerve endings are the main causes of the sense of feel of noise and they end up in the brain stem with complex muscular openings and veins. Img, 2013 The human ear collects the energy from the acoustics from the outside world and converts it into neural stimuli which are then sent to the brain for further processing after every stimulus or reflex action. The voice, noise and other types of sounds are processed and certain results are sent back to the nerve endings in the human ear for further action. (Enchantedlearning, 2013) Among the causes of deaf effects and loss of hearing, the after effects of Aminoglycosids antibiotics are the importunate. The genetic mutation rate of around 2 to 3% is calculated among the user of these medicines and the victim of such after effects fall deaf permanently. Many aminoglycosides medicines are becoming obsolete in the market because of their detrimental effects but still there were around five types of harmful antibiotic medicines in the market which are the cause of permanent hearing loss among their users. The aminoglycosides causes permanent because it is normally for the higher frequencies. With the passage of time, the temporary hearing loss in converted into the permanent deaf ears due to lack of diagnosis. There are certain types of medicines which are the primary reasons of hearing loss among the human beings. These include Neomycin which is normally used in ointments and different creams and Streptomycin which is normally used for the treatment of tuberculosis. Such types of medicines does no show their effects instantly rather they take their time and start effecting the listening capabilities of the human ear from high frequency to low frequency. If the symptoms are detected at the start and appropriate treatment is done then there is no reason that they could not be stopped from damaging the auditory systems. Amikacin and Tobramycin are also some modern kinds of Aminoglycosids antibiotics which are still available in the market. (Politedissent.com, 2010) These medicines cause a strong binding effect of special kind of polyamine. Energy from the outside enters the cochlear structure through an oval window and then the remaining energy gets diminished through the round window of the auditory walls. Due to the vibrations of the sound that enters the ear from the window, the perilymph helps to form a certain type of oscillations which in turn gives birth to waves which passes through the brain stem. This wave passes through the whole structure of the cochlea and it takes less than 5msec to pass through the body of cochlea and expand within the ear. As the wave passes through the ear and touches the walls of the cochlea, it forces the basilar membrane to move in a oscillation type movement The wave travels throughout the body of cochlea and then the energy is converted into a form which can be converted into a kind of noise which is processed by the brain in order to start further processing (Emedicine.medscape.com, 2011). Figure shows the effect of ototoxicity outer hair cells loss (Science Direct, 2001) Cystic fibrosis is a life threatening disease in which think substance containing mucus build up in the lungs and damages the lungs from inside. The digestive system is also damaged by this disease. It is very common among the youth and children. In this disease, abnormally thick mucus is built into the human body which causes a great damage to  pancreas and lungs. The mucus tends to absorb all the food in the stomach and thus the patient becomes very much weak. The patients of cystic fibrosis are injected food with different small pipes and there is a great use of aminoglycosides antibiotics in these cases. That is why; the hearing loss starts instantly when the treatment starts. An Aminoglycosides antibiotics medicine cures the disease of CF temporarily but accompanies many after effects. The after effects are surfaced after sometime of the treatment and the patients can feel that there are some problems in listening to the sounds and low level frequencies. The doctors should pay a great amount of heed to the patients of CF disease if they are treating them with cystic fibrosis, the hearing disorders can be stopped if the symptoms can be caught at early stages. This disease of CF is very common in children and the situation is very critical when children cannot hear sounds because he cannot complaint about this disorder. Rigorous tests and different treatments must be made periodically while the treatment is in process in order to control the spread of hearing disorders. The doses are usually higher than normal in the treatment process of CF disease and the hearing loss effects can occur very instantly. This can be stopped if the medics test the patient very closely and keep an eye on the auditory systems of the patients. The hearing systems can be checked with many devices like audio meters and children can be checked from their responses to the actions taken place around them and some voices should be made periodically in their ears to check their working of auditory veins (Patient.co.uk, 1960). The effects of aminoglycosides antibiotics on the child patients are very adverse and catastrophic. According to a study in which 45 children from Great Ormond Street Hospital were observed, the children who were undergoing the treatment of CF disease with aminoglycosides antibiotics experienced up to 50dB of the threshold elevation and this is a very alarming rate. A pure tone audiometer of around 20 kHz was used in this study. Around 21% of the children were experiencing hearing disorders in the first 4 months of the treatment and this depicts that how damaging and deleterious effects, aminoglycosides antibiotics can have on the auditory systems of children. In another study there is an increasing rate of around 30% vestibulotoxicity in the children who are undergoing the treatment of CF diseases through aminoglycosides antibiotics. The children are the main victims of this disease have some reasons behind it. The lungs of the children are weak and the mucus makes it place up to other parts of the body very easily. Similarly when aminoglycosides antibiotics are used in the treatment process of CF disease then the hearing loss occurs very quickly as the medics cannot detect the initial symptoms (Ncbi.nlm.nih.gov, 2011). The recommendations from ASHA and BSA suggest that early identification of the disease is the key. It can stop the further spread of the disease and will stop it instantly before the permanent hearing disorders. The cochlear damage can be detected through a number of techniques and the communication between the doctor and the patient is a key in the identification processes. ASHA strongly suggests that there are no extra symptoms of ototoxic diseases except hearing loss and vestibular function. All the focus should be done on the hearing mechanism of the patient and how well they are working. Other recommendations include identification of different classes of patients and checking the patient history before start of the treatment. Computer-generated pharmacy should be used as a primary means in this process of classification. Audiologic Management of Individuals Treated with Cochleotoxic Drug Therapy suggests that there should be a pre-defined timeline for the periodic tests of the patients because time is a very grave metric in such cases. Continuous tracking is very necessary to avoid critical and pivotal up rise in the disease (Asha.org, 2013). Health.state.mn.us According to American academy of audiology, HFA was considered as a controversial means in monitoring ototoxicity but now there has been a consensus on the utility of using the technique of HFA in the treatment process. According to the report by American academy of audiology, the initial problems with this technique were resonating mechanics of high frequency waves involved in this. There was a study in which seventeen children were tested by using the technique of pure-tone audiometry in the treatment process. There results were very optimal as 94.1% of the children showed decreased signs of hearing loss and there was a much minimized rate of ototoxicity in the EHF range. That is why this means of treatment has been considered as one of the very effective ways to reduce the hearing problems among children and adults (Ncbi.nlm.nih.gov, 2007). As in every treatment process, the early identification of the aminoglycosides-induced hearing loss problem is the key because in this case, the high frequency disorders will be stopped instantly and the patient will not suffer the consequences of this problem permanently. Similarly, if the symptoms are identified and diagnosed effectively, many unforeseen problems can be avoided as prevention is always better than cure. According to a study, early identification of these hearing problems protected around 195 patients who could otherwise go on to suffer from auditory problems permanently, and this can only be done in cooperation and effective communication of the patients and the doctors. In case of children, the identification process is far more difficult due to lack of complaints from the patient side. In such cases, the parents of children and doctors should pay immense heed and use extra sensory equipments to keep track of abnormal behaviors of auditory responses from the child (Scielo.org.za, 2008). Reference List Asha.org (2013) American Speech-Language-Hearing Association | ASHA. [online] Available at: http://www.asha.org/ [Accessed: 6 Jan 2013]. Asha.org (2013) Ototoxic Medications (Medication Effects). [online] Available at: http://www.asha.org/public/hearing/Ototoxic-Medications/ [Accessed: 6 Jan 2013]. 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