Hearing thresholds in patients with drug-resistant tuberculosis: baseline audiogram configurations and associations / Limiares auditivos em pacientes com tuberculose resistente: configurações do audiograma basal e associações

ABSTRACT Objective: To use baseline audiogram parameters in order to ascertain whether drug-resistant tuberculosis (DR-TB) has effects on hearing, as well as to describe the configurations of the audiograms and to determine whether there are parameters that can be associated with those configurations. Methods: This was a prospective study involving patients diagnosed with DR-TB at a tuberculosis treatment center in the state of Ogun, in Nigeria. The patients included in the study were submitted to pure tone audiometry at baseline (within two weeks after treatment initiation). For comparative analyses, data regarding demographic and clinical characteristics were collected from the medical records of the patients. Results: The final sample comprised 132 patients. The mean age of the patients was 34.5 ± 12.6 years (range, 8-82 years), and the male:female ratio was 2:1. Of the 132 patients, 103 (78.0%) resided in neighboring states, 125 (94.7%) had previously experienced antituberculosis treatment failure, and 18 (13.6%) were retroviral-positive. Normal audiograms were found in 12 patients (9.1%), whereas sensorineural hearing loss was identified in 104 (78.8%), the two most common configurations being ascending, in 54 (40.9%), and sloping, in 26 (19.7%). Pure-tone averages at low frequencies (0.25-1.0 kHz) and high frequencies (2.0-8.0 kHz) were 33.0 dB and 40.0 dB, respectively. Regarding the degree of hearing loss in the better ear, 36 patients (27.3%) were classified as having normal hearing and 67 (50.8%) were classified as having mild hearing loss (26-40 dB), whereas 29 (21.9%) showed moderate or severe hearing loss. Among the variables studied (age, gender, retroviral status, previous treatment outcome, and weight at admission), only male gender was associated with audiometric configurations. Conclusions: In this sample of patients with DR-TB, most presented with bilateral, mild, suboptimal sensorineural hearing loss, and ascending/sloping audiometric configurations were associated with male gender.

RESUMO Objetivo: Utilizar parâmetros do audiograma basal para verificar se a tuberculose resistente (TB-R) tem efeitos na audição, descrever as configurações dos audiogramas e determinar se há parâmetros que possam ser associados a essas configurações. Métodos: Estudo prospectivo com pacientes diagnosticados com TB-R em um centro de tratamento de tuberculose no estado de Ogun, Nigéria. Os pacientes incluídos no estudo foram submetidos à audiometria de tons puros em até duas semanas após o início do tratamento (audiometria basal). Características demográficas e clínicas foram coletadas dos prontuários médicos dos pacientes para análises comparativas. Resultados: A amostra final envolveu 132 pacientes. A média de idade dos pacientes foi de 34,5 ± 12,6 anos (variação, 8-82 anos), e a razão homem:mulher foi de 2:1. A maioria dos pacientes (n = 103; 78,0%) residia nos estados vizinhos e tinha história de falha de tratamento antituberculose (n = 125; 94.7%); 18 (13.6%) apresentavam status retroviral positivo. Doze pacientes (9,1%) apresentaram audiogramas normais, e 104 (78,8%) apresentaram perda auditiva neurossensorial, sendo as configurações mais comuns do tipo ascendente, em 54 (40,9%), e descendente, em 26 (19,7%). As médias de tons puros em frequências baixas (0,25-1,0 kHz) e altas (2,0-8,0 kHz) foram de 33,0 dB e 40,0 dB, respectivamente. Quanto ao grau de perda auditiva no melhor ouvido, 36 pacientes (27,3%) apresentaram audição normal, e 67 (50,8%) apresentaram perda auditiva leve (26-40 dB), enquanto 29 (21,9%) mostraram perda auditiva moderada ou grave. Entre as variáveis estudadas (idade, gênero, status retroviral, desfecho de tratamento anterior e peso na admissão), somente o gênero masculino foi associado às configurações audiométricas. Conclusões: Nesta amostra de pacientes com TB-R, a maioria apresentou perda auditiva neurossensorial leve e subótima bilateralmente, com configurações audiométricas ascendentes/descendentes associadas ao gênero masculino.

Vestibulo-otologic Events in Drug-resistant Tuberculosis Patients on Medications.

Aims: This study aims to document the onset, types and factors associated with vestibulo-otologic (VO) events among patients on treatment for drug resistant Tuberculosis (DRTb). Study Design: This is a prospective study of patients with drug resistant Tuberculosis who were admitted for the intensive phase of treatment with injectable medications. Place and Duration of Study: The study was carried out at drug resistant Tuberculosis (DRTb) centre, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria between October 2013 and December 2014. Methodology: Patients with complaints referable to VO effects of medications were recruited into the study. Clinical evaluation included the type, onset and duration of the vestibular or otologic events. Further information were retrieved from the patients case note records which included age, sex, retroviral status, weight on admission and height, from where the body mass index (BMI) was calculated. Data analyses were performed using SPSS version 20. Results: A total of 121 patients comprising of 80 male and 41 female patients. Modal age group distribution for all patients was the group 21-40 years (72.7%), while the mean age ±SD was 32.9±13.7 years. The duration of treatment ranged from 12 to 20 weeks, mean ±SD= 14±3.4 weeks. VO events occurred in 40.5%, vestibular events alone were in 27.3% while otologic events alone occurred in 33.1%. The VO events were noticed between 6-19 weeks of treatment (mean ±SD= 11.1±4.7 weeks). Dizziness/imbalance were the most common vestibular while tinnitus was the most common otologic event. Among the patients with VO events, 13/46=28.3%, had repeat pure tone audiometry, and 7 (15.2%) met audiometric criteria for ototoxicity. Conclusion: Vestibulo-otologic events were common among DRTb patients in Nigeria. The major complaints started around 11 weeks on medication. Factors associated with the VO events were female gender, being underweight and retroviral positive.