The Importance of Otoneurological Evaluation in Brazilian Workers Exposed to Pesticides: A Preliminary Study

Introduction: Agrochemicals, also known as pesticides, are widely used in agriculture and in public health. They are organic and inorganic chemical substances with a high level of toxicity not only for the environment, but also for human health. Objective: To verify findings on labyrinthine assessment in endemic disease control agents, and to recommend the inclusion of the vestibular exam in the set of tests for pesticide-exposed populations. Methods: Descriptive, prospective, cross-sectional study with a sample comprising 15 endemic disease control agents, males, mean age of 51.6 years old (standard deviation [SD] = 5.9). All of the participants were submitted to anamnesis, otorhinolaryngological screening, and vestibular assessment. Results: Regarding the most reported complaints, dizziness (73.4%), headache (60%), and tingling in the extremities (53.4%) were observed. The findings of the vestibular exams were normal in 53.3%, while 46.7% showed peripheral vestibular disorder, of which 26.7% were of deficitary type, and 20% of the irritative type. Conclusions: Alteration in the vestibular system was verified in 50% of the workers, with a greater prevalence in the caloric testing. Several disorders related to pesticides intoxication are scientifically known. Actions promoting knowledge and qualification of this population for the proper handling of chemicals are suggested, in addition to the elaboration and inclusion of protocols of vestibular assessment in hearing health programs for the prevention, diagnosis and treatment of vestibular disorders (AU)

The importance of audiometric monitoring in patients with multidrug-resistant tuberculosis

Abstract INTRODUCTION: A total of 771 cases of multidrug-resistant tuberculosis (MDR-TB) were reported in Brazil in 2014. Treatment of MDR-TB with aminoglycosides can produce serious side effects such as permanent and irreversible hearing loss, which occurs in 5-64% of cases, and severely compromise patient quality of life. The goal of this research was to evaluate auditory and vestibular side effects in patients treated for MDR-TB and to identify associations between these complaints and the type of aminoglycoside used. METHODS: We performed a retrospective review of 599 medical records from patients with MDR-TB who were treated at the Hélio Fraga/Fiocruz Reference Center between 2006 and 2010. Cases without auditory or vestibular complaints and patients who were not treated with aminoglycoside drugs were excluded from the study. RESULTS: Of 164 eligible cases, 55 (33.5%) reported an auditory or vestibular complaint and medication was subsequently suspended, although hearing damage was not confirmed in all cases. Audiometric testing confirmed hearing loss in 11 (21.7%) of 12 cases submitted for evaluation. Hearing loss related to ototoxicity was confirmed in 15 (62.5%) cases. Tinnitus was significantly associated with the use of amikacin and streptomycin. CONCLUSIONS: Evaluations of ototoxicity symptoms were not usually reported in the routine care of patients with MDR-TB. Complaints of tinnitus were associated with amikacin and streptomycin use. These results require confirmation in future studies.

Ototoxicidad por medicamentos / Drug-induced ototoxicity

Se define ototoxicidad a las perturbaciones transitorias o definitivas de la función auditiva, vestibular, o de las dos a la vez, inducidas por sustancias de uso terapéutico. Son muchos los trabajos de investigación que se han dedicado ha este tema quedando aun dudas por resolver debido a las complejas consecuencias donde está envuelto el daño cocleovestibular. El propósito de esta revisión, es presentar las últimas teorías que tratan de explicar desde el punto de vista de la farmacociónética/farmacodinamia, biología celular y molecular el mecanismo por el cual actúan los fármacos involucrados. Lo anteriormente señalado tiene como fin que los últimos adelantos en esta materia, permitan una mejor comprensión que nos lleve a una práctica clínica más segura con relación a la ototoxicidad medicamentosa, dando a conocerlos cuidados y precauciones que se deben tomar antes de administrar un fármaco que se reconoce ototóxico, que puede tener graves consecuencias en la calidad de vida de nuestros pacientes.

Ototoxicity is defined as the transient or definitive perturbations of the auditory and/ or vestibular function, induced by drugs of therapeutic use. Despite a large body of literature devoted to this subject, there are still unanswered questions, due to the complex consequences of cochleovestibular damage. The present study aims to review recent theories that try to explain the mechanism of action of involved drugs, from the viewpoint of pharmacokinetics/pharmacodynamics, cell and molecular biology. Our purpose is that recent advances in this matter could lead to a better understanding and safer clinical practice related to drug-induced ototoxicity, summarizing the care and precautions that should be taken when administering a known ototoxic drug...

Relato de desordens vestilococleares causadas por álcool / Report of vestibulo-cochlear disorders induced by alcohol

Este trabalho tem como objetivo demonstrar a necessidade e a importância da avaliaçäo otoneurológica neste tipo de paciente, muitas vezes visto exclusivamente pelo clínico geral e ignorado quanto aos seus distúrbios vestibulococleares