Effects of NSAIDs on the Inner Ear: Possible Involvement in Cochlear Protection

Preliminary Analysis of Drug-Induced Ototoxicity in South Korea: Trends From a National Sample Dataset

BACKGROUND AND OBJECTIVES

Certain medications are associated with ototoxicity. This study assesses drug-induced ototoxicity in South Korea by analyzing the Korean national health data.

SUBJECTS AND METHODS

Hospital records of National Health Insurance members from 2009 to 2016 were reviewed. Data were compared between patients with and without hearing loss (HL). Individuals with HL were identified as having a primary diagnosis code for sensorineural HL or another type of HL in at least one outpatient or inpatient record according to the International Classification of Diseases-10.

RESULTS

The members in the HL group increased slightly from 0.8% to 1.0% relative to the total sample, compared with 99.2% to 99.0% among the controls. The proportion of males in the HL group ranged from 45.6% to 47.6%, compared with 48.4% to 48.8% among the controls. The proportion of those aged ≥65 years in the HL group increased from 34.1% to 41.4%, compared with 10.6% to 13.3% among the controls. Hypertension prevalence (24.7%-25.7%) in the HL group was higher than that in the control group (12%-12.6%). Diabetes prevalence in the HL group was 10.6%-12.3%, compared with 4.4%-5.9% among the controls. The use of proton pump inhibitor components increased, particularly esomeprazole magnesium trihydrate and rabeprazole sodium, whereas the usage of pantoprazole sodium sesquihydrate and revaprazan was high initially but declined subsequently. The usage of painkillers such as acetaminophen, loxoprofen sodium, and ibuprofen remained high, and antibiotics such as cephalosporins indicated the highest usage. However, the use of penicillin antibiotics such as amoxicillin decreased significantly. Anticancer agents showed relatively low usage compared with other drug categories, whereas antihistamines showed extremely high usage across all years, with a continual increase.

CONCLUSIONS

These correlations and the underlying mechanisms necessitate further investigation, as several medicines have been linked to an increased risk of HL.

Which Environmental Pollutants Are Toxic to Our Ears?-Evidence of the Ototoxicity of Common Substances

Ototoxicity refers to the adverse effects of substances on auditory or vestibular functions. This study examines the evidence of ototoxicity's association with exposure to common environmental pollutants, as documented in toxicological profiles by the Agency for Toxic Substances and Disease Registry. Our aim was to evaluate whether the evidence supports modifying the charting of ototoxic effects in the summary tables of these toxicological profiles and providing a guide for scientists to access these data. Health outcomes of interest included hearing loss, vestibular effects, cochlear lesions, tonal alterations, cellular damage, and ototoxicity-related outcomes (neurological, nephrotoxic, hepatic, and developmental effects). We obtained ototoxicity information for 62 substances. Hearing-related effects were reported, along with neurological effects. Overall, 26 profiles reported strong evidence of ototoxicity, including 13 substances previously designated as ototoxic by other health and safety agencies. Commonly studied outcomes included hearing loss, damage to ear anatomy, and auditory dysfunction. Vestibular dysfunction and tinnitus are rarely studied. Our findings highlight the lack of conclusive evidence of ototoxic properties for many substances, especially for pesticides and herbicides. This review supports charting the evidence of ototoxicity separately in toxicological profiles' summary tables. Improving the communication of ototoxicity-related health effects might impact their recognition and prompt further research. A stronger evidence base could support improved prevention efforts in terms of serious health outcomes.

A Nationwide Population-Based Study for the Recurrence and Comorbidities in Sudden Sensorineural Hearing Loss

OBJECTIVES

The aims of this study were to investigate the cumulative recurrence rate of SSNHL and to determine association between comorbidities and recurrence of SSNHL by comparing patients with and without recurrence.

METHODS

Using the National Health Insurance Claims Database (NHICD) from 2009 to 2020, we conducted a population-based study. We only enrolled patients whose records showed a prescription for steroid and audiometry findings as well as an appropriate diagnostic code. Recurrence of SSNHL was defined as an episode of SSNHL greater than or equal to 3 months after the first episode of SSNHL. We compared the recurrence rate of SSNHL according to age and number of SSNHL recurrences. We also explored comorbidities including autoimmune, metabolic, chronic renal diseases, cancer, and migraine associated with recurrent SSNHL.

RESULTS

A total of 257,123 patients were identified. We found that 6.7% (17,270/257,123) of the patients had at least one recurrence of SSNHL. The recurrence rate increases with the number of recurrences and over time. The incidence per 100,000 people tended to increase with age, and the recurrence rate appeared to decrease with age. We found an increase in the incidence of ankylosing spondylitis (AS) and a decrease in the incidence of type 2 diabetes mellitus (T2DM), myocardial infarction (MI), and hemorrhagic stroke in patients with recurrence.

CONCLUSION

For patients with recurrence or AS, considerable efforts should be made to prevent recurrence. As SSNHL is an emergent otologic condition, when symptoms occur, they should receive immediate treatment. Additional well-designed population-based studies are required to generalize our results.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:1417-1425, 2024.

External auditory canal injuries in maxillofacial trauma - Proposal of a symptom-based treatment algorithm with a report of twelve cases

Purpose

Injury to the external auditory canal (EAC) may occur following facial trauma. They manifest as otalgia, ear bleeding, otorrhea, facial palsy, or altered hearing. But literature regarding its management is sparse. The study aimed to identify the incidence and types of EAC injury in facial trauma, grade their severity, and propose a symptom-based treatment algorithm.

Patients and Methods

This was a prospective case series involving patients with signs/symptoms of EAC injury following maxillofacial trauma. The EAC was evaluated by clinical examination, imaging, endoscopy, and audiometry. Clinical findings were graded into mild, moderate, and severe. Treatment was matched to clinical findings according to the proposed algorithm. The outcomes of the study were incidence and types of EAC injury in facial trauma and resolution of presenting signs/symptoms. Data were analyzed for descriptive statistics using SPSS software (v26; IBM, Armonk, NY).

Results

A total of 88 patients reported with maxillofacial trauma during a 6-month period. Signs/symptoms of EAC injury were observed in 41 patients, of which 12 (11 males and 1 female) were confirmed with a diagnosis of EAC injuries. Eight patients demonstrated only cartilaginous injuries while three had bony injuries. Treatment was successful in 11 out of 12 patients, with a best point estimate of 0.86 (Z score-1.959, 95% CI).

Conclusion

Clinical findings of EAC injury mandate thorough investigation to ascertain the site and severity of the injury. Symptom-based treatment of EAC injuries produces an effective resolution of signs/symptoms and improved treatment outcomes.

Establishment of an optimized guinea pig model of cisplatin-induced ototoxicity

Background

Cisplatin is among the most effective antineoplastic agents and has revolutionized the treatment of many cancer diseases. However, one of its serious side effects is a progressive and irreversible hearing loss, occurring in both adults and children. For the development of otoprotective therapies that prevent this side effect, cisplatin-induced hearing loss animal models are indispensable. Due to the high toxicity of cisplatin, the establishment of such animal models is a difficult and time-consuming task. Here we introduce the detailed protocol of a sophisticated guinea pig model with a sufficient and permanent hearing loss induced by cisplatin. This manuscript is intended to provide guidance in the development of future cisplatin guinea pig models which may reduce the mortality rate of the animals and help to gain more reproducible results.

Methods

Pigmented and unpigmented guineapigs were treated with an intravenous single application of 8 mg/kg cisplatin under general anesthesia. An extensive and long-term intensive care protocol consisting of scheduled application of fluids, antiemetics, analgesics, glucose and supportive feeding among others, was used to ensure wellbeing of the animals. Hearing tests were performed prior to and 5 days after cisplatin application. Animals were then euthanized.

Results

The ABR audiometry 5 days after cisplatin application revealed a hearing threshold ranging from 70 dB to 90 dB in the frequencies from 1 kHz to 32 kHz respectively.All animals presented a good health condition despite the treatment with cisplatin.

Discussion

The introduced care protocol in this manuscript is intended to serve as a guidance for the establishment of a stable guinea pig model for short- and long-term investigation regarding the inner ear and its protection in the frame work of cisplatin-induced damage.

Longitudinal Study of Analgesic Use and Risk of Incident Persistent Tinnitus

BACKGROUND

Persistent tinnitus is common, disabling, and difficult to treat. High-dose aspirin may precipitate tinnitus, but longitudinal data on typical dose aspirin and other analgesics are scarce.

OBJECTIVE

To investigate independent associations of aspirin, NSAIDs, and acetaminophen and risk of incident persistent tinnitus.

DESIGN

Longitudinal cohort study.

SETTING

Nurses' Health Study II (1995-2017).

PARTICIPANTS

A total of 69,455 women, age 31-48 years, without tinnitus at baseline.

MAIN MEASURES

Information on analgesic use and tinnitus obtained by biennial questionnaires.

KEY RESULTS

After 1,120,936 person-years of follow-up, 10,452 cases of incident persistent tinnitus were reported. For low-dose aspirin, the risk of developing persistent tinnitus was not elevated among frequent low-dose aspirin users. For moderate dose aspirin, frequent use was associated with higher risk of tinnitus among women aged < 60 years, but not among older women (p-interactionage = 0.003). Compared with women aged < 60 using moderate-dose aspirin < 1 day/week, the multivariable-adjusted hazard ratio (MVHR, 95% CI) among women using moderate-dose aspirin 6-7 days per week was 1.16 (1.03, 1.32). Among all women, frequent non-aspirin non-steroidal anti-inflammatory drug (NSAID) or acetaminophen use was associated with higher risk. Compared with women using NSAIDs <1 day/week, the MVHR for use 4-5days/week was 1.17 (1.08, 1.28) and for 6-7days/week was 1.07 (1.00, 1.16) (p-trend=0.001). For acetaminophen, compared with use <1 day/week, the MVHR for use 6-7days/week was 1.18 (1.07, 1.29) (p-trend=0.002).

LIMITATIONS

Information on tinnitus and analgesic use was self-reported. Information on indications for analgesic use was not available. Studies in non-White women and men are needed.

CONCLUSION

The risk of developing persistent tinnitus was not elevated among frequent low-dose aspirin users. Among younger women, frequent moderate-dose aspirin use was associated with higher risk. Frequent NSAID use and frequent acetaminophen use were associated with higher risk of incident persistent tinnitus among all women, and the magnitude of the risks tended to be greater with increasing frequency of use. Our results suggest analgesic users are at higher risk for developing tinnitus and may provide insight into the precipitants of this challenging disorder, but additional investigation to determine whether there is a causal association is needed.

New Insight on the Safety of Erenumab: An Analysis of Spontaneous Reports of Adverse Events Recorded in the US Food and Drug Administration Adverse Event Reporting System Database

AIM

The aim of this article was to provide an overview of adverse events reported for erenumab in post-marketing through the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and perform a disproportionality analysis with other drugs used for acute or preventative treatment of migraine as controls.

METHODS

FAERS was screened from the first quarter of 2018 to the second quarter of 2020 (latest data update 30 June 2020). Clinical and demographic characteristics of cases were described along with the seriousness and outcome of adverse events. Disproportionality analyses were performed using the reporting odds ratio (ROR).

RESULTS

In total, 23,312 cases were reported during the study period, 67.0% by consumers. Cases in the age range 18-64 years (10,922 cases; 45.8%), in female sex (15,099 cases; 64.8%), and with adverse events that were classified as non-serious (19,626 cases; 84.2%) were the most prevalent in the database. After the exclusion of duplicates, 146 fatal cases were identified. A total of 1303 unlabeled adverse events were reported, of which 49 had statistically significant disproportionality of reporting in comparison with other drugs used for acute or preventative treatment of migraine. Identified disproportionality signals included alopecia, depression, anxiety, myocardial infarction, increased heart rate, pulmonary embolism, weight alteration, insomnia, tinnitus, and influenza-like symptoms. Injection-site reactions (labeled events) were co-reported with errors in administration procedures.

CONCLUSION

Adverse events reported during the first 2 years of post-marketing surveillance were mostly non-serious and with a favorable prognosis. However, new safety aspects emerged for which further studies are needed to confirm the associations, prioritizing unlabeled events with consistent disproportionality signals (e.g., emerging in at least 4 out of 6 analyses).

Moxifloxacin-induced tinnitus in an older adult

An increased risk of bacterial resistance toward fluoroquinolones and the increased risk of disabling and serious adverse effects prompted the US Food and Drug Administration to recommend limiting fluoroquinolone use to the treatment of community-acquired pneumonia, skin and skin-structure infections, bacterial sinusitis, plague, chronic bronchitis exacerbations, and complicated intra-abdominal infections. We report a case of moxifloxacin-induced tinnitus in an older adult prescribed oral moxifloxacin 400 mg for 5 days for the treatment of acute diverticulitis, due to allergies to nonfluoroquinolone preferred agents. A thorough literature review provided few other reported incidents of this rare and serious adverse event.