Arslan E, Orzan E, Santarelli R
Audiology & Phoniatrics Department, University of Padova, Italy.
Ann N Y Acad Sci. 1999 Nov 28;884:1-14. doi: 10.1111/j.1749-6632.1999.tb00277.x.
Clinically used drugs and chemical agents may potentially cause adverse effects to the human auditory and vestibular systems. Many of them, such as aminoglycosides and cisplatin, can play a critical role in the treatment of serious or life-threatening diseases; others, like loop diuretics or salycilates, offer such important therapeutical effects compared to the ototoxic side effects that the ototoxicity risk can be considered to be of minor importance. The problem of ototoxic side effects is more acute in developing countries, where highly effective and low-cost drugs are more easily prescribed without adequate monitoring. Medical awareness of doses, forms of administration, populations at risk, and possible synergism is necessary in order to develop appropriate care in the prescription of drugs with ototoxic side effects. Relatively recent issues such as risk-benefit analysis, patient-informed consent, and quality-of-life considerations, particularly when life expectancy can be low, are also to be considered. At present, a uniform method of monitoring for all potentially ototoxic therapeutics does not seem reasonable or practical. It is recommended, however, that individual auditory function be noted for a particular drug being employed. Protocols and exams should be easy, quick, sensitive, reliable, and as objective as possible. Benefits of audiological monitoring include the opportunity to change the patient's treatment course, improvement of patient and family awareness of the impact of hearing impairment, and timely prescription of amplification devices. Finally, particular attention should be paid to high-risk populations such as neonatal intensive care unit patients.
临床使用的药物和化学制剂可能会对人类听觉和前庭系统产生潜在不良影响。其中许多药物，如氨基糖苷类和顺铂，在治疗严重或危及生命的疾病中起着关键作用；其他药物，如袢利尿剂或水杨酸盐，与耳毒性副作用相比具有重要的治疗效果，因此耳毒性风险可被视为次要问题。在发展中国家，耳毒性副作用问题更为严重，在这些国家，高效且低成本的药物在没有充分监测的情况下更容易被开处方。为了在开具具有耳毒性副作用的药物时制定适当的护理措施，有必要提高对剂量、给药形式、高危人群以及可能的协同作用的医学认识。还应考虑一些相对较新的问题，如风险效益分析、患者知情同意以及生活质量考量，尤其是在预期寿命可能较低的情况下。目前，对所有潜在耳毒性治疗药物采用统一的监测方法似乎不合理或不实际。然而，建议记录正在使用的特定药物的个体听觉功能。检测方案和检查应该简便、快速、灵敏、可靠且尽可能客观。听力监测的益处包括有机会改变患者的治疗方案、提高患者及其家属对听力损害影响的认识，以及及时开具助听设备的处方。最后，应特别关注高危人群，如新生儿重症监护病房的患者。
