University of Minnesota - Unity Hospital, Fridley, MN 55432, USA.
Ann Pharmacother. 2010 Jan;44(1):207-10. doi: 10.1345/aph.1M250. Epub 2009 Dec 22.
To document the presentation of 2 cases of sudden sensorineural hearing loss (SSHL) following methadone overdose.
We report 2 cases of acute, bilateral methadone-induced hearing loss that took place on the same night in our emergency department. A 30-year-old male and his 25-year-old wife were found unresponsive in their home after ingesting an unknown, but presumably large, quantity of methadone. Drugs that are typically categorized as ototoxic were ruled out in each patient via rapid in-house urine drug screens as well with a comprehensive analysis via gas chromatography mass spectrometry. Methadone and tetrahydrocannabinol (THC) were the only drugs found in the toxicology screenings that were common to both patients. The man had a long treatment course that included several days in the intensive care unit. The woman recovered completely and was discharged within a day of admission. The hearing loss in both patients reversed completely within 24 hours.
Several medications are commonly associated with ototoxicity, including nonsteroidal antiinflammatory drugs, antibiotics, loop diuretics, and chemotherapy agents. Although rare, drug-induced SSHL has been documented particularly among intravenous drug abusers after heroin injection. Until now, there has been only one published case report documenting drug-induced SSHL attributed to methadone.
We believe methadone to be the probable cause of SSHL in both patients, because it and THC were the only common drugs found on toxicology screens, a recent case report involved methadone-induced SSHL, and because of the suddenness of the onset and recovery of the patient's hearing coinciding with the time frame of the ingestion. The Naranjo probability scale score revealed that the adverse reaction was probable for each patient.
记录 2 例美沙酮过量后突发性感觉神经性听力损失（SSHL）的表现。
我们报告了 2 例急性双侧美沙酮诱导的听力损失病例，这两例病例均发生在我院急诊科的同一个晚上。一名 30 岁男性和他 25 岁的妻子被发现在家中失去意识，他们摄入了未知但推测大量的美沙酮。通过快速的内部尿液药物筛查以及通过气相色谱质谱进行全面分析，排除了每位患者的典型耳毒性药物。美沙酮和四氢大麻酚（THC）是唯一在毒理学筛查中发现的药物，而且这两种药物在两位患者中均存在。该男子的治疗过程较长，包括在重症监护病房住了几天。该女子在入院一天内完全康复并出院。两位患者的听力损失均在 24 小时内完全逆转。
几种药物通常与耳毒性有关，包括非甾体抗炎药、抗生素、袢利尿剂和化疗药物。尽管罕见，但药物引起的 SSHL 已在静脉注射药物滥用者尤其是在海洛因注射后被记录。到目前为止，只有 1 篇已发表的病例报告记录了美沙酮引起的 SSHL。
我们认为美沙酮是这两例患者 SSHL 的可能原因，因为它和美沙酮是毒理学筛查中唯一共同存在的药物，最近的病例报告涉及美沙酮引起的 SSHL，而且患者听力的突然发作和恢复与摄入时间一致。Naranjo 概率量表评分显示，每位患者的不良反应均为可能。
