Department of Otolaryngology, Kimberley Hospital Complex; and Division of Otolaryngology, University of Cape Town Medical School.
S Afr Med J. 2012 May 8;102(6 Pt 2):363-6. doi: 10.7196/samj.4964.
Background. Ototoxicity following aminoglycoside treatment for multidrug-resistant tuberculosis (MDR-TB) is a significant problem. This study documents the incidence of ototoxicity in HIV-positive and HIV-negative patients with MDR-TB and presents clinical guidelines relating to ototoxicity. Methods. A prospective cohort study of 153 MDR-TB patients with normal hearing and middle ear status at baseline controlling for 6 mitochondrial mutations associated with aminoglycoside-related ototoxicity, at Brooklyn Chest Hospital in Cape Town. Pure tone audiometry was performed monthly for 3 months to determine hearing loss. HIV status was recorded, as was the presence of 6 mutations in the MT-RNR1 gene. Results. Fifty-seven per cent developed high-frequency hearing loss. HIV-positive patients (70%) were more likely to develop hearing loss than HIV-negative patients (42%). Of 115 patients who were genetically screened, none had MT-RNR1 mutations. Conclusion. Ototoxic hearing loss is common in MDR-TB patients treated with aminoglycosides. HIV-positive patients are at increased risk of ototoxicity. Auditory monitoring and auditory rehabilitation should be an integral part of the package of care of MDR-TB patients.
氨基糖苷类药物治疗耐多药结核病（MDR-TB）后出现耳毒性是一个重大问题。本研究记录了 HIV 阳性和 HIV 阴性 MDR-TB 患者的耳毒性发生率，并提出了与耳毒性相关的临床指南。
在开普敦布鲁克林胸医院对 153 例基线时听力和中耳状态正常的 MDR-TB 患者进行前瞻性队列研究，控制了与氨基糖苷类药物相关的耳毒性相关的 6 种线粒体突变。每月进行纯音测听 3 个月以确定听力损失。记录 HIV 状态以及 MT-RNR1 基因中 6 种突变的存在情况。
57%的患者出现高频听力损失。HIV 阳性患者（70%）比 HIV 阴性患者（42%）更易发生听力损失。在接受基因筛查的 115 名患者中，均未发现 MT-RNR1 突变。
氨基糖苷类药物治疗的 MDR-TB 患者中常出现耳毒性听力损失。HIV 阳性患者发生耳毒性的风险增加。听觉监测和听觉康复应成为 MDR-TB 患者护理套餐的一个组成部分。
