Osma Ustun, Kurtoglu Erdal, Eyigor Hulya, Yilmaz Mustafa Deniz, Aygener Nurdan
Department of Otorhinolaryngology, Antalya Training and Research Hospital, Varlık Mh. Kazim Karabekir Caddesi, 07100, Muratpaşa, Antalya, Turkey.
Ear Nose Throat J. 2015 Dec;94(12):481-5.
The predictive value of pure-tone audiometry (PTA) in the early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions testing appears to be more sensitive to cochlear insult than conventional PTA. We conducted a cross-sectional descriptive study to compare the efficacy of distortion-product otoacoustic emissions (DPOAE) testing with that of PTA as a method of audiologic monitoring. Our study group was made up of 159 patients (318 ears)-69 males (43.4%) and 90 females (56.6%), aged 5 to 61 years (mean: 23.59 ± 12.55). All patients had been diagnosed with either β-thalassemia major (BTM) or β-thalassemia intermedia (BTI), and all had received at least 1 year of treatment within the previous year with an iron chelator-either deferasirox, desferrioxamine (deferoxamine in the United States), deferiprone, or a combination of desferrioxamine and deferiprone. PTA and DPOAE evaluations were performed by the same audiologist using the same audiometer for all patients. In the right ears, the overall incidence of ototoxicity as manifested by sensorineural hearing loss was 39.0% on PTA and 22.0% on DPOAE testing; in the left ears, the corresponding figures were 27.7 and 19.5%, respectively. There were no statistically significant differences in the incidence of ototoxicity between the BTM and BTI groups with any of the four different drug regimens on PTA (p = 0.765, p = 0.378, p = 0.265, and p = 0.579, respectively) or on DPOAE testing (p = 0.890, p = 0.263, p = 0.390, and p = 0.340, respectively). Based on these data, we found no significant difference between PTA and DPOAE testing in their ability to detect ototoxicity. We conclude that periodic testing with both PTA and DPOAE is necessary for patients with suspected β-thalassemia in order arrive at a prompt diagnosis and initiate timely management.
纯音听力测定（PTA）在耳毒性早期检测中的预测价值受到质疑，尤其是在高频范围。耳声发射测试似乎比传统的PTA对耳蜗损伤更敏感。我们进行了一项横断面描述性研究，以比较畸变产物耳声发射（DPOAE）测试与PTA作为听力监测方法的效果。我们的研究组由159例患者（318只耳）组成，其中男性69例（43.4%），女性90例（56.6%），年龄在5至61岁之间（平均：23.59±12.55）。所有患者均被诊断为重型β地中海贫血（BTM）或中间型β地中海贫血（BTI），并且所有人在过去一年中均接受了至少1年的铁螯合剂治疗，铁螯合剂为地拉罗司、去铁胺（在美国为 deferoxamine）、去铁酮，或去铁胺与去铁酮的联合使用。所有患者的PTA和DPOAE评估均由同一位听力学家使用同一台听力计进行。在右耳中，以感音神经性听力损失表现的耳毒性总体发生率在PTA测试中为39.0%，在DPOAE测试中为22.0%；在左耳中，相应数字分别为27.7%和19.5%。在PTA（分别为p = 0.765、p = 0.378、p = 0.265和p = 0.579）或DPOAE测试（分别为p = 0.890、p = 0.263、p = 0.390和p = 0.340）中，BTM组和BTI组在四种不同药物治疗方案下的耳毒性发生率均无统计学显著差异。基于这些数据，我们发现PTA和DPOAE测试在检测耳毒性的能力上没有显著差异。我们得出结论，对于疑似β地中海贫血患者，定期进行PTA和DPOAE测试对于及时诊断和启动及时治疗是必要的。
