Adult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Department of Audiology, Imperial College Healthcare NHS Trust, London, UK.
Thorax. 2020 Aug;75(8):632-639. doi: 10.1136/thoraxjnl-2019-214177. Epub 2020 May 14.
Individuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry in a sound-booth is costly, time-consuming and requires a trained audiologist. This cross-sectional study analysed tablet-based audiometry (Shoebox MD) performed by non-audiologists in an outpatient setting, alongside home web-based audiometry (3D Tune-In) to screen for hearing loss in adults with CF.
Hearing was analysed in 126 CF adults using validated questionnaires, a web self-hearing test (0.5 to 4 kHz), tablet (0.25 to 12 kHz) and sound-booth audiometry (0.25 to 12 kHz). A threshold of ≥25 dB hearing loss at ≥1 audiometric frequency was considered abnormal. Demographics and mitochondrial DNA sequencing were used to analyse risk factors, and accuracy and usability of hearing tests determined.
Prevalence of hearing loss within any frequency band tested was 48%. Multivariate analysis showed age (OR 1.127; (95% CI: 1.07 to 1.18; p value<0.0001) per year older) and total intravenous antibiotic days over 10 years (OR 1.006; (95% CI: 1.002 to 1.010; p value=0.004) per further intravenous day) were significantly associated with increased risk of hearing loss. Tablet audiometry had good usability, was 93% sensitive, 88% specific with 94% negative predictive value to screen for hearing loss compared with web self-test audiometry and questionnaires which had poor sensitivity (17% and 13%, respectively). Intraclass correlation (ICC) of tablet versus sound-booth audiometry showed high correlation (ICC >0.9) at all frequencies ≥4 kHz.
Adults with CF have a high prevalence of drug-related hearing loss and tablet-based audiometry can be a practical, accurate screening tool within integrated ototoxicity monitoring programmes for early detection.
患有慢性肺部疾病（例如囊性纤维化（CF））的个体经常接受包括氨基糖苷类药物在内的抗菌治疗，从而导致耳毒性。扩展高频听力测定法提高了对耳毒性检测的敏感性，但在隔音室内进行诊断性听力测定既昂贵又耗时，并且需要经过培训的听力学家。这项横断面研究分析了在门诊环境中由非听力学家进行的基于平板电脑的听力测定（Shoebox MD），并结合家庭网络听力测定（3D Tune-In），以筛查 CF 成人的听力损失。
使用经过验证的问卷，网络自我听力测试（0.5 至 4 kHz），平板电脑（0.25 至 12 kHz）和隔音室内听力测试（0.25 至 12 kHz）对 126 名 CF 成人的听力进行了分析。≥1 个听力测试频率下≥25 dB 的听力损失被认为是异常的。使用线粒体 DNA 测序分析了人口统计学和危险因素，并确定了听力测试的准确性和可用性。
在所测试的任何频段中，听力损失的患病率为 48％。多变量分析显示，年龄（每增加 1 岁，OR 1.127；（95％CI：1.07 至 1.18；p 值<0.0001））和 10 年内静脉内抗生素的总天数（每增加 1 天，OR 1.006；（95％CI：1.002 至 1.010；p 值=0.004））与听力损失风险增加显著相关。平板电脑听力测定具有良好的可用性，与网络自我测试听力测定和问卷相比，其对听力损失的筛查具有 93％的敏感性，88％的特异性和 94％的阴性预测值（分别为 17％和 13％）。平板电脑与隔音室内听力测定的组内相关系数（ICC）在所有≥4 kHz 的频率上均显示出高度相关性（ICC>0.9）。
CF 成人中有很高的药物相关性听力损失患病率，基于平板电脑的听力测定可以作为早期发现的综合耳毒性监测计划中实用，准确的筛查工具。
