Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
Am J Otolaryngol. 2021 Sep-Oct;42(5):102640. doi: 10.1016/j.amjoto.2020.102640. Epub 2020 Jul 8.
Current clinical evidences do not support any specific treatment against SARS-CoV-2. Chloroquine (CQ) and hydroxychloroquine (HCQ) are typically used in the treatment of rheumatoid arthritis, systemic lupus erythematosus and malaria; they have been considered for off-label and compassionate use in several countries against moderate to severe cases of COVID-19 and there's actually a massive demand of these two drugs. The aim of this paper is to briefly review the published literature, summarizing evidences about audiological implications after CQ and HCQ treatment.
We conducted a review of the literature on Medline and Pubmed platforms from 27th May 2020 to 30 May 2020. We combined MeSH terms of "chloroquine", "hydroxychloroquine", "ototoxicity", "hearing loss", "tinnitus", "deafness" and "hearing". Publications with relevant data were included. Selected data (authors, country and year; sample size; study design; audiological side effects) were extracted and summarized in a table.
Of 45 initial studies, 14 met inclusion criteria. The authors found xix cases of HCQ ototoxicity; Tinnitus was reported in 2 cases, and it was found to be reversible or irreversible. Sensorineural hearing loss after HCQ use was reported in 7 patients; it was found to be irreversible or partially reversible after discontinuation of HCQ in 6 cases. Eight papers reporting CQ ototoxicity were; tinnitus was not reported by any authors. Sensorineural hearing loss after taking CQ was reported in 6 patients; it was found to be irreversible after discontinuation of CQ in 5 patients. One patient showed abnormal gait after a single intramuscular injection of CQ. Thirteen patients' Auditory Brainstem Response (ABR) were found to be abnormal, but they resolved after CQ discontinuation.
CQ and HCQ related ototoxicity is widely reported in the literature although the pathophysiological mechanism is not well known. Current data are not sufficient enough to support the use of CQ and HCQ as therapy for COVID-19, but considering the growing demand for these two drugs and the number of people around the world who have taken and will take CQ and HCQ, it must necessarily consider the clinical and social impact of long term audiological side effects.
目前的临床证据并不支持针对 SARS-CoV-2 的任何特定治疗方法。氯喹（CQ）和羟氯喹（HCQ）通常用于治疗类风湿关节炎、系统性红斑狼疮和疟疾；在一些国家，它们被考虑用于治疗中度至重度 COVID-19，并出现了对这两种药物的大量需求。本文的目的是简要综述已发表的文献，总结 CQ 和 HCQ 治疗后听力影响的证据。
我们对 2020 年 5 月 27 日至 5 月 30 日期间 Medline 和 Pubmed 平台上的文献进行了综述。我们结合了“氯喹”、“羟氯喹”、“耳毒性”、“听力损失”、“耳鸣”、“耳聋”和“听力”的 MeSH 术语。纳入了有相关数据的出版物。提取并总结了所选数据（作者、国家和年份；样本量；研究设计；听力副作用）。
在最初的 45 项研究中，有 14 项符合纳入标准。作者发现了 19 例 HCQ 耳毒性；2 例报告耳鸣，发现为可逆或不可逆。7 例患者在使用 HCQ 后出现感音神经性听力损失；在停止使用 HCQ 后，6 例发现为不可逆或部分可逆。有 8 篇报道 CQ 耳毒性的论文；没有作者报告耳鸣。6 例患者在服用 CQ 后出现感音神经性听力损失；在停止使用 CQ 后，5 例发现为不可逆。1 例患者在单次肌肉注射 CQ 后出现步态异常。13 例患者的听觉脑干反应（ABR）异常，但在停止使用 CQ 后恢复正常。
尽管病理生理学机制尚不清楚，但 CQ 和 HCQ 相关的耳毒性在文献中广泛报道。目前的数据不足以支持将 CQ 和 HCQ 作为 COVID-19 的治疗方法，但考虑到这两种药物的需求不断增加，以及全球范围内已经服用和将要服用 CQ 和 HCQ 的人数，必须考虑到长期听力副作用的临床和社会影响。
