Extended high-frequency audiometry for ototoxicity monitoring (Stevenson et al., 2023)

Purpose: The aim of this study was to describe extended high-frequency (EHF) pure-tone audiometry monitoring of ototoxicity in a longitudinal treatment program for drug-resistant tuberculosis (DRTB). Method: This was a retrospective record review of longitudinal conventional (0.25–8 kHz) and EHF (9–16 kHz) audiometry for ototoxicity monitoring of DRTB patients undergoing treatment at community-based clinics between 2013 and 2017. Data from 69 patients with an average age of 37.9 years (SD = 11.2, range: 16.0–63.8 years) were included. Patients were assessed by primary health care audiologists (87%) or community health workers (13%) using portable audiological equipment. The average length of time between initial and exit assessments was 84.6 days (SD = 74.2, range: 2–335 days). Results: EHF ototoxicity of a mild or greater degree of hearing loss (> 25 dB HL in one or both ears across frequencies) was evident in 85.5% of patients’ posttreatment, compared with 47.8% of patients across conventional frequencies. EHF audiometry demonstrated an ototoxic shift (American Speech-Language-Hearing Association criteria) in 56.5% of cases compared with 31.9% when only conventional audiometry was considered. Mean hearing deterioration for patients was significant across EHFs (9–16 kHz) bilaterally (p < .05). Absent EHF thresholds at the initial assessment, owing to maximum output limits, was a limitation that occurred most frequently at 16 kHz (17.4%, 24/138). Conclusions: EHF audiometry is most sensitive for the early detection of ototoxicity and should be included in monitoring programs. Clinical ototoxicity monitoring protocols should consider shortened assessment approaches that target frequencies most sensitive to ototoxicity, including EHFs. Supplemental Material S1. Mean hearing thresholds for initial and exit assessment with hearing deterioration across ears (N = 69). Stevenson, L. J., Biagio-de Jager, L., Graham, M. A., & Swanepoel, D. W. (2023). Extended high-frequency audiometry for ototoxicity monitoring: A longitudinal evaluation of drug-resistant tuberculosis treatment. American Journal of Audiology, 32(1), 70–80. https://doi.org/10.1044/2022_AJA-22-00039

研究目的：本研究旨在描述针对耐多药结核病（drug-resistant tuberculosis, DRTB）患者的纵向治疗方案中，耳毒性监测的扩展高频（extended high-frequency, EHF）纯音测听应用情况。
研究方法：本研究为回顾性病历资料分析，纳入2013至2017年间在社区诊所接受治疗的DRTB患者，采用纵向常规（0.25–8 kHz）及扩展高频（9–16 kHz）纯音测听开展耳毒性监测。最终纳入69例患者的临床数据，患者平均年龄为37.9岁（标准差SD=11.2，年龄范围16.0–63.8岁）。检测工作由87%的基层卫生保健听力学专业人员及13%的社区卫生工作者借助便携式听力学设备完成。初始评估与末次评估的平均间隔时长为84.6天（SD=74.2，间隔范围2–335天）。
研究结果：治疗后，85.5%的患者出现轻度及以上程度的扩展高频耳毒性听力损失（单耳或双耳各频率听力阈值＞25 dB HL），而常规频率测听中这一比例仅为47.8%。符合美国言语语言听力协会标准的耳毒性偏移在扩展高频测听中占比56.5%，仅采用常规测听时这一比例为31.9%。患者双侧扩展高频（9–16 kHz）的平均听力下降具有统计学显著性（p < 0.05）。初始评估中因设备最大输出限制未能测得扩展高频阈值的情况，在16 kHz频率点最为常见（占比17.4%，24/138）。
研究结论：扩展高频纯音测听对耳毒性的早期检测敏感性最高，应将其纳入耳毒性监测方案。临床耳毒性监测流程应考虑采用针对耳毒性敏感频率（包括扩展高频段）的简化评估方案。
补充材料S1：纳入69例患者的初始与末次评估平均听力阈值及双耳听力下降情况（N=69）。
参考文献：Stevenson, L. J., Biagio-de Jager, L., Graham, M. A., & Swanepoel, D. W. (2023). 扩展高频纯音测听用于耳毒性监测：耐多药结核病治疗的纵向评估. 《美国听力学杂志》, 32(1), 70–80. https://doi.org/10.1044/2022_AJA-22-00039