Hearing thresholds at high frequency in patients with cystic fibrosis: a systematic review

Abstract Introduction: High-frequency audiometry may contribute to the early detection of hearing loss caused by ototoxic medications. Many ototoxic drugs are widely used in the treatment of patients with cystic fibrosis. Early detection of hearing loss should allow known harmful drugs to be identified before the damage affects speech frequencies. The damage caused by ototoxicity is irreversible, resulting in important social and psychological consequences. In children, hearing loss, even when restricted to high frequencies, can affect the development of language. Objective: To investigate the efficacy and effectiveness of hearing monitoring through high-frequency audiometry in pediatric patients with cystic fibrosis. Methods: Electronic databases PubMed, MedLine, Web of Science and LILACS were searched, from January to November 2015. The selected studies included those in which high-frequency audiometry was performed in patients with cystic fibrosis, undergoing treatment with ototoxic drugs and published in Portuguese, English and Spanish. The GRADE system was chosen for the evaluation of the methodological quality of the articles. Results: During the search process carried out from January 2015 to November 2015, 512 publications were identified, of which 250 were found in PubMed, 118 in MedLine, 142 in Web of Science and 2 in LILACS. Of these, nine articles were selected. Conclusion: The incidence of hearing loss was identified at high frequencies in cystic fibrosis patients without hearing complaints. It is assumed that high-frequency audiometry can be an early diagnostic method to be recommended for hearing investigation of patients at risk of ototoxicity.

摘要 引言：高频听力测听（high-frequency audiometry）有助于早期发现耳毒性药物（ototoxic medications）所致的听力损失。多种耳毒性药物被广泛应用于囊性纤维化（cystic fibrosis）患者的临床治疗。早期检出听力损失，可在损伤累及言语频率前，甄别出具有潜在耳毒性的药物。耳毒性引发的损伤不可逆，会造成显著的社会与心理影响。在儿童群体中，即便仅局限于高频的听力损失，也可能对语言发育产生不良影响。
目的：探讨高频听力测听用于囊性纤维化患儿听力监测的有效性与临床效能。
方法：检索2015年1月至11月期间电子数据库PubMed、MedLine、Web of Science及LILACS收录的相关文献。纳入研究需满足：针对接受耳毒性药物治疗的囊性纤维化患者实施高频听力测听，且文献语种为葡萄牙语、英语或西班牙语。采用GRADE系统（GRADE system）对纳入文献的方法学质量进行评价。
结果：2015年1月至11月的检索过程中共识别出512篇文献，其中PubMed收录250篇、MedLine收录118篇、Web of Science收录142篇、LILACS收录2篇。经筛选后最终纳入9篇文献。
结论：本研究检出，无听力主诉的囊性纤维化患者存在高频听力损失。据此推测，高频听力测听可作为针对耳毒性风险人群开展听力筛查的早期诊断手段予以推荐。