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Auditory brainstem response in young burn-wound patients treated with ototoxic drugs
Insights
Severe burn patients receiving aminoglycoside drugs may experience hearing loss. Auditory brainstem response (ABR) detected hearing deficits in 22% of pediatric burn patients, indicating its use for early detection.
Area of Science:
- Ototoxicology
- Pediatric Burn Care
- Audiology
Background:
- Burn patients frequently receive ototoxic aminoglycoside antibiotics for gram-negative sepsis.
- Cochlear hearing impairment is a potential adverse effect of this necessary medical treatment.
- Early detection of hearing deficits in pediatric burn patients is crucial.
Purpose of the Study:
- To evaluate auditory sensitivity in children with severe thermal burns using auditory brainstem response (ABR).
- To identify the incidence of hearing impairment in pediatric burn patients treated with potentially ototoxic medications.
- To compare medical treatments between children with and without auditory deficits.
Main Methods:
- Auditory brainstem response (ABR) testing was performed on 32 pediatric burn patients (18 months to 17 years).
- Patients had severe burns (mean 64% total body surface area) and normal baseline ABR.
- Medical treatments, including aminoglycosides and vancomycin, were analyzed and compared between groups.
Main Results:
- Twenty-two percent (8/32) of subjects exhibited abnormal ABR or no response before discharge.
- A higher mean vancomycin dosage was observed in the subgroup with auditory impairment.
- Prediction of ototoxicity is challenging due to multiple influencing factors in burn patients.
Conclusions:
- Auditory brainstem response (ABR) is effective for the early detection of auditory deficits in pediatric burn patients.
- Follow-up audiometric assessment is recommended due to potential delayed or progressive hearing loss.
- Understanding the risk factors for ototoxicity is critical for managing hearing health in this population.
Abstract:
Burn-wound patients often require potentially ototoxic doses of aminoglycoside drugs in the treatment of gram-negative sepsis. Cochlear hearing impairment may be an unfortunate consequence of this medical therapy. We evaluated auditory sensitivity with the auditory brainstem response (ABR) in a group of 32 children with acute, severe thermal burns ranging in age from 18 months to 17 years. The mean percent of total body surface area burns was 64%. None of the subjects had a known history of hearing deficits or aminoglycoside therapy, and all yielded a normal baseline ABR upon hospital admission. Eight of the subjects (22%) showed either an abnormal ABR, or no response, at 40 dB prior to hospital discharge. The medical treatment for this group of subjects (gentamicin, amikacin, vancomycin, amphotericin B) was compared to that of a second subgroup of 7 subjects without auditory deficit but with a statistically comparable percentage of burns. The mean dosage of vancomycin was higher for the auditory impairment group than for the unimpaired group. Prediction of ototoxicity in the acute burned patient is extremely difficult as there are numerous factors that may influence the risk of cochlear damage. We conclude, however, that the ABR can be applied in early detection of auditory deficit. Follow-up audiometric assessment is advisable since auditory deficits in this population may be delayed or progressive after discontinuance of drug therapy.