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. 2023 Nov 28;33(1):1-9.
doi: 10.1044/2023_AJA-22-00237. Online ahead of print.

Clinical Observations in Patients With Cystic Fibrosis-Related Diabetes and Self-Reported Ototoxicity Symptoms

Affiliations

Clinical Observations in Patients With Cystic Fibrosis-Related Diabetes and Self-Reported Ototoxicity Symptoms

Nicole Nichols et al. Am J Audiol. .

Abstract

Purpose: Persons with cystic fibrosis (PwCF) are at high risk for ototoxicity due to the routine use of intravenous aminoglycoside (IV-AG) antibiotics in respiratory infection management. Additionally, factors that contribute to ototoxicity-related symptom development and severity in PwCF are unknown. Given the increased risk of ototoxicity in people with diabetes, we explored the association between cystic fibrosis-related diabetes (CFRD) and self-reported ototoxicity symptoms (tinnitus and vestibular problems) in PwCF treated with aminoglycosides.

Method: PwCF (N = 39; 25 females, 14 males; Mage = 30.1 years, SD = 10.3) were recruited from the Cystic Fibrosis Care Center at Oregon Health & Science University. Patients completed the validated questionnaires to ascertain their experiences with ototoxicity-related symptoms of tinnitus and balance function. The diagnosis of CFRD, including oral glucose tolerance testing (OGTT), insulin treatment, hemoglobin A1c, and cumulative IV-AG treatment history, was obtained through a medical chart review. Participants were classified into three groups based on their medical diagnoses via OGTT: normal glucose tolerance (NGT; control; n = 16), abnormal glucose tolerance (AGT; n = 9), and CFRD (n = 14). Participants in each group were further classified based on survey outcomes for ototoxicity-related symptoms.

Results: There was a trend toward a higher proportion of patients with CFRD reporting tinnitus compared to the AGT and NGT groups, but did not meet statistical significance (X2 = 2.24, p = .13). Approximately, 43% of patients with CFRD reported experiencing clinically significant tinnitus lasting > 3 min compared to 11% in the AGT group and 13% in the NGT group (X2 = 3.751, p = .05). Cumulative IV-AG exposure tended to be higher in CFRD compared to other groups. High balance function was generally reported in all groups.

Conclusions: Patients with CFRD have greater ototoxicity-related symptoms. Further investigation of the relationship between CF-related comorbidities and the risk of developing ototoxicity-related symptoms is warranted to improve the detection and management of ototoxicity in PwCF.

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Figures

Figure 1.
Figure 1.
Flowchart related to participant responses and survey procedures. ABC = Activities-Specific Balance Confidence; CF = cystic fibrosis; TOMI = Tinnitus Ototoxicity Monitoring Index; TFI = Tinnitus Functional Index.
Figure 2.
Figure 2.
Cumulative intravenous aminoglycoside (IV-AG) dose exposure for participants in the cystic fibrosis–related diabetes (CFRD; black diamond), abnormal glucose tolerance (AGT; dark gray square), and normal glucose tolerance (NGT; light gray circle) groups; y-axis = number of IV-AG doses during one's lifetime; x-axis = age of patient (in years).
Figure 3.
Figure 3.
Proportion of patient's self-reporting tinnitus > 3 min on the Tinnitus Screener; y-axis = proportions of physical function (in %); x-axis = group (cystic fibrosis–related diabetes [CFRD], abnormal glucose tolerance [AGT], normal glucose tolerance [NGT]).
Figure 4.
Figure 4.
Reported balance confidence (high, moderate, and low) on the Activities-Specific Balance Confidence scale for all groups (cystic fibrosis–related diabetes [CFRD], abnormal glucose tolerance [AGT], and normal glucose tolerance [NGT]); y-axis = proportions of physical function reported within a participant group (in %); x-axis = group (CFRD, AGT, NGT).

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