Masqueraders for Appendicitis

INTRODUCTION: Patients with cystic fibrosis (CF) are often subject to pulmonary infections treated with antibiotics such as aminoglycosides which have the side effect of sensorineural hearing loss (SNHL). Since children with CF are often on prolonged courses and/or higher doses, they are particularly at risk. OBJECTIVE: To review the role of routine hearing screening for SNHL in children with CF who have been on aminoglycoside therapy. DATA SOURCES: PubMed, Cochrane, SCOPUS, and OVID databases REVIEW METHODS: A systematic review of the literature was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive PubMed MeSH search of the English language literature with human subjects only was performed to include all indexed years and the search strategy was adapted to the additional databases. Results: Twelve studies (1979-2014) were included in the review. Three of the 12 articles also studied adult CF patients. The study population included 762 children (age range, 5 months-20 years). Objective hearing screening measures included pure tone audiometry (PTA) at standard ± high frequency threshold (12/12), distortion product otoacoustic emissions (DPOAE) (4/12), transient-evoked otoacoustic emissions (1/12), and automated auditory brainstem response (AABR) (1/12). The overall prevalence of SNHL ranged from 0% to 29%. In a subset of children with high levels of exposure, up to 44% had SNHL. Eight studies recommended hearing screening in CF children on aminoglycosides of which 2 studies recommended screening regardless of aminoglycoside exposure. Four studies made no recommendations and in three of these, the children had a short course of aminoglycosides. HFPTA was the most commonly recommended screening measure followed by DPOAEs. CONCLUSION: Hearing screenings are quick and inexpensive measures leading to interventions that can prevent significant cognitive and linguistic developmental difficulties in children secondary to hearing loss. Routine hearing screening in children with CF exposed to aminoglycosides is supported by the current literature based on the high prevalence of SNHL in this population. Future studies should define the optimal timing for hearing screening during and after aminoglycoside therapy.