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Hearing loss and audiology testing

Repeated courses of intravenous aminoglycosides is associated with an increased risk of hearing loss. Amikacin seems to be particularly associated with hearing problems. In addition, a rare mitochondrial mutation m.1555A>G, which predisposes to aminoglycoside ototoxicity, and can lead to deafness after a single dose. Prevalence of the mutation is estimated at 1 in 520.

We recommend:

• A family history of deafness should be sought in all families BEFORE the first course of iv aminoglycosides.
• All children are now routinely tested for the mitochondrial mutation m.1555A>G. This test result should be checked BEFORE the first course of iv aminoglycosides
• Audiology testing for hearing loss should be carried out
  • annually in children having iv aminoglycosides every 6 months or less, AND who have had 10 or more courses of iv aminoglycosides
  • 6 monthly in children having iv aminoglycosides more often than every 6 months (for example those on treatment for M. abscessus) - and should be done before the next course of iv aminoglycoside is due
  • Any child with a high aminoglycoside trough level
  • Any child reporting a hearing problem

Routine hearing tests are not required for children having iv aminoglycosides every 6 months or less, and who have had less than 10 courses in total, and who have never had a high aminoglycoside blood level.