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Dr. Andrew Rynne

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Child took REZ-Q syrup and got hearing loss. Will it be cured?

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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2554 Questions

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Posted on Wed, 2 Jan 2013 in Ear, Nose and Throat Problems
Question: My daughter 8 years old effected with drug ototoxicity. REZ-Q Syrup used for Malaria and she effected for hearing loss after REZ-Q Syrup. Immediately ENT had given steriods and still hearing loss (65 db) is there. Internet literature says that hearing loss is reversible in quinine cases. It was happend 11 months ago. Kindly advise. Is the hearing loss reversible?
doctor
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your query.

1. It is possible that besides the quinine, there were other factors such as high fever, type of malarial parasite, complications of malaria and so on which may have a role in her hearing loss. What type of malarial parasite was detected?

2. This is possible as quinine ototoxicity occurs in the higher frequencies while she now appears to have a 65 db loss. As you have correctly mentioned, the hearing loss due to quinine ototoxicity is usually reversible. It is also never so high (65dB). Hence there must have been another added problem. Though there are exceptions with permanent hearing loss after quinine use. You may share the (PTA) Pure Tone Audiogram here. I am assuming that the loss is across all frequencies and is purely sensorineural. What is her (SDS) Speech Discrimination Score?

3. The normal course of treatment provided for SSHL in a non diabetic is high dose steroids. Since you have already tried steroids, what was the dose? It may have to be increased if it is SSNHL. Other medication includes anti-virals, blood thinning agent, rheologic or blood flow improvement, neural tonics, Carbogen (vasodilator) and Hyperbaric Oxygen Therapy (HBOT), if available. The alternative treatment is transtympanic (intratympanic) steroids. If a PTA shows more than 20-30 dB hearing loss in three contiguous frequencies then it is defined as Sudden Sensori-Neural Hearing Loss (SSNHL). SSNHL is a medical emergency. The therapeutic window is 4-6 weeks for optimal results.

4. It is unfortunate that 11 months have passed. You may try one course of i.v. high dose steroids and HBOT. Ideally HBOT should be given within 3 months. If no further treatment is given, she will require amplification with hearing aids depending upon the PTA & SDS. Does she manage with her studies at school?

5. You may share your audiograms, investigations and progress reports here for more specific treatment and rehabilitation options.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti 38 minutes later
Respected sir,

Thank you very much for your detailed reply. I am answering some of your questions.

1. Paediatrician had suspected as Malaria and given Quinine medicine but there was no malaria parasyte at all. We were not aware of the ototoxicity of quinine at that time.

2. We had approached ENT immediately after hearing loss. ENT had injected steriods into the inner ear with grommet insertion. This treatment was done in less than 12 hours.

3. She is not managing her studies as earlier. Baby is quite active in nature. She speaks well and deliver big movie dialogues also. There is no problem with speech.

4. She is able to hear all small noises also but not able to follow our speech.

5. I am uploading the discharged summary of the Paediatrician and ENT. I will upload the recent PTA report tomorrow.

6. We are praying to each and every God of every minute for my daughter's recovery.

Kindly help.

Thanking you,

- XXXXXXX
doctor
Answered by Dr. Sumit Bhatti 10 hours later
Hi,

Thank you for writing back.

1. This is a case of post lingual deafness. Hence she is able to speak in spite of loss of clarity of speech. Is she able to recite film dialogues or songs of movies release after she developed hearing loss? Does she lip read?

2. Attaching the audiograms and reports will definitely help in an accurate assessment.

3. Can you get an aided audiogram done?

Awaiting your reply.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 8 hours later
Respected sir,

Thank you very much for your reply.

I uploaded discharge summary of paediatrician and ENT yesterday. Are you able to see those documents.

Now I am uploading PTA which had taken on 1 Dec 2012. PTA shows that 80 db loss but the audilogist and ENT said that the loss would be arround 65 to 70 db as the baby may not respond accurately to PTA.

No. She is not able to speak the new movies dialogues.

Kindly see the reports and give your kind reply.
doctor
Answered by Dr. Sumit Bhatti 9 hours later
Hi,

Thank you for writing back.

1. The bone conduction (BC) levels of the right ear are not marked. Repeat the PTA. Even at 65-70 dB, clarity of speech is not possible as the speech frequencies are lost.

2. The blood reports done in Dec 2011 indicates a bacterial infection and raised C-Reactive Protein which is consistent with acute infection. Was the test repeated?

3. Get an Aided Audiometry and Speech Discrimination Score (SDS) done.

4. A BERA (Brainstem Evoked Response Audiometry)/ ABR (Auditory Brainstem Recording) and an ASSR (Auditory Steady State Response) Testing may be done to assess the site of the damage in the auditory pathway.

5. Aided Behavioral / Play Observation Audiometry , Impedence Audiogram to rule out middle ear defects and Genetic Testing may be done.

6. MRI & HRCT Temporal Bones to check the inner ear structures and to rule out ossification of the cochlea (inner ear).

7. Unfortunately, the time window for successful therapy of Sudden Sensori-Neural Hearing Loss (SSNHL) is only 4-6 weeks. It may be stretched to three months for Transtympanic Steroids and HBOT (Hyperbaric Oxygen Therapy). 11 months later, if there has been no recovery, it is unlikely that any medical treatment will now work and the loss is permanent.

8. She should receive a trial with hearing aids for 3-6 months. If there is no benefit with hearing aids, then a cochlear implant may be considered.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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