Re: different drugs question-SCARED again! (HEARING LOSS)

[Guest guest]

I just want to send hugs to everyone out there. The disease is horrible and the

decisions are hard to make on what med's to try and like it has been said the

med's affect everyone differently. I have been at a loss on what to do and I

don't think my daughter is in the " worse " case scenario at this point but it is

enough to take...on top of it she has hearing loss in her left ear

(sensioneural/which means it is permanent and severe at the higher frequencies).

We had just gotten situated with it one year ago from her diagnosis of JRA. I

wonder what next near will bring??? I am also wondering if any kids out there

have hearing loss and JRA. Our daughter failed her newborn hearing

screening...but managed to pass afterwards and had a normal if not early speech

pattern. It wasn't til she started kindergarten that we caught the hearing

loss. It wasn't even the school that caught it, but us as parents questioning

over and over her asking to repeat things. Our most recent concern was that

stareted out in mid March with swollen knuckles on the middle three

fingers on both hands...(of course after that she complained of her kneck and

toes hurting). Anyway...she immediately started on naproxen with our

pediatrician who ordered all the necessary tests. got her diagnosis on

6/5/08. However...it wasn't til a couple of weeks ago that I was at the

audiologist and mentioned her diagnosis. Her audiologist asked if her hearings

has changed from what we have noticed since she started naproxen. I found out

that NSAID's are known to cause hearing loss (it is NOT something you should

worry about with a child with normal hearing). However, since already

has hearing loss.......she probably shouldnt' be on it. I just feel like I need

help...and if ANYONE can provide ANY input it would be great. is on MTX.

Her rheumatologist said to back her off of the naproxen to an as needed

basis....since I pointed this out (not to mention I mentioned her hearing loss

at her FIRST appt). Anyway...it is all completely exhausting and just want to

send you all hugs and hope someone can provide me some insight.

Hugs

Jen

(, 7, Poly)

different drugs question-SCARED again!

>

> Date: Friday, August 1, 2008, 1:20 PM

> Hi all,

>

> I posted a couple months ago about my daughter being put on

> MTX and how I

> was scared of all the side effects. You were all wonderful

> and told your

> stories about it and it helped me feel better about putting

> her on it. Well

> after only 4 weeks on it she started to get liver damage so

> we had to take

> her off and up her steroid dose which has made her huge and

> still does not

> keep it all the way under control. Now they want to try

> Enbrel injections

> once a week on her. I'm not happy about any of the

> drugs as I think it is

> harmful to the body but we don't have a choice since

> she is so sick without

> them. I read up on this drug and it scares me just as bad

> at MTX did even

> worse since it could have the side effect of cancer and

> pneumonia among many

> other things. Again I turn to you all to ask your

> experience with this drug

> for your children and what happened with them while on it.

> I'm also scared

> to have to give her a shot myself. Should we test her

> liver before starting

> the drug to make sure it is back to normal? What are the

> early symptoms of

> the drug causing problems I should watch for? I'm just

> so apprehensive to

> give her more poison to suppress her immune system into not

> knowing it is

> being attacked. I just hate this whole damn thing!

>

> Thanks

> Kim

> (Kairi 3 years old-systemic)

>

>

>

[Guest guest]

Hi Jen,

Maggie does have hearing loss in both ears, but it is conductive so more of

the low pitch sounds (male voices and such).

This was attributed to her OI (brittle bone disease) the Stapes' in her ears

are fixed or frozen, she has had surgery to try and correct the problem but it

failed.

She has bright purple hearing aides that sparkle they are the most beautiful

things in the world...she picked them out....she hates them!She almost NEVER

wears them! She claims they pick up annoying sounds like the air conditioner

and such but not the things she wants to hear....like the TV.

I am not sure if JRA and hearing loss are connected, I also did not know that

those who have hearing loss should be concerned about NSAIDS, Maggie is on

200mgs of Celebrex a day. She has been on this dose since last spring. I suppose

there are more side effects to medications then even the doctor's are aware of

sometimes.

I think the hardest thing I have overcome was to learn to put my trust into

the lap of Maggie's doctors. Eventually I have come to the conclusion either I

fully trust her doctor, or I move on. I do still question a lot of the choices

that they make and I never let go of that gut feeling that a mom gets when they

know something just doesn't sound,look or feel right.

I was sad too when I found out that Maggie had hearing loss, doubly sad when I

let them put her through Major surgery that was horrible and painful only to

find out they could not repair the bones. I was happy when I found out that

hearing aides would help her to hear those sounds that she was missing...angry

that she will not wear the aides....and so on.

I think when your child has a chronic illness, you get on a roller coaster of

ups and downs and even a few loops once and awhile. It's ever changing and

always emotional.

Thanks for the info on the NSAIDS, I wish I could help you on the hearing

loss. You will be in our thoughts and prayers!

Hang in there! Sending Hugs from Iowa!

Diane and Maggie age 11 (OI,CP,Systemic JIA,Uveitis,PIDD)

>

> > From: Kim Newman <kim.newman@...>

> > Subject: different drugs question-SCARED

> again!

> >

> > Date: Friday, August 1, 2008, 1:20 PM

> > Hi all,

> >

> > I posted a couple months ago about my daughter being

> put on

> > MTX and how I

> > was scared of all the side effects. You were all

> wonderful

> > and told your

> > stories about it and it helped me feel better about

> putting

> > her on it. Well

> > after only 4 weeks on it she started to get liver

> damage so

> > we had to take

> > her off and up her steroid dose which has made her

> huge and

> > still does not

> > keep it all the way under control. Now they want to

> try

> > Enbrel injections

> > once a week on her. I'm not happy about any of

> the

> > drugs as I think it is

> > harmful to the body but we don't have a choice

> since

> > she is so sick without

> > them. I read up on this drug and it scares me just

> as bad

> > at MTX did even

> > worse since it could have the side effect of cancer

> and

> > pneumonia among many

> > other things. Again I turn to you all to ask your

> > experience with this drug

> > for your children and what happened with them while

> on it.

> > I'm also scared

> > to have to give her a shot myself. Should we test

> her

> > liver before starting

> > the drug to make sure it is back to normal? What are

> the

> > early symptoms of

> > the drug causing problems I should watch for?

> I'm just

> > so apprehensive to

> > give her more poison to suppress her immune system

> into not

> > knowing it is

> > being attacked. I just hate this whole damn thing!

> >

> > Thanks

> > Kim

> > (Kairi 3 years old-systemic)

> >

> >

> > [Non-text portions of this message have been

> removed]

>

>

>

>

>

>

[Guest guest]

Hi Jen,

Maggie does have hearing loss in both ears, but it is conductive so more of

the low pitch sounds (male voices and such).

This was attributed to her OI (brittle bone disease) the Stapes' in her ears

are fixed or frozen, she has had surgery to try and correct the problem but it

failed.

She has bright purple hearing aides that sparkle they are the most beautiful

things in the world...she picked them out....she hates them!She almost NEVER

wears them! She claims they pick up annoying sounds like the air conditioner

and such but not the things she wants to hear....like the TV.

I am not sure if JRA and hearing loss are connected, I also did not know that

those who have hearing loss should be concerned about NSAIDS, Maggie is on

200mgs of Celebrex a day. She has been on this dose since last spring. I suppose

there are more side effects to medications then even the doctor's are aware of

sometimes.

I think the hardest thing I have overcome was to learn to put my trust into

the lap of Maggie's doctors. Eventually I have come to the conclusion either I

fully trust her doctor, or I move on. I do still question a lot of the choices

that they make and I never let go of that gut feeling that a mom gets when they

know something just doesn't sound,look or feel right.

I was sad too when I found out that Maggie had hearing loss, doubly sad when I

let them put her through Major surgery that was horrible and painful only to

find out they could not repair the bones. I was happy when I found out that

hearing aides would help her to hear those sounds that she was missing...angry

that she will not wear the aides....and so on.

I think when your child has a chronic illness, you get on a roller coaster of

ups and downs and even a few loops once and awhile. It's ever changing and

always emotional.

Thanks for the info on the NSAIDS, I wish I could help you on the hearing

loss. You will be in our thoughts and prayers!

Hang in there! Sending Hugs from Iowa!

Diane and Maggie age 11 (OI,CP,Systemic JIA,Uveitis,PIDD)

>

> > From: Kim Newman <kim.newman@...>

> > Subject: different drugs question-SCARED

> again!

> >

> > Date: Friday, August 1, 2008, 1:20 PM

> > Hi all,

> >

> > I posted a couple months ago about my daughter being

> put on

> > MTX and how I

> > was scared of all the side effects. You were all

> wonderful

> > and told your

> > stories about it and it helped me feel better about

> putting

> > her on it. Well

> > after only 4 weeks on it she started to get liver

> damage so

> > we had to take

> > her off and up her steroid dose which has made her

> huge and

> > still does not

> > keep it all the way under control. Now they want to

> try

> > Enbrel injections

> > once a week on her. I'm not happy about any of

> the

> > drugs as I think it is

> > harmful to the body but we don't have a choice

> since

> > she is so sick without

> > them. I read up on this drug and it scares me just

> as bad

> > at MTX did even

> > worse since it could have the side effect of cancer

> and

> > pneumonia among many

> > other things. Again I turn to you all to ask your

> > experience with this drug

> > for your children and what happened with them while

> on it.

> > I'm also scared

> > to have to give her a shot myself. Should we test

> her

> > liver before starting

> > the drug to make sure it is back to normal? What are

> the

> > early symptoms of

> > the drug causing problems I should watch for?

> I'm just

> > so apprehensive to

> > give her more poison to suppress her immune system

> into not

> > knowing it is

> > being attacked. I just hate this whole damn thing!

> >

> > Thanks

> > Kim

> > (Kairi 3 years old-systemic)

> >

> >

> > [Non-text portions of this message have been

> removed]

>

>

>

>

>

>

[Guest guest]

Hi Jen,

So sorry, to hear this latest news.

Hearing loss as a side effect is rare ... but not unheard of. Often, the hearing

loss tends to be temporary. Not sure, with your daughter's prior hearing issues,

how that may effect things. I guess only time will tell. A quick Google search

turned up the following article. Not a pediatric case but still informative.

Sending virtual hugs to you and ,

Aloha,

Georgina

Case report: Naproxen-associated sudden sensorineural hearing loss

McKinnon, J

LCDR J. McKinnon, MC USN*

CAPT Lorenz F. Lassen, MC USN*

Naproxen is a commonly used nonsteroidal anti-inflammatory drug (NSAID) whose

side effects include tinnitus and transient hearing loss. Sudden sensorineural

hearing loss has rarely been reported as a result of NSAID use. This usually

occurs in patients taking other ototoxic medications, with poor renal function,

or with autoimmune disease. This article reports the case of an otherwise

healthy patient who experienced permanent sensorineural hearing loss after a

brief course of naproxen and reviews the literature on NSAID-related permanent

sensorineural hearing loss.

Introduction

Naproxen is a commonly used nonsteroidal anti-inflammatory drug (NSAID) that is

generally considered effective, safe, and well tolerated. It is available both

by prescription and as an over-the-counter medication. A propionic acid

derivative related to ibuprofen, its anti-inflammatory effects are thought to be

from the inhibition of cyclooxygenase and the resultant decrease of

prostaglandin synthesis. Naproxen is completely absorbed from the

gastrointestinal tract and is 99% bound to the serum. Although temporary

ototoxic side effects (tinnitus with occasional transient hearing loss and/or

vertigo) have been reported to occur in 1 to 9% of patients,' sensorineural

hearing loss from the use of naproxen is rare.2-5

Case Report

An otherwise healthy 35-year-old African-American woman was prescribed naproxen

(500 mg by mouth twice a day) for low-back pain. Forty-eight hours after the

first naproxen dose, she experienced bilateral hearing loss, tinnitus, otalgia,

intolerance to loud noise, and dizziness. She was seen by a primary care

physician and referred to an otolaryngologist.

Head and neck examination was normal. Audiometric evaluation showed moderate,

bilateral sensorineural hearing loss (Fig. 1). A military reference audiogram,

done several years earlier, was normal. Rotational chair vestibular examination

was normal, and electronystagmography showed left-sided vestibular nerve

weakness. Magnetic resonance imaging of the brain and internal auditory canals

was normal. There was a slightly elevated erythrocyte sedimentation rate (23

mm/h) and a weakly positive anti-nuclear antibody test (1:40). Raji cell assay

was negative. Other laboratory studies (complete blood count, electrolytes,

complement profile, microhemagglutination-treponema pallidum, and thyroid and

liver function tests) were normal.

The patient was given a 2-week course of prednisone (60 mg/d) without resolution

of her symptoms. Follow-up 6 months later showed no significant improvement in

hearing, tinnitus, or noise intolerance. At present, she uses bilateral hearing

aides, but these are uncomfortable because of her poor dynamic range and

hyperacusis.

Discussion

Although salicylates have been used since the 4th century BC, it was in

1877 who recognized the ototoxic effects of salicylates in high doses.3

Typically, the hearing loss is a temporary 20- to 40-dB threshold shift that is

bilateral, symmetric, and sensorineural. Tinnitus usually accompanies hearing

loss and is a result of this auditory distortion caused by alterations of

cochlear neuron activity. Tinnitus may precede the development of sensorineural

hearing loss.3

The mechanisms of naproxen's ototoxic effects have been suggested to be similar

to those described for salicylates.35 Ototoxicity appears to be multifactorial.3

Salicylates and NSAIDs have been shown to increase levels of norepinephrine,

decrease concentrations of prostaglandins, and increase leukotrienes in the

perilymph.6 Decreased blood flow and cochlear hemorrhage (which may be

influenced by catecholamines and arachidonic metabolites) have been suggested as

occurring in salicylate and NSAID ototoxicity.3-6 Reversible morphologic changes

to cochlear outer hair cells have been observed that may result from changes in

cellular permeability.3 Physiologic evidence of cochlear outer hair cell injury

is strongly supported by diminished otoacoustic emission activity during

salicylate toxicity.3

Several reports of permanent sensorineural hearing loss associated with either

salicylates or NSAIDs describe individuals who had underlying renal dysfunction,

rheumatoid arthritis, polyarteritis nodosa, advanced age, or the use of NSAIDs

with other potentially ototoxic medications.2'8 In 1982, Chapman2 reported five

patients who developed sensorineural hearing loss while taking naproxen; only

two patients completely recovered after stopping the medication. Chapman

implicated impaired renal function as a cofactor in one patient with permanent

hearing loss. Similar adverse reactions have been reported with piroxicam7 and

ketoralac.1

The patient described here had a slightly elevated erythrocyte sedimentation

rate and a weakly positive anti-nuclear antibody test. Although there were no

other signs or symptoms of autoimmune disease, she could have had a subclinical

early autoimmune problem. Kastanioudakis et al. evaluated 45 patients with

rheumatoid arthritis and observed a 35.5% incidence of mild symmetric bilateral

sensorineural hearing loss.9 There was no correlation of hearing loss with drug

therapy (which included NSAIDs, D-penicillamine, plaquenil, and methotrexate),

age, sex, disease duration, articular and extra-articular manifestation, or the

presence of autoantibodies. Hence, the significance of the minimally abnormal

anti-nuclear antibody test and erythrocyte sedimentation rate in an otherwise

healthy individual to the development of sudden hearing loss is difficult to

interpret.

Conclusions

That salicylates and NSAIDs can cause reversible sensorineural hearing loss is

well known to most health care providers. What is not as well appreciated is

that NSAID-induced sensorineural hearing loss can be permanent. Cofactors may

include renal disease and autoimmune disorders. Clearly, the prescribing health

care provider should ask the patient about such conditions and warn of hearing

loss as a potential side effect.

That the first symptom of sensorineural hearing loss from NSAIDs is tinnitus

should be communicated to the patient. The patient should be told to immediately

discontinue NSAIDs and seek help should tinnitus or distorted hearing develop.

References

1. Clinical Pharmacology. Gold Standard Multimedia, 1997. 2. Chapman P: Naproxen

and sudden hearing loss. J Laryngol Otol 1982; 96: 163-6. 3. Jung TI, Choi DC,

Park YS, Lee CS, Rhee CK: Ototoxicity of salicylate, nonsteroldal

antiinflammatory drugs, and quinine. Otolaryngol Clin North Am 1993; 26:

791-810.

4. Brien JA: Ototoxicity associated with salicylates: a brief review. Drug Saf

1993; 9: 143-8.

Seligmann H, Goldsher M, Fradis M, Ben- J, Podoshin L: Drug-induced

tinnitus and other hearing disorders. Drug Saf 1996; 14: 198-212. Jung IT, Baer

W, Park YM, Woo HY, Rozehnal S, SK: Effect of round window membrane

application of salicylate and indomethacin on hearing and levels of arachidonic

acid metabolites in perilymph. Acta Oto-Laryngol Suppl 1992; 493: 81-7.

Vernick DM, JH: Sudden hearing loss associated with piroxicam. Am J Otol

1986; 7: 97-8.

Schaab KC, Setzen G, Dickinson ET: Acute sensorineural hearing loss following

intravenous ketoralac administration. J Emerg Med 1995;13: 509-13.

Kastanioudakis I, Moustopoulos MH, Drosos AA, Tsiakou E, idis V, Skevas A:

Inner ear involvement in rheumatoid arthritis: a prospective clinical study. J

laryngol Otol 1995; 109: 713-8.

*Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center,

Portsmouth, VA 23708-2197.

t Department of Otolaryngology-Head and Neck Surgery. Eastern Virginia Medical

School, Norfolk, VA 23507-1912.

The views expressed in this article are those of the authors and do not reflect

the official policy or position of the Department of the Navy, the Department of

Defense, or the U.S. Government.

Reprint requests: LCDR J. McKinnon, MC USN, Naval Medical Center,

Portsmouth, Department of Otolaryngology-Head and Neck Surgery (Code 0609), 630

Circle, Portsmouth, VA 23708-2197.

This manuscript was received for review in December 1997 and was accepted for

publication in March 1998.

Copyright Association of Military Surgeons of the U.S. Nov 1998

Provided by ProQuest Information and Learning Company. All rights Reserved

different drugs question-SCARED again!

>

> Date: Friday, August 1, 2008, 1:20 PM

> Hi all,

>

> I posted a couple months ago about my daughter being put on

> MTX and how I

> was scared of all the side effects. You were all wonderful

> and told your

> stories about it and it helped me feel better about putting

> her on it. Well

> after only 4 weeks on it she started to get liver damage so

> we had to take

> her off and up her steroid dose which has made her huge and

> still does not

> keep it all the way under control. Now they want to try

> Enbrel injections

> once a week on her. I'm not happy about any of the

> drugs as I think it is

> harmful to the body but we don't have a choice since

> she is so sick without

> them. I read up on this drug and it scares me just as bad

> at MTX did even

> worse since it could have the side effect of cancer and

> pneumonia among many

> other things. Again I turn to you all to ask your

> experience with this drug

> for your children and what happened with them while on it.

> I'm also scared

> to have to give her a shot myself. Should we test her

> liver before starting

> the drug to make sure it is back to normal? What are the

> early symptoms of

> the drug causing problems I should watch for? I'm just

> so apprehensive to

> give her more poison to suppress her immune system into not

> knowing it is

> being attacked. I just hate this whole damn thing!

>

> Thanks

> Kim

> (Kairi 3 years old-systemic)

>

>

>

[Guest guest]

Hi Jen,

So sorry, to hear about this latest news. Hearing loss as a side effect is

rare ... but not unheard of. Often, this type of hearing loss tends to be

temporary. Not sure with your daughter's prior hearing issues, how that may

effect things. I guess only time will tell. But we definitely will hope for

the best outcome. A quick Google search turned up the following article. Not

a pediatric case but still informative.

Sending virtual hugs to you and ,

Aloha,

Georgina

Case report: Naproxen-associated sudden sensorineural hearing loss

McKinnon, J

LCDR J. McKinnon, MC USN*

CAPT Lorenz F. Lassen, MC USN*

Naproxen is a commonly used nonsteroidal anti-inflammatory drug (NSAID)

whose side effects include tinnitus and transient hearing loss. Sudden

sensorineural hearing loss has rarely been reported as a result of NSAID

use. This usually occurs in patients taking other ototoxic medications, with

poor renal function, or with autoimmune disease. This article reports the

case of an otherwise healthy patient who experienced permanent sensorineural

hearing loss after a brief course of naproxen and reviews the literature on

NSAID-related permanent sensorineural hearing loss.

Introduction

Naproxen is a commonly used nonsteroidal anti-inflammatory drug (NSAID) that

is generally considered effective, safe, and well tolerated. It is available

both by prescription and as an over-the-counter medication. A propionic acid

derivative related to ibuprofen, its anti-inflammatory effects are thought

to be from the inhibition of cyclooxygenase and the resultant decrease of

prostaglandin synthesis. Naproxen is completely absorbed from the

gastrointestinal tract and is 99% bound to the serum. Although temporary

ototoxic side effects (tinnitus with occasional transient hearing loss

and/or vertigo) have been reported to occur in 1 to 9% of patients,'

sensorineural hearing loss from the use of naproxen is rare.2-5

Case Report

An otherwise healthy 35-year-old African-American woman was prescribed

naproxen (500 mg by mouth twice a day) for low-back pain. Forty-eight hours

after the first naproxen dose, she experienced bilateral hearing loss,

tinnitus, otalgia, intolerance to loud noise, and dizziness. She was seen by

a primary care physician and referred to an otolaryngologist.

Head and neck examination was normal. Audiometric evaluation showed

moderate, bilateral sensorineural hearing loss (Fig. 1). A military

reference audiogram, done several years earlier, was normal. Rotational

chair vestibular examination was normal, and electronystagmography showed

left-sided vestibular nerve weakness. Magnetic resonance imaging of the

brain and internal auditory canals was normal. There was a slightly elevated

erythrocyte sedimentation rate (23 mm/h) and a weakly positive anti-nuclear

antibody test (1:40). Raji cell assay was negative. Other laboratory studies

(complete blood count, electrolytes, complement profile,

microhemagglutination-treponema pallidum, and thyroid and liver function

tests) were normal.

The patient was given a 2-week course of prednisone (60 mg/d) without

resolution of her symptoms. Follow-up 6 months later showed no significant

improvement in hearing, tinnitus, or noise intolerance. At present, she uses

bilateral hearing aides, but these are uncomfortable because of her poor

dynamic range and hyperacusis.

Discussion

Although salicylates have been used since the 4th century BC, it was

in 1877 who recognized the ototoxic effects of salicylates in high doses.3

Typically, the hearing loss is a temporary 20- to 40-dB threshold shift that

is bilateral, symmetric, and sensorineural. Tinnitus usually accompanies

hearing loss and is a result of this auditory distortion caused by

alterations of cochlear neuron activity. Tinnitus may precede the

development of sensorineural hearing loss.3

The mechanisms of naproxen's ototoxic effects have been suggested to be

similar to those described for salicylates.35 Ototoxicity appears to be

multifactorial.3 Salicylates and NSAIDs have been shown to increase levels

of norepinephrine, decrease concentrations of prostaglandins, and increase

leukotrienes in the perilymph.6 Decreased blood flow and cochlear hemorrhage

(which may be influenced by catecholamines and arachidonic metabolites) have

been suggested as occurring in salicylate and NSAID ototoxicity.3-6

Reversible morphologic changes to cochlear outer hair cells have been

observed that may result from changes in cellular permeability.3 Physiologic

evidence of cochlear outer hair cell injury is strongly supported by

diminished otoacoustic emission activity during salicylate toxicity.3

Several reports of permanent sensorineural hearing loss associated with

either salicylates or NSAIDs describe individuals who had underlying renal

dysfunction, rheumatoid arthritis, polyarteritis nodosa, advanced age, or

the use of NSAIDs with other potentially ototoxic medications.2'8 In 1982,

Chapman2 reported five patients who developed sensorineural hearing loss

while taking naproxen; only two patients completely recovered after stopping

the medication. Chapman implicated impaired renal function as a cofactor in

one patient with permanent hearing loss. Similar adverse reactions have been

reported with piroxicam7 and ketoralac.1

The patient described here had a slightly elevated erythrocyte sedimentation

rate and a weakly positive anti-nuclear antibody test. Although there were

no other signs or symptoms of autoimmune disease, she could have had a

subclinical early autoimmune problem. Kastanioudakis et al. evaluated 45

patients with rheumatoid arthritis and observed a 35.5% incidence of mild

symmetric bilateral sensorineural hearing loss.9 There was no correlation of

hearing loss with drug therapy (which included NSAIDs, D-penicillamine,

plaquenil, and methotrexate), age, sex, disease duration, articular and

extra-articular manifestation, or the presence of autoantibodies. Hence, the

significance of the minimally abnormal anti-nuclear antibody test and

erythrocyte sedimentation rate in an otherwise healthy individual to the

development of sudden hearing loss is difficult to interpret.

Conclusions

That salicylates and NSAIDs can cause reversible sensorineural hearing loss

is well known to most health care providers. What is not as well appreciated

is that NSAID-induced sensorineural hearing loss can be permanent. Cofactors

may include renal disease and autoimmune disorders. Clearly, the prescribing

health care provider should ask the patient about such conditions and warn

of hearing loss as a potential side effect.

That the first symptom of sensorineural hearing loss from NSAIDs is tinnitus

should be communicated to the patient. The patient should be told to

immediately discontinue NSAIDs and seek help should tinnitus or distorted

hearing develop.

References

1. Clinical Pharmacology. Gold Standard Multimedia, 1997. 2. Chapman P:

Naproxen and sudden hearing loss. J Laryngol Otol 1982; 96: 163-6. 3. Jung

TI, Choi DC, Park YS, Lee CS, Rhee CK: Ototoxicity of salicylate,

nonsteroldal antiinflammatory drugs, and quinine. Otolaryngol Clin North Am

1993; 26: 791-810.

4. Brien JA: Ototoxicity associated with salicylates: a brief review. Drug

Saf 1993; 9: 143-8.

Seligmann H, Goldsher M, Fradis M, Ben- J, Podoshin L: Drug-induced

tinnitus and other hearing disorders. Drug Saf 1996; 14: 198-212. Jung IT,

Baer W, Park YM, Woo HY, Rozehnal S, SK: Effect of round window

membrane application of salicylate and indomethacin on hearing and levels of

arachidonic acid metabolites in perilymph. Acta Oto-Laryngol Suppl 1992;

493: 81-7.

Vernick DM, JH: Sudden hearing loss associated with piroxicam. Am J

Otol 1986; 7: 97-8.

Schaab KC, Setzen G, Dickinson ET: Acute sensorineural hearing loss

following intravenous ketoralac administration. J Emerg Med 1995;13: 509-13.

Kastanioudakis I, Moustopoulos MH, Drosos AA, Tsiakou E, idis V,

Skevas A: Inner ear involvement in rheumatoid arthritis: a prospective

clinical study. J laryngol Otol 1995; 109: 713-8.

*Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center,

Portsmouth, VA 23708-2197.

t Department of Otolaryngology-Head and Neck Surgery. Eastern Virginia

Medical School, Norfolk, VA 23507-1912.

The views expressed in this article are those of the authors and do not

reflect the official policy or position of the Department of the Navy, the

Department of Defense, or the U.S. Government.

Reprint requests: LCDR J. McKinnon, MC USN, Naval Medical Center,

Portsmouth, Department of Otolaryngology-Head and Neck Surgery (Code 0609),

630 Circle, Portsmouth, VA 23708-2197.

This manuscript was received for review in December 1997 and was accepted

for publication in March 1998.

Copyright Association of Military Surgeons of the U.S. Nov 1998

Provided by ProQuest Information and Learning Company. All rights Reserved

different drugs question-SCARED again!

>

> Date: Friday, August 1, 2008, 1:20 PM

> Hi all,

>

> I posted a couple months ago about my daughter being put on

> MTX and how I

> was scared of all the side effects. You were all wonderful

> and told your

> stories about it and it helped me feel better about putting

> her on it. Well

> after only 4 weeks on it she started to get liver damage so

> we had to take

> her off and up her steroid dose which has made her huge and

> still does not

> keep it all the way under control. Now they want to try

> Enbrel injections

> once a week on her. I'm not happy about any of the

> drugs as I think it is

> harmful to the body but we don't have a choice since

> she is so sick without

> them. I read up on this drug and it scares me just as bad

> at MTX did even

> worse since it could have the side effect of cancer and

> pneumonia among many

> other things. Again I turn to you all to ask your

> experience with this drug

> for your children and what happened with them while on it.

> I'm also scared

> to have to give her a shot myself. Should we test her

> liver before starting

> the drug to make sure it is back to normal? What are the

> early symptoms of

> the drug causing problems I should watch for? I'm just

> so apprehensive to

> give her more poison to suppress her immune system into not

> knowing it is

> being attacked. I just hate this whole damn thing!

>

> Thanks

> Kim

> (Kairi 3 years old-systemic)

[Guest guest]

Georgina,

Thank you for the information...I appreciate it....so it sounds rare for NSAID's

to cause hearing loss....but since she already has it, it makes me feel more

cautious. Thanks

Jen

different drugs question-SCARED again!

>

> Date: Friday, August 1, 2008, 1:20 PM

> Hi all,

>

> I posted a couple months ago about my daughter being put on

> MTX and how I

> was scared of all the side effects. You were all wonderful

> and told your

> stories about it and it helped me feel better about putting

> her on it. Well

> after only 4 weeks on it she started to get liver damage so

> we had to take

> her off and up her steroid dose which has made her huge and

> still does not

> keep it all the way under control. Now they want to try

> Enbrel injections

> once a week on her. I'm not happy about any of the

> drugs as I think it is

> harmful to the body but we don't have a choice since

> she is so sick without

> them. I read up on this drug and it scares me just as bad

> at MTX did even

> worse since it could have the side effect of cancer and

> pneumonia among many

> other things. Again I turn to you all to ask your

> experience with this drug

> for your children and what happened with them while on it.

> I'm also scared

> to have to give her a shot myself. Should we test her

> liver before starting

> the drug to make sure it is back to normal? What are the

> early symptoms of

> the drug causing problems I should watch for? I'm just

> so apprehensive to

> give her more poison to suppress her immune system into not

> knowing it is

> being attacked. I just hate this whole damn thing!

>

> Thanks

> Kim

> (Kairi 3 years old-systemic)

[Guest guest]

Diane,

Thank your for your note. I am sorry to hear of all that you and Maggie have

been though with her hearing loss. You definitely have had a lot to deal with.

's hearing loss is only in her left ear at this point. She does wear her

hearing aid which we got just a little over a year ago. It is a behind the ear

hearing aid, which matches her blonde hair, but the mold is pink sparkly. The

first time she put her hearing aid in at the office she said she was hearing a

clicking noise (the airconditioner). Shortly after that I was flipping through

a magazine and she said the pages clicked as I turned them. She even made a

comment about the click when I fastened my seatbelt when we got in the car. I

think it is harder for them at first as they pick up more of these

unwanted/unneeded noises...but the brain eventually is supposed to learn to

filter them out??? She wears it because it helps her and is a VERY stubborn

little girl, but has agreed to this (thankfully). I know as a kid when I was in

first grade I wouldn't wear glasses even with my horrible vision...so I am

happy she will wear her aid. There is always so much to think about between the

JRA and hearing loss (her hearing could get worse and they say to avoid contact

sports, which right now she has no interest in sports anyway, but a hard hit to

the ear could make her hearing worse, but of course we can't put her in a

bubble). Thanks for all your kind words.

Take care

(, 7, poly)

different drugs question-SCARED

> again!

> >

> > Date: Friday, August 1, 2008, 1:20 PM

> > Hi all,

> >

> > I posted a couple months ago about my daughter being

> put on

> > MTX and how I

> > was scared of all the side effects. You were all

> wonderful

> > and told your

> > stories about it and it helped me feel better about

> putting

> > her on it. Well

> > after only 4 weeks on it she started to get liver

> damage so

> > we had to take

> > her off and up her steroid dose which has made her

> huge and

> > still does not

> > keep it all the way under control. Now they want to

> try

> > Enbrel injections

> > once a week on her. I'm not happy about any of

> the

> > drugs as I think it is

> > harmful to the body but we don't have a choice

> since

> > she is so sick without

> > them. I read up on this drug and it scares me just

> as bad

> > at MTX did even

> > worse since it could have the side effect of cancer

> and

> > pneumonia among many

> > other things. Again I turn to you all to ask your

> > experience with this drug

> > for your children and what happened with them while

> on it.

> > I'm also scared

> > to have to give her a shot myself. Should we test

> her

> > liver before starting

> > the drug to make sure it is back to normal? What are

> the

> > early symptoms of

> > the drug causing problems I should watch for?

> I'm just

> > so apprehensive to

> > give her more poison to suppress her immune system

> into not

> > knowing it is

> > being attacked. I just hate this whole damn thing!

> >

> > Thanks

> > Kim

> > (Kairi 3 years old-systemic)

> >

> >

> > [Non-text portions of this message have been

> removed]

>

>

>

>

>

>