Could HIV make hearing worse?

Human immunodeficiency virus can be incredibly debilitating, leaving individuals vulnerable to serious illnesses. On top of this, researchers have now suggested that adults with the virus have poorer low- and high-frequency hearing than adults who do not have the disease.

 

The findings, published in JAMA Otolaryngology – Head and Neck Surgery, come after an evaluation of the pure-tone hearing thresholds of men and women, some with the human immunodeficiency virus (HIV+) and some without (HIV-).

HIV is a virus that impairs the immune system, making people with the condition increasingly susceptible to infection and disease. There is currently no cure, but HIV+ individuals can be given a combination of medicines called highly active antiretroviral therapy (HAART) to slow the spread of the virus.

Since HAART became widely used, there has been very little investigation into the relationship between HIV infection and hearing loss, according to the study authors.

“There have been limited data obtained on the effects of HIV-related medication use on hearing loss,” they write, “and in the few published studies, it is difficult to attribute the increases in hearing loss specifically to HIV medication use rather than age or cumulative noise exposure.”

Dr. Peter Torre III, of San Diego State University in California, and colleagues set out to determine whether HIV disease variables and HAART are associated with changes to pure-tone threshold levels – the softest sounds audible to individuals for the majority of the time.

Evaluating the pure-tone threshold averages

For the study, the researchers assessed the hearing of 262 men with an average age of 57 and 134 women with an average age of 48.

Of the men, 117 (44.7%) were HIV+, and of the women, 105 (78.4%) were HIV+. Participants were taken from the sites of the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study.

Pure-tone threshold levels were measured in both ears in a sound-treated room. The researchers tested a wide range of frequencies, from 250 Hz to 8,000 Hz.

The researchers discovered that high- and low-frequency pure tone averages (LPTA and HPTA) were significantly higher in the better ears of the HIV+ participants, indicating that their hearing was poorer than the HIV- participants.

Even after adjusting the findings for current CD4+ cell count, HIV viral load and long-term exposure to antiretroviral medication, the results remained the same.

“To our knowledge, this is the first study to demonstrate that HIV+ individuals have poorer hearing across the frequency range after many other factors known to affect hearing have been controlled for,” write the authors.

Poorer hearing also found in individuals with diabetes mellitus

“The participants were middle-aged,” write the authors, “so an HIV effect on LPTA was not expected, given the speculation that long-term [HAART] exposure or HIV itself contributes to premature aging.”

Although unexpected, the authors also note that hearing loss at both LPTA and HPTA has previously been observed to be more likely in adults with diabetes mellitus. “It is possible that both HIV infection and diabetes, being systemic diseases, could affect the neural function of the cochlea,” they suggest.

The study is limited by the fact that participants were only recruited from specific geographical areas, namely Baltimore, MA, and Washington, DC. For women, the ratio of HIV+ to HIV- participants was also uneven, and future studies could rectify these representational imbalances.

“Although we do not understand the mechanism of hearing loss found in our study, our results suggest that HIV+ individuals may have physiologic changes that mimic other chronic conditions that affect hearing levels,” conclude the authors.

Earlier this month, Medical News Today reported on a mouse study suggesting hearing loss could be prevented by a vitamin supplement that protects the nerves stimulating the cochlea.

Written by James McIntosh

 

 

More than three years after pulsed-KTP laser treatment, 96 percent of patients with early vocal-cord tumors are cancer-free

The first long-term study of a pioneering endoscopic laser treatment for early vocal-cord cancer, developed at Massachusetts General Hospital (MGH) and previously shown to provide optimal voice outcomes, finds that it is as successful as traditional approaches in curing patients’ tumors while avoiding the damage to vocal quality caused by radiotherapy or by conventional laser or cold-instrument surgery. The report in the December Annals of Otology, Rhinology & Laryngology describes results for the first 117 patients treated for vocal-cord cancer with the green-light potassium-titanyl-phosphate (KTP) laser by Steven Zeitels, MD, director of the MGH Voice Center and developer of the procedure.

“Use of the KTP laser, which eradicates blood vessels in a process called photoangiolysis, was conceived to treat vascular malformations in infants’ delicate skin; but we have demonstrated that this specialized laser is especially effective in treating vocal-cord cancer,” says Zeitels. “These tumors have a denser blood supply than the underlying vocal-cord tissue, preservation of which is necessary to retain optimal vocal quality. As reported in this paper, our success in curing patients with small tumors with the angiolytic KTP laser is extremely high and very high for those with mid-sized tumors.

“Since radiation can damage the non-cancerous tissue of one or both vocal cords and conventional laser surgery destroys more delicate vocal tissue than is necessary, KTP laser treatment typically produces better vocal results while being more cost-effective,” he adds. “And a key issue when selecting a treatment for vocal-cord cancer is that radiation is considered to be a single-use treatment. So it is important to preserve the option of radiotherapy for treating future, more substantial cancers, the development of which is not uncommon.”

Zeitels first reported the use of the yellow-light, pulsed-dye laser to treat early vocal-cord cancer ten years ago, and in 2006 he and his colleagues introduced treatment with the more precise green-light KTP laser. Initial results with the KTP laser, describing the outcomes for 22 patients an average of 27 months after their procedures, were announced at the 2008 American Broncho-Esophagological Association (ABEA) annual meeting and published in Annals of Otology, Rhinology & Laryngology. A 2013 paper in the same journal reported excellent vocal outcomes for the first 92 treated patients, but neither paper included the kind of follow-up data required to confirm the treatment’s long-term effectiveness in curing the tumors.

The current paper describes results for 117 patients treated with the green-light KTP laser between 2006 and 2010. Some had cancer invading both vocal cords, but none had received radiotherapy before the laser treatment. Of the 82 treated patients with small tumors, 96 percent (79 of 82) have had no recurrence more than three years after treatment, and 80 percent (28 of 35) of those with mid-size tumors also have had no recurrence. Among the 10 patients whose tumors did recur, radiation treatment was successful in controlling the cancer in 5. Overall 96 percent – 112 of 117 patients – of those treated have survived an average of almost four and a half years and are cancer-free without loss of their larynx. At this year’s ABEA annual meeting the researchers received the organization’s prestigious Broyles Maloney Award for their successful development of this innovative, minimally-invasive strategy for treating vocal cord cancer.

Since 2010, more than 75 additional patients have received pulsed-KTP laser treatment for early vocal-cord cancer at MGH. Zeitels recently treated a 13-year-old boy with vocal-cord cancer, a rare condition in one so young. The first child to receive the KTP laser cancer treatment, he was referred to Zeitels after cancer was discovered in a biopsy of what were originally believed to be benign human papilloma virus (HPV) warts. While in only the first months after treatment for tumors involving both vocal cords, the youth’s voice has returned to near normal for a young man of his age. (An endoscopic video showing before-and-after results for this patient may be viewed here:

Another important aspect of the green-light KTP laser approach, Zeitels adds, is that biopsy and treatment of patients whose cancer involves a single vocal cord usually can be accomplished in the same procedure, whereas radiotherapy requires a prior biopsy to determine the extent and location of the tumor, followed by daily radiation treatments over approximately six weeks. For patients with tumors involving both vocal cords, a planned second-stage KTP laser treatment is done to optimize their voice outcomes. In addition, Zeitels notes, the treatment’s mechanism of eradicating the blood vessels supplying a tumor – highly effective for conventional vocal-cord cancer – is even more useful for treating tumors caused by HPV infection, which are characterized by an excessive overgrowth of blood vessels.

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/286774.php