Value And Strategy Research Of Hearing Monitoring On The Early Treatment During Thalassemia Patients

Objective:Our study is aimed to confirm whether there is the hearing loss and its incidence in thalassemia. We monitor auditory changes during thalassemia patients with treatment of deferoxamine (DFO) and explore the application value of extended high frequency audiometry and word recognition scores during early hearing loss to provide the reliable evidence for diagnosis and intervention in thalassemia patients with early hearing loss.Method:Prospectively study included hematology outpatient 71 patients in Guangxi medical university first affiliated hospital who contain thalassemia intermedia (TI) and thalassemia major(TM) patients from December 2010 to December 2014. According to nature and degree of conventional pure tone audiometry, the whole patient was divided into the normal group and hearing loss group. We compared the distribution of gender, age, the type of thalassemia or history of blood transfusion and treatment of DFO between two groups; Audiological tests were obtained on the pre-treatment regularly in all the patients, including pure tone audiometry(PTA) contain conventional pure tone audiometry and extended high frequency audiometry, acoustic immittance Besides word recognition score(WRS) was obtained in 38 thalassemia patients. We compared the changes between conventional pure tone audiometry, extended high frequency audiometry and WRS on the pre-treatment and post-treatment to confirm the characteristics of auditory.Result:77 patients included 43male and 34 female, the ratio between them was 4:3. There were 28 cases(42ears) have the hearing loss during conventional pure tone audiometry and the incidence was 36.36% and the patients were sensorineural hearing loss(SNHL). There were 24 TI (31.17%),4 TM (5.19%), 18 SNHL patients(29ears) with the normal degree and 10 mild SNHL patients, neither media nor moderate deaf on the pre-treatment day. But 4 (5.19%)SNHL ears had hearing loss significantly post-treatment showed as high frequency drop in 15-20dB. There were no statistically significant differences with respect to gender, the type of thalassemia or history of blood transfusion and the treatment of DFO(P>0.05)between normal group and hearing loss group, but statistically significant differences in age (P<0.05), positive correlating with hearing loss (r=0.552, P=0.000<0.05). Conventional pure tone audiometry was similar on the pre-treatment and post-treatment in both normal group and hearing loss group. The differences of the extended high frequency audiometry and the hearing without detection rate between the pre-treatment and the post-treatment day significantly increased, WRS in 38cases were lower.Conclusion:TI and TM patients have hearing loss during conventional pure tone audiometry. The ratio of auditory injury in thalassemia was 36.36% on the pre-treatment but increased 5.19% through treatment of DFO. All the cases were SNHL and most were mild deaf. Hearing loss was no correlated with gender, the type of thalassemia and blood transfusion but was correlated with age. There was no significantly hearing loss after one year’s treatment. We found that DFO was not obviously ototoxic. The extended high frequency audiometry and WRS might be more sensitive in evaluating the early hearing loss for thalassemia. The conventional pure tone audiometry, the extended high frequency and WRS needed to be combined to reflect the whole auditory level in thalassemia patients.