Here's the story of a patient complaining of a major hearing loss, especially at right.
5'9'' - 162lbs - 21 yrs
cystic fibrosis
Liver transplant
diabetes
+ lazy suprarenal glands
...
Transplanted in May 2009
he's taking the following:
tacrolimus (prograf) 3.5 bid
testim (testosterone) 5g/day alt. 7.5g
cortef 15mg 10mg 5mg = 30mg/day
TOBI (tobramycin for inhalation) 150mg each day
oxycodone 10mg prn
clonidine 0.1 bid
coumadin 2.5mg
singulair 10mg hs
desyrel 50 hs
lyrica 50 bid (stopping)
... for the least
New addition these past weeks was the clonidine to treat high pressure probably associated with tacrolimus undoubtedly.
Today, he came at the hospital for a regular appointment.
labs: Total testosterone way too high. Potassium at 5.9 just an edge under my established toxic limits (6.0). Creat 140 (tacrolimus decreasing renal fonction), not too bad and and I don't think it can explain this acute hyperkalemia. The rest is normal for him.
Then, he complained of hearing loss that has begun since 2 months or so. He has always had a small tinnitus, but it's is even more noticeable in his right ear since that time. He thinks the tinnitus is still the same, but he is hearing it more because of this hearing loss (this is logic).
Past audiograms (6 months ago) were showing a considerable loss @ 8khz, medium loss @ 7 and very small at 6, the rest is normal. This was asymmetric, the right ear was a bit more affected than the left one. We are all sure that this loss of high frequencies was caused by neurotoxic ears medication, such as tobramycin IV.
He has noticed that, some time after pain and a take of oxycodone, the tinnitus is increasing and he is earing less. I searched some information about hearing loss with the take of oxycodone, this was not proved, though Vicodin, an other codeinic, is already known for impairing ears (so it might be related to codeinics like oxycodone in some ways... or not).
Then I came with this idea (since I am an anesthesiologist student so I know a lot about opiates but nothing about ears), which sounds not that crazy after all, is the fact that most opiates are increasing K+ currents synapticly. And this, combined with a progressive hyperkalemia could perhaps lead to an hearing disorder according to his case and his symptoms because now he feels that he lost some hearing.
I need someone who can help me on that one.
Is it reversible or not? Do we need to worry? Do we need to act quickly?
How does potassium channels impact on hearing?
5'9'' - 162lbs - 21 yrs
cystic fibrosis
Liver transplant
diabetes
+ lazy suprarenal glands
...
Transplanted in May 2009
he's taking the following:
tacrolimus (prograf) 3.5 bid
testim (testosterone) 5g/day alt. 7.5g
cortef 15mg 10mg 5mg = 30mg/day
TOBI (tobramycin for inhalation) 150mg each day
oxycodone 10mg prn
clonidine 0.1 bid
coumadin 2.5mg
singulair 10mg hs
desyrel 50 hs
lyrica 50 bid (stopping)
... for the least
New addition these past weeks was the clonidine to treat high pressure probably associated with tacrolimus undoubtedly.
Today, he came at the hospital for a regular appointment.
labs: Total testosterone way too high. Potassium at 5.9 just an edge under my established toxic limits (6.0). Creat 140 (tacrolimus decreasing renal fonction), not too bad and and I don't think it can explain this acute hyperkalemia. The rest is normal for him.
Then, he complained of hearing loss that has begun since 2 months or so. He has always had a small tinnitus, but it's is even more noticeable in his right ear since that time. He thinks the tinnitus is still the same, but he is hearing it more because of this hearing loss (this is logic).
Past audiograms (6 months ago) were showing a considerable loss @ 8khz, medium loss @ 7 and very small at 6, the rest is normal. This was asymmetric, the right ear was a bit more affected than the left one. We are all sure that this loss of high frequencies was caused by neurotoxic ears medication, such as tobramycin IV.
He has noticed that, some time after pain and a take of oxycodone, the tinnitus is increasing and he is earing less. I searched some information about hearing loss with the take of oxycodone, this was not proved, though Vicodin, an other codeinic, is already known for impairing ears (so it might be related to codeinics like oxycodone in some ways... or not).
Then I came with this idea (since I am an anesthesiologist student so I know a lot about opiates but nothing about ears), which sounds not that crazy after all, is the fact that most opiates are increasing K+ currents synapticly. And this, combined with a progressive hyperkalemia could perhaps lead to an hearing disorder according to his case and his symptoms because now he feels that he lost some hearing.
I need someone who can help me on that one.
Is it reversible or not? Do we need to worry? Do we need to act quickly?
How does potassium channels impact on hearing?
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