key: cord-338798-xsun927w
authors: Ciorba, Andrea; Skarżyński, Piotr Henryk; Pelucchi, Stefano; Hatzopoulos, Stavros
title: Ototoxicity prevention during the SARS-CoV-2 (Covid-19) emergency
date: 2020-10-17
journal: J Glob Antimicrob Resist
DOI: 10.1016/j.jgar.2020.09.030
sha: 
doc_id: 338798
cord_uid: xsun927w

• To remind the risk of ototoxicity when using chloroquine and hydroxychloroquine, in particular as prophylactic agents against SARS-CoV-2, during the pandemic. • Otoacoustic Emissions (OAEs) are reported to be very sensitive in evaluating early manifestations of cochlear ototoxic damages. • Healthy subjects taking chloroquine and hydroxychloroquine as prophylactic agent against SARS-CoV-2, during the pandemic, should be screened periodically, at least by OAEs.

eventually adequate treatment is established (3) (4) (5) . Sensorineural hearing loss, particularly among high frequencies, tinnitus and imbalance, are the main manifestation reported, due to chloroquine and hydroxychloroquine intoxication (3) (4) (5) . Possible mechanisms of chloroquine and hydroxychloroquine ototoxicity include: (i) damages to the stria vascularis with consequent endolymphatic poisoning, (ii) microcirculatory damage/thrombosis, (iii) damage to the inner ear melanocytes with induced degenerative changes in the stria vascularis (3) (4) (5) . Typically, the initial damage involves the outer hair cells in the cochlear basal turn, then progressing to the apical turn (2) (3) (4) . Further damage can also occur in the inner ear associated neural structures (3) (4) (5) .

Pure tone audiometry represents the main instrument for the identification and classification of hearing impairment; however, Otoacoustic Emissions (OAEs) are reported to be very sensitive in evaluating early manifestations of cochlear damages (6), as ototoxic drugs typically affect primarily outer hair cells (1, (3) (4) (5) . Particularly in young subjects, OAEs sensitivity is greater than conventional audiometric testing in detecting an initial inner ear damage (7) . Therefore, healthy subjects taking chloroquine and hydroxychloroquine as prophylactic agent against SARS-CoV-2, during the pandemic, should be screened periodically, at least by OAEs.

Clearly, even without a fatal condition, it is important to avoid the onset of ototoxic manifestations, especially when chloroquine and hydroxychloroquine are administered with a prophylaxis intent. In fact, sensorineural hearing loss, or tinnitus, or imbalance, when irreversible and persistent, can have significant negative impact on communication abilities and therefore on quality of life (QoL) perception. In particular, some Authors have already reported that audio-vestibular symptoms can impact negatively on mental well-being and QoL perception and have been linked to the onset and the sustaining of depression and self-isolation (7).

In our opinion, it is crucial to keep high our awareness about the potential impact of ototoxicity, especially if using ototoxic drugs on healthy subjects, without defined protocols.

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Ethical Approval: Not required.