3/7/2018 1 Drug Side Effects on Audiological and Vestibular Testing Robert M. DiSogra, Au.D., FAAA Audiology Consultant Millstone Twp., NJ www.drbobdisogra.com Disclosure I There are no financial or non- financial relationships to disclose for this presentation Disclosure II Robert M. DiSogra and the Indiana Speech-Language- Hearing Association endorse any of the products mentioned in today’s program This program is not a complete summary of all drugs that could affect audiologic or vestibular testing Disclosure III Dr DiSogra is receiving an honorarium for this lecture Disclosure IV Learner Outcomes 1. Identify oversights your case history intake form that could lead to a misdiagnosis 2. Identify auditory, vestibular, cognitive and other systems side effects of interest to audiologists
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3/7/2018
1
Drug Side Effects on
Audiological and Vestibular Testing
Robert M. DiSogra, Au.D., FAAAAudiology Consultant
Millstone Twp., NJ
www.drbobdisogra.com
Disclosure I
There are no financial or non-
financial relationships to disclose
for this presentation
Disclosure II
Robert M. DiSogra and the
Indiana Speech-Language-
Hearing Association
endorse any of the products
mentioned in today’s program
This program is not a
complete summaryof all drugs that could
affect audiologic or
vestibular testing
Disclosure III
Dr DiSogra is receiving an
honorarium for this lecture
Disclosure IV
Learner Outcomes
1. Identify oversights your casehistory intake form that couldlead to a misdiagnosis
2. Identify auditory, vestibular,cognitive and other systems side
effects of interest to audiologists
3/7/2018
2
Learner Outcomes
3. Learn where to look for reliabledrug side effect information onthe internet
4. Learn how to report discrepantfindings
5. Improve communication between
patient and referring physicianconcerning drug side effects andtest results
6. Learn how to report an adversedug reaction to the FDA
Learner Outcomes
Adverse Drug
Reaction (ADRs)
Drug Side
Effects
Adverse Drug
Reactions
For Audiologists,
ADRs Affect 6 Areas
Auditory Balance
Cognitive Vascular
Neurological Speech
Why should Audiologists be
concerned about Adverse
Drug Reactions (ADRs)?
(other than hearing loss, tinnitus
or balance problems)
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Decreased outer hair cell function
Tinnitus Hearing loss
Dizziness Vertigo
ADRs can cause…
Perceptual changes
Sensitivity changes
(hyperacusis)
ADRs can also cause…
Fluctuations in hearing,
perception or tinnitus
due to changes in
cochlear blood flow
ADRs can also cause…
Affect
vestibular
function
and associated
balance tests
ADRs can also…
Affect visual
tracking abilities
or other visual
system functions
ADRs can also…
Mimic Hearing Loss
(hearing loss complaints with normal
audiogram, OAEs,
tymps & MEMRs)
ADRs can also…
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Result in obtaining inadequate
or “less than accurate” case
history information
Result in the selection of the
wrong diagnostics tests
ADRs can also…
Result in the wrong interpretation
of subjective tests
Result in in numerous and
unnecessary
hearing aid re-check visits
because…
ADRs can also…
“My new hearing aids just don’t
work like they used to!” 1. 30 min. - Review recent medical history (illness, new medical diagnosis, trauma, etc.)
- Otoscopy
- Listening check
- Cleaning
- Reprogram both aids
- One month recheck - N/C visit
2. 30 min. - “No improvement, Doc.”
- Send right aid to manufacturer for “bench check”
- ~ $150.00 cost to mfgr. to check an aid!
- “No problem found”
3. 30 min. - Refit right aid; send left to
mfgr.
a. ~ $150.00 cost to mfgr. to
check the aid
b. “No problem found”
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4. 30 min. - Refit left;
- Reprogram each aid;
- Rec: 1 month recheck
5. 45 min. “It’s not any better!”
- Retest hearing: no changes
- Reprogram again?
6. Patient does not come back
7. “Release of Medical Records Form”
received in your office!
What Happened?
COSTS
YOU: 2.75 hours @ $200.00/hr..... $550.00
MFGR: 2 “checks” @ $150.00….. $300.00
TOTAL = $850.00!
Recommendations
for additional
diagnostic tests can be…
Recommendations
for hearing aid
services can be…
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Academic or
occupational
recommendations can be…
Counseling
recommendations
can be…
Just How Many ADRs
“Of Interest” Are There
For Audiologists?
403
DiSogra, RM. Adverse drug reactionsand patient management. Aud Today,September 2008
403 Adverse Drug Reaction
Related Disturbances
Auditory/Hearing Related
Central Nervous System
Cognitive
Facial Nerve
LanguageDiSogra, RM Adverse Drug Reactions
and patient management, Aud Today,
September 2008
403 Adverse Drug Reaction
Related Disturbances
Nose, Throat and Sinus
Neurological
Speech
Vascular
Vestibular
VisualDiSogra, RM Adverse Drug Reactions
and patient management, Aud Today,
September 2008
ADR Descriptors
Reported to the FDA…
Language not
standardized
Can be very
subjective
Transient
deafness
Feeling
inebriated
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AUDITORY
Auditory disturbances Transient deafness
Ear discomfort Ear congestion
Some ADR Descriptors
AUDITORY
Roaring ears Nerve deafness
Tingling ears Tinnitus
Hearing Loss
Some ADR Descriptors
Awareness, altered
Concentration, impaired
Confusion/Forgetfulness
Disorientation
COGNITIVE
Some ADR Descriptors
Mental acuity, loss of
Mental clouding Mental slowness
Mental status, altered
COGNITIVE
Some ADR Descriptors
Proprioception, loss of
Stupor Thinking abnormality
Thinking, slowed
COGNITIVE
Some ADR Descriptors
VESTIBULAR
There are 161 ocular, optic,
visual, vascular-related, peripheral vestibular related