Could an app be the future to monitoring hearing loss in CF?

There is an increased risk of hearing loss in people with cystic fibrosis (CF) due to damaging effects from the antibiotics they require to treat infection, according to a study published in Thorax.

The study, led by Dr Anand Shah, respiratory consultant at Royal Brompton & Harefield NHS Foundation Trust, and funded by the Cystic Fibrosis Trust, looked at 126 adults with CF and found that those given more intravenous antibiotics over a 10 year period were more likely to experience hearing loss. In addition, the study also looked at whether some people with CF have mutations in their genes which makes them more susceptible to developing hearing loss.

Despite the link between hearing loss and long-term use of antibiotics in the CF population, there are currently no standardised recommendations in place for screening for hearing loss for this group and existing audiology tests require specialist staff and equipment and further outpatient visits. 

This is where the second part of Dr Shah’s study comes in. His team tested a novel ipad-based audiometry application, alongside a web-based hearing test developed in collaboration with the Imperial College Dyson School of Design Engineering, to determine if it could be used to reliably screen for hearing loss in adults with CF. 

The study compared three types of hearing test; 

  • an online based hearing test and questionnaire carried out by the person with CF at home, using regular headphones
  • a hearing test carried out on an ipad using special headphones, and conducted by a non-audiologist in an outpatient setting
  • a regular audiology test carried out using standard testing equipment by an audiologist

The study found that the online test, given it used standard headphones, was not as good at detecting hearing loss. However, the ipad-based test was very sensitive and specific compared to standard audiometry tests conducted by an audiologist. 

So, what does this mean for people with CF? Dr Shah said:

“Unfortunately, hearing loss is an under-recognised and very common side-effect for individuals with CF. Our study shows that almost 50% of adults with CF have detectable hearing loss, with almost 10% in a range that would affect hearing speech, significantly affecting quality of life. 

“One of the major problems we currently face is that access to formal hearing tests is difficult, expensive and requires further visits to hospital. This very often results in delayed detection of irreversible hearing loss at a stage where it will already affect quality of life. This study is the first to show that you can accurately detect drug-related hearing loss using easy-to-use portable equipment in an outpatient setting that can be performed by anyone. This will enable us to screen for hearing loss much more efficiently and pick up problems at a far earlier stage.”

And as for what’s next, Dr Shah said:

“Our study has already shown that we can accurately use ipad based tests in an outpatient setting which will enable us to implement a robust hearing screening strategy across our centre. This will also be applicable to numerous other diseases where drug-related hearing loss is common. 

“In light of the current COVID-19 pandemic, it is even more important to develop innovative monitoring solutions for health, and we are continuing our collaboration with Imperial College London to develop accurate remote web-based monitoring.

On what this will mean for patients with CF in the future, Dr Keith Brownlee, Director of Policy, Programmes and Support at the Cystic Fibrosis Trust, said:

“Intravenous antibiotics are often used to treat CF-related lung infections. We know that one group of these, known as aminoglycosides, may cause damage to hearing. Having an easy to administer, economic and accurate hearing test will help people with CF enormously. In the future it could mean that they can have more informed discussions with their CF team about options for their care.

The study was funded by the Cystic Fibrosis Trust and the NHS Darzi Fellowship scheme and carried out in collaboration with Imperial College London, Imperial College Healthcare NHS Trust, Guys and St Thomas’ NHS Foundation Trust and the University of Twente, Netherlands.

If you would like to find out more about any of the research mentioned in this story, or any other research at our Trust, please contact us.