Limiar tonal de audibilidade de transplantados hepáticos em uso de diferentes protocolos de imunossupressão

Abstract

Many are the problems already documented in scientific literature that can derive from immunosuppression, such as: infections, neurologic complications, systemic arterial hypertension, renal dysfunction, diabetes, bone disease, obesity, among others. Regarding hearing, there are reports in international scientific literature that associate change in the pure tone threshold of audibility to immunosuppressants. In the use of Csa, there is interaction with erythromicin and a case report of hearing loss associated with FK506. FK506 is a macrolide just like erythromycin, of which reports about sensorineural hearing loss have been described in literature for about three decades. Clinical observation of gross hearing alterations in patients subjected to orthotopic liver transplant has led to the interest in studying the auditory acuity of liver transplant patients (TxH), since in domestic literature there are no studies related with hearing in that population. The aim of this research was to verify the potential effects associated with hearing in liver transplant patients and compare the potential changes in the pure tone threshold stemming from the use of cyclosporin (Csa) and tacrolimus (FK506). The subjects were assessed by liminal pure tone audiometry for pure tone thresholds of audibility in 84 ears of 42 patients, before and after orthotopic liver transplant. The patients were divided in two groups, cyclosporin (Csa n=18) and tacrolimus (FK n=24). The statistic analysis was carried out through application of non-parametric tests and use of occupational audiology criteria. The results pointed out to a statistically significant change in pure-tone threshold, particularly in high frequencies, in orthotopic liver transplant. Csa and FK506 were assumed to have noxious effects on the inner ear of these patients. Other results showed a greater significant change in the pure-tone threshold, between the right and left ears, in high frequencies, in group FK. The analyses undertaken, from an occupational perspective, confirmed the statistic data that pointed out to a trend of change in the puretone threshold in group FK. It was concluded that: liver transplant patients showed a worse pure-tone threshold after orthotopic liver transplant; the ones using tacrolimus showed more accentuated losses than those using cyclosporin; the worsening in the pure-tone threshold of audibility is more accentuated in high frequencies; the ones using tacrolimus had a loss in the pure-tone threshold in both high and low frequencies. The effects of a worsened pure-tone threshold may be multifactorial, since these patients show more co-morbidities and, thus, are subjected to several drug treatments, being exposed to the adverse effects and side effects of the drugs used. It´s underscored, however, that in this study the patients served as witnesses to themselves before and after the orthotopic liver transplant. Further studies are suggested so that the variables can be sorted with the purpose of characterizing this population in order to institute a phonoaudiological counseling.