手语世界

这是一篇刊登于国际重听人联合会网站里的文章，内容是关于耳毒性药物。其作者是医学博士史蒂芬.爱普斯顿。他是一个耳科医生合头颈外科医生。他也是美国耳鼻喉学会的和美国外科医生联合会的成员，他还是设立于马里兰的耳科治疗中心的负责人。

之所以选取这篇文章进行翻译是因为大家都知道，很多重听朋友们都是由于服用了或者注射了链霉素等药物造成过敏后丧失了自己的部分听力，而且最悲惨的是，这样的听力损失往往是不可逆转性的永久性听力损害。大家知道吗？链霉素、庆大霉素甚至作为感冒的常用药阿司匹林都是耳毒性药物。所以了解耳毒性药物的种类已使大家在服用药物的时候避开对听力有伤害的药物，这对还有残余听力的重听人来说是非常有必要的。对于有孩子的聋人们来说也是应该知道的知识。由于原文是英文，所以枯叶蝶试着将这篇文章翻译了一下，由于文章中大量药物术语的使用并且枯叶蝶并非药物专业出身，所以其中药物名称定有错漏或者翻译不全的地方，请大家不吝提出意见。另外特别要感谢的是唐无欢先生，是他为大家找到了这篇文章。在此特地谢谢！

What You Should Know About Ototoxic Medications by Stephen Epstein, M.D. Reprinted with Permission the SHHH Journal, September/October 1995 © Self Help for Hard of Hearing People, Inc. Ototoxic medications are those drugs that have the potential to cause damage to the inner ear structures which may result in temporary or permanent loss of hearing or an aggravation of an existing sensorineural hearing loss. If you have an existing sensorineural hearing loss, regardless of the cause, when using ototoxic medications, you are more vulnerable to aggravation of that hearing loss. As a result of using ototoxic medications, the degree of hearing loss that occurs and the amount of recovery that follows depends upon the amount and duration of the use of that particular medication. If you are consuming more than one ototoxic medication, you are even more vulnerable to developing a sensorineural hearing loss or aggravation of your existing sensorineural hearing loss. Some ototoxic medications such as aspirin and aspirin-containing drugs — regardless of the amount and duration of usage — when discontinued, result in complete recovery of hearing and cessation of associated symptoms such as tinnitus. Guidelines to Follow In regard to the use of ototoxic medications, whether they are over-the-counter or prescription, there are several important facts you should know and several important rules you should follow: · Always inform your doctor that you have a sensorineural hear loss or nerve-type hearing loss. · Always ask your doctor, when he is prescribing new medications for you, to inform you of any potential side effects, especially if the medication is ototoxic. · Always read the labels or ask your pharmacist about the potential ototoxic effects of over-the-counter medications. · Always be aware of the early warning signs of ototoxicity. Signs of Ototoxicity, Listed in Order of Frequency · The development of tinnitus (noises in the ears) in one or both ears. · The intensification of existing tinnitus or the appearance of another sound that didn’t exist before. · Fullness or pressure in your ears — other than being secondary to an upper respiratory infection. · The awareness of a hearing loss in an unaffected ear or the progression or fluctuation of an existing loss. · The development of vertigo or spinning sensation usually aggravated by motion and may or may not be accompanied by nausea. Should any of these symptoms develop while taking any medication — stop the medication immediately and call your doctor. Ototoxic Medications Finally, you should be aware of the common ototoxic medications, how they are prescribed, and for what conditions they are given. The following is a simplified list of ototoxic medications and represents the most common drugs. (There are many other medications that have bee listed as potentially ototoxic; however the incidence is insignificant. Consult your physician to be sure.) Keep this list for ready reference. 1. Salicylates – Aspirin and aspirin-containing products · Toxic effects usually appear after consuming an average of 6-8 pills per day. · Toxic effects are always reversible once medications are discontinued. 2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) – Advil, Aleve, Anaprox, Clinoril, Feldene, Indocin, Lodine, Motrin, Nalfon, Naprosyn, Nuprin, Poradol, Voltarin · Toxic effects usually appear after consuming an average of 6-8 pills per day. · Toxic effects are usually reversible once medications are discontinued. 3. Antibiotics – Aminoglycosides, Erythromycin, Vancomycin · Aminoglycosides – Streptomycin, Kanamycin, Neomycin, Gentamycin, Tobramysin, Amikacin, Netilmicin These medications are ototoxic when used intravenously in serious life threatening situations. The blood levels of these medications are usually monitored to prevent ototoxicity. Topical preparations and ear drops containing these antibiotics, Neomycin and Gentamycin, have not been demonstrated to be ototoxic in humans. · Erythromycin – EES, Eryc, E-mycin, Ilosone, Pediazole, and new derivatives of Erythromycin — Biaxin, Zithromax Erythromycin is usually ototoxic when given intravenously in dosages of 2-4 grams per 24 hours — especially if there is underlying kidney insufficiency. The usual oral dosage of Erythromycin averaging one gram per 24 hours is not ototoxic. There are no significant reports of ototoxicity with the new Erythromycin derivatives since they are given orally and in lower dosages. · Vancomycin – Vancocin This antibiotic is used in a similar manner as the aminoglycosides; when given intravenously in serious life-threatening infections, it is potentially ototoxic. It is usually used in conjunction with the aminoglycosides which enhances the possibility of ototoxicity. 4. Loop Diuretics – Lasix, Edecrin, Bumex These medications are usually ototoxic when given intravenously for acute kidney failure or acute hypertension. Rare cases of ototoxicity have been reported when these medications are taken orally in high doses in people with chronic kidney disease. 5. Chemotherapeutic Agents – Cisplatin, Nitrogen Mustard, Vincristine These medications are ototoxic when given for treatment of cancer. Their ototoxic effects can be minimized by maintaining blood levels of the medications and performing serial audiograms. The ototoxic effects of these medications are enhanced in patients who are already taking other ototoxic medications such as the aminoglycoside antibiotics and the loop diuretics. 6. Quinine – Aralen, Atabrine (for treatment of malaria), Legatrin, Q-Vel Muscle Relaxant (for treatment of night cramps) The ototoxic effects of quinine are very similar to aspirin and the toxic effects are usually reversible once medication is discontinued. Just as you are responsible for your overall health, you are responsible for the preservation of your hearing or the preservation of your existing hearing reserve. Being aware of ototoxic medications and their potential warnings is a good safeguard to protect your hearing — and a sound investment! Stephen Epstein, M.D., F.A.C.S., is an otologist and a fellow of the American Academy of Otolaryngology – Head and Neck Surgery, Inc., and the American College of Surgeons. He is the director of The Ear Center in Wheaton, Maryland. Special tip for filling out medical forms One SHHH member reports that when filling out medical questionnaires, she lists ototoxic medications under “known allergies”. This invariably results in questions medical staff, making them more aware of her hearing loss.

你所应该知道的耳毒性药物

史蒂芬.爱普斯顿（医学博士）著

此文经许可从1995年第9.10期SHHH杂志转载，重听自助有限公司

耳毒性药物是指那些有可能造成内耳结构性损伤的药物，这种损伤将会导致临时或者永久的听力缺失，也会对已存的感音性听觉缺失造成更大伤害。如果你现已有感音性的听觉损失，不管这损失是什么造成的，一旦服用了耳毒性药物，那么你更容易遭到听力损失的加重。 作为服用耳毒性药物带来的后果，听力损失的发生数量和其后的恢复数量仰赖于耳毒性药物的用量和时间。如果你服用了不止一种耳毒性药物，那么你将会更可能遭受渐进的感音性听力损失或者使你已存在的感音性听力损失更加恶化。一些耳毒性药物比如阿司匹林和含有阿司匹林的药物（不管已经服用的剂量和时间）当停止服用时,将带来听力完全恢复和诸如耳鸣等听力损失关联症状的消失. 应遵循的指导方针： 关於耳毒性药物的服用，无论是直接出售的还是处方开出的, 有一些重要的事实和重要的规则是你应该知道和遵从的:

1. 知会你的医生，告诉他你患有感音性听力损失或者神经性听力损失；
2. 当医生使用新药为你治疗时，一定要请他告诉你这种药有没有任何潜在性的副作用，特别开具的新药是耳毒性药物是更要如此；
3. 直接在柜台购买药物时，仔细阅读标签或向药剂师询问此药物是否存在潜在耳毒性危害；
4. 注意耳毒性出现的早期征兆。

耳毒性的征兆（以发生的频率次序列出）：

（1）单耳或者双耳出现耳鸣（即是耳朵里的噪音）；（2）以前耳鸣过，现在耳鸣更加恶化或者耳鸣时的鸣叫是以前没有出现过的声音；

（3）耳内发胀或者有压力――不同于由于上呼吸道感染时导致的胀压；

（4）发现听力健全的那只耳朵出现听力损失或者已经出现听力损失的耳朵损失程度加重或者异常波动；

（5）运动时眩晕感或旋转感加重，并通常伴随着恶心和反胃的感觉. 当你接受药物治疗的时候 ,如果出现这些症状之中的任何一个 — 立刻停止药物治疗并且打电话给你的医生.

最后，你应该知道常用的耳毒性药物,它们的处方开具,和在什么条件下它们将被开具等常识。 下列各项是关于耳毒性药物的一个被简化目录并且列出的都是最常用的药. (还有许多药物存在潜在耳毒性，但是它们的影响微乎其微所以在此不再列出。但服用前一定要先问过医生)以下理出的药物作为参考：

（1）. 水杨酸盐 – 阿斯匹林和包含阿斯匹林的药物产品；毒效通常在平均每天6-8粒药丸的服用量后出现；毒效是可逆的，一经药物治疗被停止便消失。（2）. 非类固醇消炎类药物（NSAIDS）： Advil, Aleve, Anaprox, Clinoril, Feldene, Indocin（氯苯酰甲氧基甲基吲哚乙酸）, Lodine, Motrin, Nalfon, Naprosyn, Nuprin, Poradol,(译者注：这些药物在医学字典里也找不到，只有等哪个网友找到了给大家分享一下了) 毒效通常在平均每天6-8粒药丸的服用量后出现； 毒效是可逆的，一经药物治疗被停止便消失。

（3）. 抗生素 -氨基甘油配糖类抗生素 ，红霉素 , 万古霉素 · 氨基甘油配糖类抗生素- 链霉素、卡拉霉素、新霉素、庆大霉素、托普霉素 ，氨基羟丁基卡那霉素A(即：抗菌素BBK8)、内醍尔霉素 在病人有生命危险时而需做静脉注射时，这些药物是具有耳毒性的。通常会对病人的血液水平做监控以免受到耳毒性的侵袭。 话题的准备和听力下降包括这些抗生素、新霉素和庆大霉素,但它们并没有被人们证明是具有耳毒性的。 l 红霉素- 红霉素 (抗生素)里的EES ，Eryc ，E-霉素，Ilosone ，Pediazole 和红霉素新的变种抗生素 — Biaxin,Zithromax 红霉素当在每24小时 2-4 克的静脉药量滴注的时候会产生耳毒性。尤其是患者有肾脏方面的疾患时毒性更大. 平常的红霉素平均每24小时的口服药量不足以造成耳毒性. 目前并没有关于红霉素的新型延伸药物在口服剂量和较低剂量的静脉注射时会导致耳毒性的重要记载。 l 万古霉素-万霉素： 这种抗生素的使用方式类似于抗生素，也就是说对有生命危险的病人进行静脉注射时使用万古霉素时也许会发生耳毒性反应。而万古霉素通常和抗生素一起使用，这就增加了耳毒性耳聋发生的可能性。

（4）. 利尿剂 – Lasix ， Edecrin,Bumex 当这些药物被用于治疗急性肾炎或者急性高血压而座静脉注射的时候，它们是具有耳毒性的。 但是鲜有这些药物在治疗慢性肾病而被病人高剂量口服时产生耳毒性的相关报告。

（5）. 化疗药剂- Cisplatin, Nitrogen Mustard（氮芥末）, Vincristine 当作为癌症的治疗药物时，这些化疗药剂是耳毒性的。但能藉由维持血液中的药物水平和实施持续性听力敏度图而使耳毒性危害减到最少。但如果癌症患者同时服用了抗生素或者利尿剂那么耳毒性危害将会增加。

（6）. 奎宁-Aralen，Atabrine(为疟疾的治疗)，Legatrin,Q- Vel 肌肉放松(为夜晚抽筋的治疗) 奎宁带来的耳毒性类似于阿司匹林，而且毒效通常是可逆的：一经药物治疗被停止毒性会在停止服用药物后消失。

正如你对你的身体健康负有全责,你必须保护你现在的听力或者保护你现在残余的听力.了解这些耳毒性药物和它们可能造成的危害是对自己很好保护也是一个值得的健康投资！

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