Abstract
At this time of the COVID-19 pandemic, potentially effective treatments are currently under urgent investigation. Benefits of chloroquine and hydroxychloroquine for the treatment of COVID-19 infection have been proposed and clinical trials are underway. Chloroquine and hydroxychloroquine, typically used for the treatment of malaria and autoimmune diseases, have been considered for off-label use in several countries. In the literature, there are reports of ototoxic effects of the drugs causing damage to the inner ear structures, which then result in hearing loss, tinnitus, and/or imbalance. This mini-review represents a summary of the findings from a systematic search regarding ototoxicity of chloroquine and hydroxychloroquine in the published literature. The characteristics of sensorineural hearing loss and/or tinnitus after chloroquine or hydroxychloroquine treatment can be temporary but reports of persistent auditory and vestibular dysfunction exist. These are not frequent, but the impact can be substantial. Additionally, abnormal cochleovestibular development in the newborn was also reported after chloroquine treatment in pregnant women. The suggested dose of chloroquine for COVID-19 infection is considerably higher than the usual dosage for malaria treatment; therefore, it is plausible that the ototoxic effects will be greater. There are potential implications from this review for survivors of COVID-19 treated with chloroquine or hydroxychloroquine. Patient reports of hearing loss, tinnitus, or imbalance should be noted. Those with troublesome hearing loss, tinnitus and/or imbalance are encouraged to be referred for hearing evaluation and interventions once they are stable. Clinical trials of chloroquine or hydroxychloroquine should also consider including audiological monitoring in the protocol.
Highlights
At this time of the COVID-19 global pandemic, potentially effective treatments are currently under urgent investigation
Three out of ten cases had temporary sensorineural hearing loss after chloroquine treatment that improved after cessation of the medication [14, 19]
Permanent severe sensorineural hearing loss has been reported in 2 cases [17, 20]
Summary
At this time of the COVID-19 global pandemic, potentially effective treatments are currently under urgent investigation. There is no evidence from randomized clinical trials that any specific therapy improves outcomes in patients with COVID-19 [1]. Chloroquine and Hydroxychloroquine Ototoxicity pathophysiological considerations and in vitro results [2, 3] These drugs have received particular attention as they are widely available and inexpensive. Some alterations in central auditory function, which may trigger tinnitus, have been observed after quinine administration [13] This mini-review represents a summary of the findings from a literature search regarding ototoxicity of the drugs in the published literature as well as the discussion of potential implications for survivors of COVID-19 so treated.
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