ENT Toxicity

Hydroxychloroquine has been reported to effect ENT (ears, nose and throat) systems in a variety of ways including:

• Taste and odour changes

• Dysphagia (difficulty swallowing) due to changes in muscle toxicity

• Acute and chronic audio vestibular manifestations (tinnitus, vertigo and deafness)¹

The prevalence of taste and odour changes is unknown but thought to be uncommon and reversible after treatment cessation¹. The manifestation of audio vestibular problems, known as ototoxicity, are more common.

Audio vestibular disorders have a prevalence of 10% in patients treated with hydroxychloroquine, with complications appearing from the first point of administration but more frequently arise after 1 year of treatment suggesting that a prolonged exposure time and high dosage are significant risk factors^1,2. Although the ototoxicity causing sensorineural hearing loss may be irreversible, it is thought that if the use of hydroxychloroquine is stopped early on the damage may be reversible in some cases^2,3.

References:

1. Muller R. Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilities. Rheumatology International. 2021:1-14.

2. Prayuenyong P, Kasbekar AV, Baguley DM. Clinical implications of chloroquine and hydroxychloroquine ototoxicity for COVID-19 treatment: a mini-review. Frontiers in public health. 2020;8:252.

3. Ciorba A, Skarżyński PH, Pelucchi S, Hatzopoulos S. Ototoxicity prevention during the SARS-CoV-2 (COVID-19) emergency. Journal of Global Antimicrobial Resistance. 2020;23:263-4.

4. De Luca P, Scarpa A, De Bonis E, Cavaliere M, Viola P, Gioacchini FM, et al. Chloroquine and hydroxychloroquine ototoxicity; potential implications for SARS-CoV-2 treatment. A brief review of the literature. American Journal of Otolaryngology. 2021;42(5):102640.