Open Access
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(01): e167-e177
DOI: 10.1055/s-0041-1740986
Systematic Review

The Ototoxicity of Chloroquine and Hydroxychloroquine: A Systematic Review

Carolina Pereira Fernandes 
1   Language and Hearing Sciences at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
,
Luíza Silva Vernier 
2   Graduate Program in Health Sciences at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
,
Eliane Dallegrave 
3   Analytical Toxicology and Graduate Program of Health Sciences at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
,
Márcia Salgado Machado 
4   Speech-Language Pathology and Audiology Program at Universidade Federal de Ciências da Saúde de (UFCSPA), Porto Alegre, RS, Brazil
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Abstract

Introduction Chloroquine and hydroxychloroquine are antimalarial drugs widely used in the treatment of rheumatic diseases. With the global pandemic caused by the new coronavirus, there was an increase in the prescription of these drugs, which led to a major concern regarding their ototoxic effects.

Objectives The objective of the present study was to assess existing scientific evidence about the toxic effects of chloroquine and hydroxychloroquine on the peripheral and/or central auditory system.

Data Synthesis A systematic literature review was performed by searching the PubMed (Medline), Scopus, Web of Science, LILACS, and SciELO electronic databases, in a search of articles that fullfiled the predefined inclusion and exclusion criteria. The review was conducted in three phases and, in all of them, analyses were performed by two independent researchers. Disagreements were discussed with a third researcher until a consensus was reached. A total of 437 articles were found and 8 were included in this review. Seven of the included studies reported hearing loss in their samples and presented a diagnostic hypothesis of ototoxicity induced by chloroquine or hydroxychloroquine. The most common type of hearing loss was sensorineural, with varying laterality and degrees of severity. The most frequently used audiological test was pure tone audiometry, and only two studies assessed brainstem evoked responses.

Conclusion The scientific evidence compiled in this research showed that chloroquine and hydroxychloroquine have an ototoxic effect in the peripheral auditory system. These drugs can cause cochlear damage, including changes in the stria vascularis and lesions in sensory hair cells.

Keywords

chloroquine - hydroxychloroquine - ototoxicity - hearing loss

Final Comments

The present literature review led us to conclude that CQ and HCQ are capable of inducing hearing impairment in their users. The most common finding was sensorineural hearing loss, most likely due to cochlear damage. No differences were found regarding the ototoxic properties of the two drugs. Further studies with greater methodological rigor are needed for the continued clarification of the subject.


Declarations

No funding was received for conducting this study. This study did not involve human or animal subjects. All data generated or analyzed during this study are included in this published article.




Publication History

Received: 21 June 2021

Accepted: 19 September 2021

Article published online:
25 January 2022

© 2022. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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