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May 2025 RDS newsletter now available. Expand this announcement to view.

Welcome to the May 2025 update from the RDS team

1.     RDS deployments

Three small-scale releases took place during April and May, including the following fixes and improvements:

  • Applying moderate severity security patch to Umbraco.
  • Fixes to:
    • Random ordering of tiles on mobile app
    • Simultaneous issuing of multiple copies of content review alerts
    • Content display on mobile app for the left hand menu navigation option
  • Whitelisting of Jotforms outcomes pages so that recommendations for action can be displayed following completion of a form or calculation.

2.     RDS performance

Two short outages took place on the mornings of 12th and 22nd May. Tactuum is still investigating the root cause and will report on this shortly.

3.     Redesign of Gentamicin and Vancomycin calculator interfaces

New designs have been produced which make the health board name and calculator title clear to the user on these calculator pages, with a warning message and link to ensure users access the right calculator for their board. These designs have been implemented in a test environment and are now under review.

4.     RDS Redesign, archiving and version control

We now plan to release at end of July 2025 the following major enhancements:  redesigned Right Decision Service homepage, new search and browse interface, upgraded archiving and version control, and capability to edit content adopted from the Shared Content Library. We will provide slides and demos in advance of the release to introduce users and editors to the new functionality.

5. Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Monday 16 June 12.30-1.30 pm
  • Tuesday 24 June 3.45-4.45 pm

Running usage statistics reports using Google analytics

  • Wednesday 11th June: 2-3pm

 To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

6.New RDS toolkits

The following toolkits were launched during March 2025:

7.New RDS developments

Work is progressing on a number of decision support systems that are part of the wider Right Decision Service platform, beyond the web and mobile apps:

  • The Patient Reported Outcome Measures system. A minimum viable product version will be available for functional testing by key stakeholders at end of July.
  • Pharmacogenomics decision support as an extension of the current high risk prescribing decision support integrated with primary care electronic health record systems. This is part of a European research and innovation project.
  • Planned Date of Discharge decision support system to be tested in NHS Lanarkshire. Will undergo user acceptance testing in July with a view to piloting from November.

8. Implementation projects

Public library services in Inverclyde, East Renfrewshire, Glasgow Life, Angus, Falkirk and Stirling have come forward to work with the RDS team, the Scottish Library and Information Council and local Realistic Medicine leads, to develop their role in engaging citizens in Realistic Medicine. This includes promoting the Being a partner in my care app: Realistic Medicine Together. This provides tools and resources to support conversations about what matters to the person,  shared decision-making and self-management.

 

If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

 

 

 

Audiological Investigation in patients with Cystic Fibrosis, Paediatrics (1031)

Objectives

This guideline describes referral, monitoring and follow-up pathways for audiological screening of children with cystic fibrosis (CF) at RHC Glasgow who may have received IV or Nebulised aminoglycosides or oral Macrolides as part of their treatment. The aim of the Guideline is to allow for early detection of hearing loss in these children with referral to Audiological Specialist services where required.

Scope

Children with CF attending RHC Glasgow who may receive IV Aminoglycosides or oral Macrolides.

Background

Audiological screening is recommended for patients with Cystic Fibrosis (CF) in order to monitor potential drug induced ototoxicity following Aminoglycoside and Macrolide administration 1,2

AMINOGLYCOSIDE USE IN CF

Children with CF may require several courses of IV Aminoglycosides per year and some patients require daily nebulised Aminoglycosides longer-term.

Aminoglycoside antibiotics, however administered, have been shown to be associated with ototoxicity 1. Classical findings are of high frequency hearing loss =/- vestibular symptoms.

MACROLIDES USE IN CF

Children with CF are often prescribed oral Azithromycin for treatment of infections and as an anti-inflammatory agent long-term.  There is evidence 2 that long-term use of Macrolide antibiotics may be associated with sensorineural hearing loss. We have arranged that CF patients receiving regular Macrolide therapy undergo audiological screening outlined below.

M ABSCESSUS TREATMENT

Children with CF who are undergoing treatment for M abscessus lung disease will be receiving daily Nebulised Aminoglycosides (usually Amikacin) and an oral Macrolide. They may also be receiving intermittent IV Aminoglycosides. These patients require to have audiological assessment at least 6 monthly.  

Referral pathway

Patients with CF attending RHC Glasgow are classified according to the following Screening Groups. Referral for Audiological Screening and follow up is based on Screening Group and outcome of testing.

REFERRAL AND FOLLOW-UP BY SCREENING GROUP

Image of referral pathway

Genetic screening

Although assays for IV Aminoglycoside levels are monitored closely, published literature has highlighted evidence that there may be a small percentage of patients who may exhibit enhanced susceptibility to Aminoglycoside-induced ototoxicity, even at normal serum assay levels.

This susceptibility may be genetically determined and may predispose to hearing impairment many years after initial exposure to Aminoglycoside.
[Fischel-Ghodsian et al UCLA 2004] 

  • A1555G / delT961Cn in the mitochondrial 12s ribosomal RNA gene
  • Multiple studies reporting presence of A1555G in patients with sensorineural hearing loss associated with Aminoglycoside antibiotics.
    • 17% A1555G +ve in study of 41 adults exhibiting hearing impairment post-Aminoglycosides
      [Fischel-Ghodsian et al UCLA 2004]
  • A1555G mutation also reported in hearing-impaired patients with NO history of Aminoglycoside exposure
    [Tang et al 2002]
  • Overall population prevalence of A1555G and delT196Cn
    • AI555G 09%
    • DelT961Cn 6%
      [Tang et al ; Texas 2002]

Ongoing research may be informative for the co-utilisation of protective measures in genetically susceptible individuals who, for clinical reasons, would be disadvantaged by the cessation of all Aminoglycoside therapy. 3

Genetic screening for AI555G mutation will be carried out as part of first Annual Review investigations for patients with Cystic Fibrosis attending RHC.

Parent information sheet

Hearing Test Information Sheet (pdf)

Editorial Information

Last reviewed: 14/12/2020

Next review date: 31/05/2025

Author(s): Dr Jane Wilkinson; Dr Juan Mora; Mr Jim Harrigan; Kirstin Marchbanks.

Version: 1

Approved By: Paediatric Clinical Effectiveness & Risk Committee

Document Id: 1031

References
  1. Rizzi, Mark Douglas; Hirose, Keiko. Aminoglycoside ototoxicity. Current Opinion in Otolaryngology & Head & Neck Surgery. 15(5):352-357, 2007.
  2. Westerberg, Mick P. Sensorineural hearing loss as a probable serious adverse drug reaction associated with low-dose oral azithromycin. Journal of Otolaryngology. 36(5):257-63, 2007.
  3. Tien Nguyen, Anita Jeyakumar. Genetic susceptibility to aminoglycoside ototoxicity. International Journal of Pediatric Otorhinolaryngology. Vol 120, May 2019, pp15-19.