氯奎寧（hydroxychloroquine）在類風濕性關節炎患者所引起之聽力喪失

Hydroxychloroquine Related Irreversible Hearing Loss in a Patient with Rheumatoid Arthritis

氯奎寧（Hydroxychloroquine）在治療類風濕性關節炎及其它的風濕病已行之有年。較常見的副作用為皮膚及視網膜病變。然而，氯奎寧的耳毒性較少為人所知，其表現通常較輕微且以雙側性表現。在類風濕性關節炎的患者，亦曾報導過有聽力的受損，然而其在聽力圖測定主要是影響“低頻＂為主。我們報導一個48歲的類風濕性關節炎的女性病人，於接受氯奎寧治療2年後發生了單側耳鳴及聽力減退的現象。經耳鼻喉科的檢查，其前庭神經功能為正常，而在聽力圖測定主要影響“高頻＂為主；同時，其類風濕性關節炎的症狀亦在穩定控制中。在文獻報導中所提到的病例，大部分在停藥後可以逐漸恢復聽力。然而，我們的病人於停藥之後，其聽力並沒有獲得明顯的改變。

Hydroxychloroquine has been widely used in the treatment of rheumatoid arthritis (RA) and other connective tissue diseases. Its side effects, such as skin eruption and retinopathy, are often mild and not uncommon, whereas hydroxychloroquine-induced ototoxicity is a rarely reported in the literature and is usually mild and symmetric. In this report, we described the development of unilateral otoxicity in a 48-year-old female RA patient who was treated with hydroxychloroquine for two years. This patient experienced unilateral tinnitus, and high frequency hearing loss of the same ear was then confirmed by audiogram examination. The hydroxychloroquine-induced hearing loss appears to be irreversible. Therefore, we concluded that the possibility of developing ototoxicity should always be kept in mind in patients receiving hydroxychloroquine therapy.