Hearing Loss after a Liver Transplant?

This past week I had a patient who received a liver transplant over 3 years ago.  He went to a world-renowned clinic for the procedure and during his post-transplant follow up he took advantage of his location and obtained diagnostic evaluation and treatment of his perceived hearing loss.  As a clinician, I know what I say and what the patient understands can be vastly different.  That said, he reports that when he told the clinic he experienced a hearing loss after the transplant, there was no report generated or acknowledgment from the clinic that this could occur.

Since there is so much recent documentation relating cardiovascular disease and kidney disease connected to hearing loss, I figured it wouldn’t be a stretch for liver disease.  Why?  Anything that disturbs the flow of blood and the quality of the filtering of the blood might reasonably be thought to affect hearing as a by-product.  I went on the internet to investigate this topic and found far less documentation available for liver disease than for CV or kidney diseases, relative to hearing loss.  However, some studies since the 1990s  state there is significant enough connection to note that hearing loss can occur after a transplant.  There are different ideas as to why a hearing loss occurs, one is from the immunosupressive drugs, but if the loss was reported quickly the hearing loss could be reversible if the medication was changed to a different dose or other drug.

Our patient also had hepatic encephalopathy, which is a decrease in brain functioning from frequent complication of acute disorders of the liver, including infection.  Liver transplant patients are at high risk for liver infection. Our patient’s hepatic encephalopathy followed the transplant, by report.   The hospital report states the condition does not contribute to hearing loss, but antibiotics used to treat can cause hearing loss.  One general infection treatment in the past was neomycin— an ototoxic drug of long-standing that is rarely used nowadays.  Our patient did not keep track of the medications he was put on and feels it is now water under the bridge.  On the one hand he wants to know but on the other knowing will not change him having a hearing loss.  Since I am not a medical doctor I can not say either way.

More research in medicine is connecting the dots between health of the body to the health of the ear.  We need to continually read and dig in the medical literature to educate ourselves as well as our patients on emerging ear-organ-body connections.  In my patient’s case, he was grateful that we took the time to educate ourselves and speculate on possible reasons for the coincidence of his hearing loss with the liver transplant.  His hearing has been stable since the post-transplant audiometric baseline.  He is no longer on ototoxic medications so his fear of progressive hearing loss is reduced, though we counseled him that progression is always possible — as it is for any hearing loss.

I am curious if anyone else has run across this in their patient population?


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