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Irreversible Hearing Loss Due To The Use Of Oral Isotretinoin

A 15-year-old male presented to Dicle University Faculty of Medicine Hospital complaining of hearing loss. He had a history of nodulocystic acne on the face. Five days ago, he had been started on isotretinoin (1.0 mg/kg/ day, in two divided doses) by a dermatologist. He had not taken any drugs other than isotretinoin. There were no other diseases, ear problems or surgery. Physical examination including otological and neurologic examination was unremarkable. Rinne test was positive, and a Weber test revealed no lateralization. There were no waves in transient otoacoustic emissions and the patient presented poor speech discrimination. Magnetic resonance imaging revealed no abnormality. The patient did not improve after withdrawal of isotretinoin. The patient was followed for about six months. Repeated audiograms showed the same alterations. Tinnitus decreased, although the patient's SNHL audiometry persisted and there was no change in average hearing levels by using Student's t test for paired group (p>0.05). There have been many cases around the world reporting that hearing loss due to isotretinoin is reversible in a course of three weeks to two months after drug withdrawal. In contrast to these cases, the hearing loss of our patient did not improve -which suggests that isotretinoin may be ototoxic.