International Ototoxicity Management Group (IOMG)

The International Ototoxicity Management Group (IOMG) is a global consortium created to address a gap in healthcare regarding the treatment of individuals who experience hearing difficulties following the administration of ototoxic medications or exposure to ototoxicants in the environment. The group is composed by stakeholders from universities, health foundations, professional societies, and government agencies. It is led by an overall chair with co-chairs leading each work group that focuses on specific areas of ototoxicity management.

Ototoxicity management (OtoM) includes the clinical and therapeutic management of these cases. Clinical practice in these situations, particularly in the case of adult patients and infectious disease populations, is not consistent across countries. Guided by an international team of clinicians, pharmacists, researchers, and patient stakeholders the group plans to develop and disseminate guidelines on OtoM in traditional and non-traditional formats with an emphasis on provider- and patient-centric educational materials. The first meeting of the group was held at the National Center for Rehabilitative Auditory Research (NCRAR) in the United States on September 28, 2019.

Objectives and Strategies
The long-term goal of the IOMG is to develop and implement a cohesive set of guidelines and/or position statements that will address OtoM care gaps and harmonize with the priorities of the medical specialties providing ototoxic therapies. To reach this goal, near-term objectives are to establish best practices for widespread implementation of OtoM in specific clinical environments (e.g., medical oncology, pulmonology, otology, cystic fibrosis and infectious disease clinics), health care structures (e.g., community-based, occupational health programs, government, third party payer), and regional economies (emerging, transitional, strong). Work groups have been established to focus on the following projects:

'''Project 1. Conduct an environmental scan of ototoxicity management (OtoM) practices across myriad countries, clinical environments and patient populations''' to identify OtoM care gaps, barriers and facilitators in relation to best practice guidelines. Established qualitative methods will be used to obtain and analyze survey and interview data in order to gain the perspectives of patient, provider and policy-maker stakeholders. Care will be taken to get input that can inform on a range of health care structures in countries with emerging, transitional and strong economies.

'''Project 2. Conduct literature reviews''' to synthesize OtoM guidelines, strategies and clinical practices as well as evidence on the efficacy and effectiveness of OtoM for improving patient- and treatment-level outcomes. In order to efficiently search for relevant literature, the PICOT framework will be utilized. This involves defining the patient problem, intervention, comparison, outcome and type of question to be answered and using these key structures as search criteria.

'''Project 3a. Develop a cohesive set of guidelines and position statements in collaboration with representatives from the specific clinical specialties and/or community health care workers providing ototoxic therapies''' to promote widespread OtoM and prevent inconsistent practices.

'''Project 3b. Develop patient- and provider-facing educational materials using traditional and non-traditional formats''' to facilitate stakeholder involvement and maintain continuity of OtoM care.

Projects 3a and 3b will involve determining appropriate OtoM schedules and methods that maximize patient outcomes while minimizing preventable ototoxicity, are tolerable for the patient and logistically feasible. This aim will be accomplished by addressing the specific populations of medically complex patients receiving ototoxic therapies, the health care structures in which the OtoM is administered, and by incorporating patient, provider and policy-maker input.

Ototoxicity of cancer treatment (chemo/radiation therapy)
Cancer treatment has both immediate and late effects that impact quality of life if left untreated. These can include hearing loss, tinnitus and balance problems. Consensus for clinical care, enhanced tools and health promotion are needed to manage ototoxicity from cancer treatment. This group's goals are to develop a roadmap/call to action to a global template for implementation of ototoxicity management for cancer treatment, identify solutions to address gaps in ototoxicity research and management across the lifespan (including impacts to quality of life beyond hearing loss and recognition of immediate and late effects), identify effective tools, policy enhancements, and delivery frameworks for universal ototoxicity management, and develop resources and strategies that educate, empower, and engage stakeholders (including patients, families, and care teams).

Aminoglycoside-induced ototoxicity
Patients who are treated with aminoglycosides are more likely to develop hearing loss, tinnitus and/or balance problems than those who do not receive aminoglycoside treatment. Patients are not routinely monitored for hearing loss, tinnitus and/or balance problems. This group's goals are to collate/review existing recommendations, work with patients and providers to develop recommendations for applying audiology practice guidelines for ototoxicity management in patients treated with aminoglycosides, survey patients and providers regarding the acceptance and utility of recommendations, and submit consensus document for publication.

Environmental and occupational ototoxicants
Some pollutants and chemicals at work can cause damage to different parts of the ear. Exposure to theses ototoxicants has be found to be associated with hearing loss and balance difficulties. Sometimes, exposure to chemicals can make ears more sensitive to the harmful effects of noise. There are no standard methods for the auditory surveillance of individuals exposed to environmental or occupational chemicals. Consensus guidelines for the clinical care of exposed persons and tools for implementation and health promotion are needed to manage ototoxicity from environmental and occupational exposures. This group's goals are to collate existing recommendations, update reviews, work with stakeholders in the fields of occupational health, hearing care and audiology to develop recommendations for applying audiology practice guidelines for ototoxicity management at work and in the clinic, and submit this consensus document for publication.

International considerations
Patients treated with ototoxic medications get their healthcare differently depending on the health care structures in their regions and their access to care. Practice recommendations and implementation toolkits tailored to the healthcare structures and global region are needed to increase access and value of ototoxicity management. This group's goals are to collate/review existing recommendations, survey patients and providers to develop recommendations for applying ototoxicity management guidelines in different health care structures and global regions, and submit findings for publication.