Audiovestibular findings in beta-thalassemia patients receiving chelation therapy: an observational cross-sectional study

Abstract Background Iron chelators, including deferasirox, deferiprone, and deferoxamine, are used to reduce iron overload in patients with beta thalassemia. Deferoxamine has the most consistently reported dose- and duration-related ototoxic profile, whereas evidence regarding cochlear or vestibular involvement with deferiprone and deferasirox remains limited. This study aimed to evaluate vestibular function in patients with beta thalassemia receiving chelation therapy using modern vestibular test batteries, including the video head impulse test and cervical vestibular evoked myogenic potentials. Methods Forty patients with beta thalassemia receiving iron chelation therapy were included in the study. The patient group consisted of 17 females and 23 males, with a mean age of 18.7 ± 5.2 years. Patients were treated with deferasirox, deferiprone, deferoxamine, or combination regimens. Because deferasirox was the predominant chelator in the cohort, used in 33 of 40 patients, the findings should be interpreted primarily in relation to deferasirox exposure. The control group included 25 healthy individuals, consisting of 13 females and 12 males, with a mean age of 20.5 ± 5.7 years and no auditory or vestibular complaints. Auditory function was assessed using pure-tone audiometry and acoustic immittance measures, while vestibular function was evaluated using the video head impulse test and cervical vestibular evoked myogenic potentials. Results There were no statistically significant differences between the chelation and control groups in pure-tone averages, vestibulo-ocular reflex gains of the semicircular canals on the video head impulse test, or cervical vestibular evoked myogenic potential parameters, including p1 and n1 latencies and threshold values. However, the incidence of high-frequency sensorineural hearing loss was numerically higher in the chelation group, but this difference did not reach statistical significance. Conclusion In this predominantly deferasirox-treated beta thalassemia cohort, chelation therapy was not associated with measurable vestibular dysfunction based on the video head impulse test or cervical vestibular evoked myogenic potentials. However, the numerically higher incidence of high-frequency sensorineural hearing loss may warrant consideration in audiological follow-up during chelation therapy. Because the number of patients receiving deferoxamine- or deferiprone-based regimens was limited, these findings should not be generalized to all iron chelators without larger agent-specific studies.