INS and Hearing impairment: The AE profile of TEP appears to be acceptable, but deterioration of glucose control in patients with diabetes or prediabetes, at times requiring insulin therapy, was noted in 10% of patients.94 Muscle cramps were reported in 25% of patients treated with TEP, nausea in 17%, alopecia in 13%, fatigue in 12%, and, importantly, hearing impairment in 10% of patients.91 A recent summary of five series reported hearing impairment in 29 of 190 (15.2%) patients treated with TEP, with resolution in 16 (55%) but persistence in 13 (45%) patients.95