No abstract

Objectives: To analyze the role of audiometry in considering change to a less ototoxic treatment in head and neck cancer (HNC) patients. Methods: Consecutive patients prescribed high-dose cisplatin (100 mg/m²) between January 2013 and February 2015 were enrolled. Audiometry was performed at baseline and before cisplatin. Change to a less ototoxic agent or reduced cisplatin dose was considered with audiometric decreases >25 dB. Results: A total of 103 patients were included; the median age of the patients was 59 years (range 18−75). Cisplatin was intended curative (58%), adjuvant (32%), or palliative (10%). Forty-two participants (41%) did not commence high-dose cisplatin because of baseline audiometric alterations. Of 61 patients treated with high-dose cisplatin, 40 (66%) showed marked ototoxicity at the end of treatment. The mean hearing loss between initial and final audiometries showed a hearing loss at 4 and 8 kHz in both ears (p = 0.002). Thirteen patients switched to carboplatin and 15 to a lower dose of cisplatin. The outcome was not significantly altered when cisplatin was replaced with carboplatin or cetuximab. Conclusions: Audiometric alterations are common in HNC with high-dose cisplatin, and switching to a less ototoxic regimen does not adversely affect outcome. Audiometric examination could help to prevent hearing loss in this population.

The use of Taponoto or Otocerum did not significantly improve the proportion of tympanic membranes that were completely visualized compared with saline solution when they were instilled 15 minutes before ear irrigation.

OBJECTIVE: 1) Describe the radiographic findings of the membranous labyrinth, facial nerve, and cochleovestibular nerve in patients with pontine tegmental cap dysplasia (PTCD). 2) Correlate the radiographic findings and the potential for successful cochlear implantation. METHOD: A retrospective case series at a tertiary care pediatric hospital was performed. Three patients were identified with PTCD. High-resolution CT and MR scans were reviewed by a pediatric neuroradiologist. Variables evaluated included radiographic findings typical of PTCD, the presence and course of cranial nerves, the appearance of the cochlea and vestibule, the size of the IAC and the presence of a duplicated IAC. Clinical data was reviewed. RESULTS: All patients demonstrated characteristic MRI findings of PTCD. Mild, bilateral cochlea dysplasia was noted in two patients and all patients had a normal vestibular labyrinth. The cochleovestibular nerves were absent bilaterally in all patients. The facial nerves were deficient bilaterally in one patient, unilaterally in the second patient, and normal in the third. An accessory canal for the seventh cranial nerve was present in all patients (duplicated IAC). ABR testing revealed profound bilateral sensorineural hearing loss in all the patients. No patient had facial weakness. One patient was implanted with bilateral cochlear implants and had minimal response to sound-field audiometry at one-year follow-up. CONCLUSION: Bilateral profound hearing loss in patients with PTCD is due to absence of the cochleovestibular nerve. The entity should be recognized and prognosis for successful cochlear implantation is poor.