Audiometric Patterns in Ototoxicity of Intra-Arterial Cisplatin Chemoradiation in Patients with Locally Advanced Head and Neck Cancer

Abstract

This study describes audiometric patterns of ototoxicity in a consecutive series of patients uniformly treated with intra-arterial high-dose cisplatin chemoirradiation for advanced cancer of the head and neck. Air conduction thresholds were measured from 0.125 to 16 kHz and bone conduction thresholds were measured from 0.5 to 4 kHz. The overall audiometric pattern was characterized by maximum threshold shifts after the 2nd cisplatin infusion and a maximum total threshold shift at 8 kHz, irrespective of gender, age, pretreatment sensorineural hearing loss (SNHL) or subjective complaints during therapy. A hearing deterioration gradient was observed from (ultra-) high to low frequencies, worse with increasing pre-existent SNHL and with increasing cumulative dose of cisplatin chemoradiation. Cisplatin chemoradiation-induced hearing loss seemed to reach a plateau at higher levels (75–80 dB HL) for frequencies above 8 kHz compared to frequencies up to 8 kHz (45–60 dB HL). Recovery of SNHL was found after therapy in 27 ears characterized by extensive hearing loss at frequencies 1, 2 and 4 kHz.

Recovery from cisplatin-induced ototoxicity: A case report and review

“…Recovery in humans has been reported by Aguilar-Markus, Laurell, and Vermorken [8,28,29]. More recently, Zuur et al described 27 ears that demonstrated recovery of hearing loss at 1, 2, and 4 kHz after chemoradiation for head and neck cancer patients [30]. 7.…”

“…The exact mechanism of strial damage leading to outer hair cell damage and death is also unclear. However, the progression from strial damage to OHC loss may be a graduated process that may provide a mechanism to explain the reversibility of hearing loss that has been described in animal models as well as few human case reports including this report [8,[28][29][30]. Marginal cells are capable of DNA repair and reducing peak platinum adduct burden via reparative mechanisms as described by Siddik et al [11].…”

Report on hearing loss in oncology

“…Cisplatin ototoxicity is the result of cochlear injury, initially in the vascular striae and the outer hair cells of the basal gyrus, which result in hearing loss at high frequencies (Rademaker et al 7 ; Rybak et al 8 ). Continued use of the drug may result in hearing loss at low frequencies (Pedalini et al 4 , Zuur et al 9 ). Hearing loss may cause significant loss in the quality of life of patients; thus, a concern with ototoxicity should be present throughout oncological therapy.…”

Is Routine Audiometric Evaluation Necessary in Gynaecologic Tumour Patients Undergoing Chemotherapy?

“…Laurell et al [11] reported high-frequency hearing loss in 22% of their patients in their older age group but did not find pretreatment with chemotherapy as a predictor for ototoxic change. Cisplatin ototoxicity has been demonstrated to cause an initial high-frequency hearing loss and the continued use of the drug has been shown to result in low-frequency hearing loss [16,17]. High-frequency hearing loss can impact negatively on educational achievement, socio-emotional development, and quality of life.…”