Audiovestibular clinician experiences and opinions about cisplatin vestibulotoxicity

Prayuenyong, Pattarawadee; Kasbekar, Anand V.; Hall, Deborah A.; Baguley, David

doi:10.1007/s00405-020-06033-4

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…While asking for a self-report of dizziness symptoms is feasible, it alone may not be informative to rule out vestibular dysfunction for this population. Recent literature on individuals with cisplatin-based vestibulotoxicity suggests that vestibular impairment is often missed by clinicians when only relying on symptom report because patients often underreport (Prayuenyong et al 2018, 2020). Peripheral vestibular involvement could be underlying but go unnoticed functionally if the person was centrally compensating, especially in the case of progressive bilateral vestibular dysfunction (van de Berg et al 2015) as compared with sudden onset, or if the patient or healthcare provider assumes that the dizziness symptoms are due to acute effects of the substance as opposed to a newly developed vestibular impairment (Prayuenyon et al 2018).…”

Section: Discussionmentioning

confidence: 99%

The Effects of Substance Misuse on Auditory and Vestibular Function: A Systematic Review

Chiao,

Hughes,

Karimuddanahalli Premkumar

et al. 2023

Ear &Amp; Hearing

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Background: Chronic substance misuse is an ongoing and significant public health concern. Among a myriad of health complications that can occur, substance misuse potentially causes ototoxic effects. Case reports, retrospective chart data, and a few cohort studies suggest that certain prescription opioids and illicit drugs can have either temporary or permanent effects on auditory and/or vestibular function. Given the steady rise of people with a substance-use disorder (SUD), it is of growing importance that audiologists and otolaryngologists have an insight into the potential ototoxic effects of substance misuse. Objectives: A systematic review was conducted to (1) synthesize the literature on the illicit drugs, prescription opioids, and alcohol misuse on the auditory and vestibular systems, (2) highlight common hearing and vestibular impairments for each substance class, and (3) discuss the limitations of the literature, the potential mechanisms, and clinical implications for clinicians who may encounter patients with hearing or vestibular loss related to substance misuse, and describe opportunities for further study. Design: Systematic searches were performed via PubMed, Scopus, and Google Scholar, and the final updated search was conducted through March 30, 2022. Inclusion criteria included peer-reviewed articles, regardless of study design, from inception until the present that included adults with chronic substance misuse and hearing and/or vestibular complaints. Articles that focused on the acute effects of substances in healthy people, ototoxicity from already known ototoxic medications, the relationship between hearing loss and development of a SUD, articles not available in English, animal work, and duplicates were excluded. Information on the population (adults), outcomes (hearing and/or vestibular data results), and study design (e.g., case report, cohort) were extracted. A meta-analysis could not be performed because more than 60% of the studies were single-case reports or small cohort. Results: The full text of 67 studies that met the eligibility criteria were selected for the review. Overall, 21 studies reported associations between HL/VL related to illicit drug misuse, 28 studies reported HL/VL from prescription opioids, and 20 studies reported HL/VL related to chronic alcohol misuse (2 studies spanned more than one category). Synthesis of the findings suggested that the misuse and/or overdose of amphetamines and cocaine was associated with sudden, bilateral, and temporary HL, whereas HL from the combination of a stimulant and an opioid often presented with greater HL in the mid-frequency range. Reports of temporary vertigo or imbalance were mainly associated with illicit drugs. HL associated with misuse of prescription opioids was typically sudden or rapidly progressive, bilateral, moderately severe to profound, and in almost all cases permanent. The misuse of prescription opioids occasionally resulted in peripheral VL, especially when the opioid misuse was long term. Chronic alcohol misuse tended to associate with high-frequency sudden or progressive sensorineural hearing loss, or retrocochlear dysfunction, and a high occurrence of central vestibular dysfunction and imbalance. Conclusions: Overall, chronic substance misuse associates with potential ototoxic effects, resulting in temporary or permanent hearing and/or vestibular dysfunction. However, there are notable limitations to the evidence from the extant literature including a lack of objective test measures used to describe hearing or vestibular effects associated with substance misuse, small study sample sizes, reliance on case studies, lack of controlling for confounders related to health, age, sex, and other substance-use factors. Future large-scale studies with prospective study designs are needed to further ascertain the role and risk factors of substance misuse on auditory and vestibular function and to further clinical management practices.

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Section: Discussionmentioning

confidence: 99%

The Effects of Substance Misuse on Auditory and Vestibular Function: A Systematic Review

Chiao,

Hughes,

Karimuddanahalli Premkumar

et al. 2023

Ear &Amp; Hearing

View full text Add to dashboard Cite

show abstract

“…Several drugs (summarized in Table 1) are ototoxic; among them, cisplatin stands out in potency and prevalence. However, vestibulotoxicity is poorly investigated, and the correlation between symptoms and examination should be interpreted cautiously (Prayuenyong, 2018;Prayuenyong et al, 2020). Additionally, measurements of vestibular impairment are expensive and time-consuming and, therefore, not routinely performed in our clinic in the absence of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Incidence of cisplatin-induced ototoxicity in adult cancer patients based on audiometric confirmation of patient self-report

Voruz,

Vuilleumier,

Migliorini

et al. 2023

Front. Audiol. Otol.

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IntroductionRobust clinically relevant epidemiological and audiological data are needed to prepare for future clinical trials aiming at preventing cisplatin-induced ototoxicity in this suffering cancer population. We assessed the incidence, severity, and potential risk factors of symptomatic cisplatin-induced hearing loss in a large cohort of adults.MethodsRetrospective cohort study at a tertiary care university hospital. The study group included consecutive patients over 18 years old treated with cisplatin-based chemotherapy without concomitant inner ear radiotherapy or other ototoxic medication. Every participant underwent baseline pretreatment audiometry and was asked for audiological symptoms (tinnitus or subjective hearing loss) during the treatment. If symptomatic, comparative standard audiometry (0.125 to 8 kHz) was performed. Hearing loss was defined by a threshold shift ≥15 dB HL in at least one of the tested frequencies.ResultsA total of 401 cancer patients (59% males) with a mean age of 56 years (range 18-80) were included. Eighty-one patients (20%) developed symptomatic hearing loss, predominantly affecting the high frequencies from 4 to 8 kHz. Among them, 49 (60%) experienced simultaneous new-onset tinnitus. None of the analyzed potential risk factors (age, sex, smoking, hypertension, diabetes, dyslipidemia, chemotherapeutic regimen, and cumulative cisplatin dose) was statistically correlated with hearing loss.DiscussionAt least 1 out of 5 patients treated with cisplatin developed audiological symptoms associated with audiometric hearing loss within the 0.125 to 8 kHz range, for which new-onset tinnitus is a sensitive symptom. Not all audiological symptoms are accompanied by audiometric change. No predisposing factor could be identified. Standardized audiological monitoring before and during cisplatin-based chemotherapy allows quantitative assessment of early audiometric signs of ototoxicity, offering to optimize anticancer therapy while minimizing morbidity in a multidisciplinary setting.

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Cisplatin vestibulotoxicity: a current review

Fleihan,

Nader,

Dickman

2024

Front. Surg.

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Cisplatin, a commonly used chemotherapy drug, is well-established for its ototoxic effects, primarily attributed to the damage it inflicts on cochlear hair cells. However, its impact on the vestibular system remains inadequately understood. Here, we provide a comprehensive review of existing literature concerning cisplatin-induced vestibulotoxicity. Animal studies have shown that cisplatin induces a vestibular hair cell loss that is dose-dependent, with the severity of damage also varying according to the route of administration. Notably, intratympanic and systemic injections in animal models have manifested significant damage primarily to utricular hair cells, with a lesser degree of damage observed for the other vestibular end organs. The underlying mechanisms of cisplatin induced vestibular hair cell loss include apoptosis, oxidative stress, and inflammatory cytokines. Several protective agents, such as Pifithrin-α, DAPT, Ginkgolide B, and heat shock proteins, have demonstrated efficacy in inhibiting cisplatin-induced vestibular damage in preclinical studies. Human clinical findings indicate that cisplatin treatment can cause vestibular dysfunction, characterized by symptoms ranging from transient dizziness to persistent vertigo. Challenges in diagnosis, including the limited utilization of comprehensive vestibular testing for many patients, contribute to the variability in reported outcomes. Cisplatin-induced vestibulotoxicity is a significant complication of chemotherapy, necessitating further research to understand its mechanisms and to improve diagnosis and management, ultimately aiming to enhance the quality of life for cancer patients undergoing cisplatin therapy.

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Audiovestibular clinician experiences and opinions about cisplatin vestibulotoxicity

Cited by 3 publications

References 29 publications

The Effects of Substance Misuse on Auditory and Vestibular Function: A Systematic Review

The Effects of Substance Misuse on Auditory and Vestibular Function: A Systematic Review

Incidence of cisplatin-induced ototoxicity in adult cancer patients based on audiometric confirmation of patient self-report

Cisplatin vestibulotoxicity: a current review

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