Hearing Loss in Patients Who Received Cranial Radiation Therapy for Childhood Cancer

Abstract

Purpose Patients treated with cranial radiation therapy (RT) are at risk for sensorineural hearing loss (SNHL). Although SNHL is often characterized as a delayed consequence of anticancer therapy, longitudinal reports of SNHL in childhood cancer survivors treated with contemporary RT are limited. We report the incidence, onset, severity, and long-term trajectory of SNHL among children receiving RT. Potential risk factors for SNHL were also identified. Patients and Methods Serial audiologic testing was conducted on 235 pediatric patients who were treated with conformal or intensity-modulated RT as part of an institutional phase II trial for localized primary brain tumors, including craniopharyngioma, ependymoma, and juvenile pilocytic astrocytoma. All but one patient had measurable cochlear radiation dose (CRD) greater than 0 Gy. The median follow-up from RT initiation to latest audiogram was 9 years with a median of 11 post-RT audiograms per patient. Audiograms were classified by the Chang Ototoxicity Grading Scale. Progression was defined by an increase in Chang grade from SNHL onset to the most recent evaluation. Results At last evaluation, SNHL was prevalent in 14% of patients: 2.1% had mild and 11.9% had significant SNHL requiring hearing aids. Median time from RT to SNHL onset was 3.6 years (range, 0.4 to 13.2 years). Among 29 patients with follow-up evaluations after SNHL onset, 65.5% experienced continued decline in hearing sensitivity in either ear and 34.5% had no change. Younger age at RT initiation (hazard ratio [HR], 2.32; 95% CI, 1.21 to 4.46), higher CRD (HR, 1.07; 95% CI, 1.03 to 1.11), and cerebrospinal fluid shunting (HR, 2.02; 95% CI, 1.07 to 3.78) were associated with SNHL. Conclusion SNHL is a late effect of RT that likely worsens over time. Long-term audiologic follow-up for a minimum of 10 years post-RT is recommended.

Treatment of late sequelae after radiotherapy for head and neck cancer

“…Damage to the hearing apparatus with resultant sensorineural hearing loss (SNHL) is a common adverse event after RT [175–177], occurring in up to 43% of irradiated HNC patients. Its incidence is increased to 17–88% when RT is combined with cisplatin [178].…”

Pediatric oncology provider perspectives and practices: Supporting patients and families in schooling after cancer diagnosis

“…For example, hearing loss may require supports in the school environment for this population. Studies report the prevalence of sensorineural hearing loss associated with cranial radiation at 14%, while prevalence of cisplatin‐related loss ranges from 20% to 67% . Hearing loss is associated with declines in cognitive function and diminished academic outcomes in the childhood cancer population .…”

“…Studies report the prevalence of sensorineural hearing loss associated with cranial radiation at 14%, while prevalence of cisplatin-related loss ranges from 20% to 67%. 34,35 Hearing loss is associated with declines in cognitive function and diminished academic outcomes in the childhood cancer population. 36,37 School absenteeism due to clinic visits for provision of cancer treatment or treatment side effects including fatigue is often overlooked for its impact on school functioning and achievement.…”

The experience of hearing loss in adult survivors of childhood and young adult cancer: A qualitative study

“…A recent study of 23,000 survivors of childhood cancer who were diagnosed between 1970 and 1999 demonstrated an increased incidence of hearing loss over time, even as the incidence of several other late effects decreased . Prior studies have suggested that many childhood and young adult cancer survivors have severe hearing loss that could benefit from hearing aids and that, for some, hearing loss worsened years after treatment …”

“…4 Prior studies have suggested that many childhood and young adult cancer survivors have severe hearing loss that could benefit from hearing aids and that, for some, hearing loss worsened years after treatment. 5,6 Unfortunately, the social consequences of hearing loss can be profound. In older adults, hearing loss has been associated with depression, cognitive impairment, and social isolation.…”