Sensorineural hearing loss in patients treated for nasopharyngeal carcinoma: A prospective study of the effect of radiation and cisplatin treatment

Kwong, Dora L.W.; Wei, William I.; Sham, Jonathan S. T.; Ho, Wai Kuen; Yuen, Po Wing; Chua, Daniel T.T.; Au, Darren; Wu, P. C.; Choy, D.

doi:10.1016/s0360-3016(96)00302-1

Cited by 174 publications

(175 citation statements)

References 28 publications

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“…Few studies have reported the median interval for development of persistent SNHL as ranging from immediate follow up period up to 48 months [5,12]. However, our study was consistent with one of those studies with the onset of SNHL noted from immediate post chemoradiation to 4 months follow up period.…”

Section: Discussionsupporting

confidence: 91%

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Effects of Chemoradiation on Hearing in Patients with Head and Neck Malignancies: Experience at a Tertiary Referral Care Hospital

Jain¹,

Banerjee²,

Dandinarasaiah

2016

Indian J Otolaryngol Head Neck Surg

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Hearing loss as a side effect in patients with head and neck malignancies with chemoradiation is frequently ignored. Its effects on auditory functions are less studied and there are studies done on animals which are less reliable. The present study was undertaken to identify the type of hearing loss and also to quantify the degree of hearing loss in these patients. A prospective, descriptive study was undertaken in histologically proven head and neck cancer patients treated with cobalt 60 teletherapy who received a dose of 60-66 Grays (Gy) over a period of 6-7 weeks with concurrent Cisplatin 30 mg/m 2 once weekly for 6 weeks. The study included 40 patients (80 ears) undergoing chemoradiation. A baseline pure tone audiometry and impedance audiometry was performed in all the cases prior to the therapy and the same was repeated immediately after the completion of treatment, at 8 and 16 weeks. The changes in pure tone level thresholds and impedance from baseline were correlated with the dose of radiation and chemotherapy. Sensori neural hearing loss (SNHL) and conductive hearing loss was observed in 82.5 and 17.5 % respectively. At the end of 16 weeks, SNHL was found in 27.5, 72.5 and 82.5 % at 2, 4 and 8 kHz respectively. In addition, Eustachian tube dysfunction and Otitis media with effusion was observed in 10 and 7.5 % of patients respectively which lead to conductive hearing loss. Further, it was noted that SNHL in patients with high risk site malignancy (81.8 %) was alarmingly higher compared with low risk site malignancy (18.1 %). The hearing loss at 62, 64 and 66 Gy in comparison to 60 Gy was statistically significant. Hearing loss, specially SNHL was the predominant finding in our study with [80 % of patients showing the inner ear damage due to irradiation of head and neck malignancies. Although, all the frequencies like 2, 4 and 8 kHz were significantly affected, SNHL was more marked in the latter two frequencies. Nearly, 90 % of the patients who had SNHL belonged to high risk site category of head and neck malignancies. Increasing the radiation dosage was directly proportional to the degree of hearing loss with the dose more than 60 Gy causing significant injury to the middle and inner ear.

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Section: Discussionsupporting

confidence: 91%

“…Majority of the studies on SNHL in such patients were published on nasopharyngeal carcinoma patients receiving radiation [3][4][5][6][7][8] except few studies [9][10][11]. However, there is still uncertainty prevailing regarding the pattern of hearing loss, the frequencies affected and the dose of chemoradation effects on the hearing.…”

Section: Discussionmentioning

confidence: 99%

Effects of Chemoradiation on Hearing in Patients with Head and Neck Malignancies: Experience at a Tertiary Referral Care Hospital

Jain¹,

Banerjee²,

Dandinarasaiah

2016

Indian J Otolaryngol Head Neck Surg

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“…This kind of study was conducted on 132 patients with NPC, and a high incidence rate of 22% persistent sensorineural hearing loss was obtained. 18 However, again, the patients analyzed were treated using 2.5 cGy and 3.5 cGy per fraction, a radiotherapy regimen different from most patients with NPC, who are irradiated with daily doses of 180 -200 cGy. Even so, we believe that, among the many patients with NPC who suffer from hearing difficulty, there may be patients with auditory deterioration that is a direct result of radiation to the cochlear nerve itself.…”

Section: Discussionmentioning

confidence: 99%

Radiation‐related cranial nerve palsy in patients with nasopharyngeal carcinoma

Lin

Jen

Lin

2002

Cancer

145

104

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BACKGROUNDCranial nerve palsy is a rare complication after patients with nasopharyngeal carcinoma (NPC) receive radiotherapy using a technique that delivers 180–200 centigrays (cGy) per day. Cranial neuropathy is of particular clinical interest in terms of making a differential diagnosis, because it is also a common presenting manifestation in patients with NPC. Cranial neuropathy may lead to distressing signs and symptoms in these patients, and their treatment has not been addressed in previous reports. This article presents the authors' experience with radiotherapy‐related cranial nerve palsy in patients with NPC.METHODSNineteen patients were diagnosed with radiation‐related neuropathy. Patients with recurrent tumors or with a suspicion of persistent or recurrent tumors were excluded. Most patients were treated using 180 cGy or 200 cGy per fraction per day. The total dose was 7000–13,000 cGy to the nasopharynx and 5000–9000 cGy to the neck. Unilateral vocal cord paralysis alone and hearing loss were not included in the analysis.RESULTSThere were 15 male patients and 4 female patients. The latency before palsy occurred was 12–240 months. Single nerve palsy developed in four patients, including two patients with hypoglossal palsy and two patients with recurrent laryngeal palsy. Two patients had three nerve palsies each. The other 13 patients presented with 2 nerve palsies each. Vagus and hypoglossal palsy appeared to be a frequent combination and occurred in 11 patients. Overall, there were 17 patients with hypoglossal palsy (7 bilateral, 8 left‐sided, and 2 right‐sided), 11 patients with vagus palsy (2 bilateral, 7 left‐sided, and 2 right‐sided), 6 patients with recurrent laryngeal nerve palsy (5 bilateral), and 2 patients with accessory palsies (all bilateral). Marked neck fibrosis was present in 12 patients. Patients who had vocal cord paralysis suffered from easy choking and hoarseness. Severe respiratory difficulty occurred in two patients who had bilateral vocal cord palsy. Surgical procedures included laryngoplasty, tracheostomy, and gastrostomy. Quality of life improved considerably after patients underwent surgery.CONCLUSIONSRadiotherapy‐related cranial nerve palsy may occur in patients with NPC after they receive conventional radiotherapy. Hypoglossal nerve palsy was found the most frequently in this series, followed by vagus nerve palsy and recurrent laryngeal nerve palsy. Neck fibrosis and the course of the three nerves through the neck may be important risk factors for the development of palsy. The diagnosis must be made only after the possibilities of tumor‐induced palsy and idiopathic palsy are excluded. Surgery is helpful in improving the quality of life in many patients. Cancer 2002;95:404–9. © 2002 American Cancer Society.DOI 10.1002/cncr.10668

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“…The indeterminate SNHL was defined that SNHL was continued less than 1 year and on last follow-up. Serous otitis media (SOM) was diagnosed by otologist when there were clinical findings suggesting SOM and more than 10 dB air -bone gap [11]. The protocol and definition of terminology was as Kwong's report for comparison of data.…”

Section: Auditory Assessmentmentioning

confidence: 99%

“…In addition, it is expected that the combined cisplatin and radiation therapy for NPC results in more SNHL compared to radiation therapy alone because ototoxicity is well known complication of cisplatin. However, Kwong et al [11] reported that pre-irradiation cisplatin did not increase the risk of SNHL compared to radiation therapy alone even though the dosage of cisplatin was low. In addition, there were few data about SNHL after CCRT for NPC in literature search.…”

Section: Introductionmentioning

confidence: 99%

Sensory neural hearing loss after concurrent cisplatin and radiation therapy for nasopharyngeal carcinoma

Kim

Choi

et al. 2004

Radiotherapy and Oncology

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Sensorineural hearing loss in patients treated for nasopharyngeal carcinoma: A prospective study of the effect of radiation and cisplatin treatment

Cited by 174 publications

References 28 publications

Effects of Chemoradiation on Hearing in Patients with Head and Neck Malignancies: Experience at a Tertiary Referral Care Hospital

Effects of Chemoradiation on Hearing in Patients with Head and Neck Malignancies: Experience at a Tertiary Referral Care Hospital

Radiation‐related cranial nerve palsy in patients with nasopharyngeal carcinoma

Sensory neural hearing loss after concurrent cisplatin and radiation therapy for nasopharyngeal carcinoma

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