This study examined the effect of platinum compounds on hearing in 104 children with solid tumours. As would be expected, this group was heterogeneous and included a range of ages, tumour types, chemotherapeutic agents and dosing regimens. Age-appropriate audiometry was undertaken at baseline (initiation of treatment), prior to each chemotherapy cycle and at least annually for a median of 3.4 years. Results were graded from zero to four using the SIOP Boston ototoxicity scale. This is based on hearing thresholds >20dBHL at frequencies 2-8KHz or, in this study, a change in the hearing threshold of 20dB or more compared to baseline. All children started with normal hearing and there were no cases of hearing loss at 0.5 or 1KHz. Overall, 25% had hearing loss (SIOP grade >0). This included 25% of those treated with cisplatin only, 19% with carboplatin only and 35% with both agents. No cases improved during monitoring, and 35% of those who experienced ototoxicity (8.6% overall) had worsening hearing even after completion of treatment. The cumulative dose of cisplatin (but not carboplatin) and prior radiotherapy correlated with hearing loss. No correlation was seen with age or gender. Cases identified as grade two or higher (12.5%) required a change in treatment regime, the only available management strategy in current practice. In future, use of systemic or intratympanic otoprotective agents is likely to become more commonplace as treatment or prophylaxis for this serious side-effect of cancer treatment. 

Audiological monitoring in children treated with platinum chemotherapy.
Fetoni AR, Ruggiero A, Lucidi D, et al.
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Stephen James Broomfield

University Hospitals, Bristol, UK.

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