Sensorineural Hearing Loss: Who is most at risk? — ASN Events
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Sensorineural Hearing Loss: Who is most at risk? (#216)

Phoebe Shorter , Fiona Harden 1 , Bryan Burmeister 2 3 , Kerrie Mengersen , Rebecca Owen 2 , Matthew Foote 2 3
  1. Queensland University of Technology, Brisbane, Queensland
  2. Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland
  3. School of Medicine, University of Queensland, Brisbane, Queensland

Background

Ototoxicity is a known complication for patients with head and neck cancer (HNC) receiving cisplatin-based chemoradiation (CbCRT). This study sought to identify potential risk profiles for patients most at risk of developing sensorineural hearing loss (SNHL).

Methodology

A retrospective review of 150 patients with HNC, who received definitive CbCRT, was undertaken. Patients with pre-treatment otologic problems were specifically excluded. Principal component analysis (PCA) was used to identify clusters within the data and regression models to determine the relative contributions of variables including patient and tumour characteristics, pre-treatment hearing thresholds and treatment parameters.

Results

Of the 150 patients reviewed, 139 patients were suitable for analysis and of these, only 34.7% received audiometry testing. The mean hearing deterioration at pure-tone average 1-2-4 kHz was mild (from 22.4 dB HL to 27.6 dB HL).  However, individual patients demonstrated clinically significant hearing loss, with 10 dB threshold shifts in 80 %, 53.3 % and 31.1 % at pure-tone average 0.5-1-2 kHz, 1-2-4 kHz and 8 kHz, respectively. PCA indicated two risk profiles: (1) low or medium frequency SNHL and, (2) high frequency SNHL. Multivariate analysis demonstrated that tobacco consumption (ρ < 0.006) and alcohol intake (ρ < 0.08) significantly predicted high frequency SNHL (F(3,33) = 3.59, ρ < 0.02, R2 = 0.177), with cumulative cisplatin dose (ρ < 0.006) significantly predicting low and medium frequency SNHL (F(3,34) = 14.81, ρ < 0.001, R2 = 0.528).  

Conclusion

Whilst SNHL rates may be under reported without routine audiometry, the incidence of CbCRT-induced SNHL, in HNC patients, in this study, is high. Clinically significant hearing loss was evident in patients with increased tobacco and alcohol consumption. These patients can be identified using the proposed predictive model, aiming to decrease the risk of ototoxicity.

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