Ototoxicity from cisplatin therapy in childhood cancer

Cisplatin has been associated with hearing damage. It is usually irreversible, bilateral, and characterized by high-frequency sensorineural hearing loss. This study was carried out to identify impairment of hearing function in children and adolescents with cancer after cisplatin therapy. Twenty-three survivors of childhood cancer treated with cisplatin at our Unit from 1991 to 2004 performed tympanometry, pure tone audiometry, transient otoacoustic emissions, and distortion product otoacoustic emissions (DPOAE). The median age at diagnosis was 12.3 years and the median total dose of cisplatin received was 406 mg/m2. Fifty-two percent of patients had bilateral and in the high frequencies range hearing loss on audiometry. Transient otoacoustic emission and DPOAE abnormalities were detected in 22% and in 71% of the patients, respectively. We found a high concordance between the findings of audiometry and DPOAE (P=0.01). There was no influence of sex and number of ototoxic drugs other than cisplatin on hearing loss. There was a trend for younger age and higher cumulative dose of cisplatin to be associated with greater severity of hearing damage. Our data provide further evidence on hearing damage due to cisplatin therapy in children. The high incidence of patients with hearing function abnormalities found in this study and in previous reports highlights the importance of monitoring hearing function in children and adolescents undergoing cisplatin therapy, or as early as possible at follow-up. This study also demonstrates that DPOAE should be used for screening of hearing abnormalities and, once hearing damage is identified, patients require expert audiologic pediatric evaluation and (where indicated) use of hearing aids and/or speech therapy.