A new grading system for ototoxicity in adults

Area of Science:

• Audiology
• Ototoxicology
• Cancer Therapeutics

Background:

• Ototoxicity, often a side effect of cancer treatments like chemotherapy and radiotherapy, can significantly impair hearing.
• Current grading systems may not fully capture the functional impact of hearing loss on daily activities.
• There is a need for a more sensitive ototoxicity assessment tool.

Purpose of the Study:

• To develop and validate a novel ototoxicity grading system.
• To enhance sensitivity to hearing deficits affecting speech intelligibility and ultra-high sound perception.
• To compare the feasibility of the new system against existing criteria (CTCAEv4, ASHA).

Main Methods:

• Incorporated pure tone averages (PTAs) for speech (1-2-4 kHz) and ultra-high frequencies (8-10-12.5 kHz).
• Considered threshold shifts and post-treatment hearing levels.
• Evaluated criteria on head and neck cancer patients undergoing (chemo-)radiotherapy ([C]RT).

Main Results:

• Grades 1 & 2 based on threshold shifts and subjective complaints.
• Grades 3 & 4 defined by specific dB hearing loss thresholds at speech-relevant frequencies.
• New criteria showed comparable results to CTCAEv4/ASHA in high-dose cisplatin cases, but higher sensitivity in RT/low-dose cisplatin scenarios.

Conclusions:

• The proposed grading system demonstrates increased sensitivity to ototoxicity compared to CTCAEv4 and ASHA.
• It offers valuable insights into how hearing loss impacts daily life functions.
• The system is deemed feasible for both clinical practice and research applications.