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Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma
Johnnie K Bass1, Jie Huang2, Chia-Ho Hua3
1Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN.
American Journal of Audiology
|August 4, 2018
Summary
Proton radiotherapy (PRT) shows potential for reducing late complications like hearing loss in children. Early auditory outcomes indicate normal hearing in conventional frequencies, but subclinical decreases in extended high frequencies warrant long-term monitoring.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Audiology
Background:
- Proton radiotherapy (PRT) offers potential advantages over photon-based treatments by minimizing radiation exposure to healthy tissues.
- This can lead to a reduction in late complications, such as sensorineural hearing loss (SNHL), particularly in pediatric patients.
- Craniopharyngioma treatment in children often involves radiation, making auditory outcome assessment crucial.
Purpose of the Study:
- To evaluate the early auditory outcomes in children treated with PRT for craniopharyngioma.
- To assess the incidence and characteristics of hearing changes following PRT.
- To compare auditory function before and after PRT using comprehensive audiological assessments.
Main Methods:
- Prospective, longitudinal study involving 74 children treated with PRT for craniopharyngioma.
- Utilized conventional frequency (CF) and extended high-frequency (EHF) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments.
- Auditory outcomes were evaluated at a median of 2 post-PRT visits, with ototoxicity graded using established criteria (Chang and ASHA).
Main Results:
- No SNHL was observed in the conventional frequency range at the last evaluation.
- Two patients experienced SNHL in the extended high-frequency range (Chang Grade 1a).
- Decreases in hearing were noted in 9 patients in the EHF range alone and 15 patients in both CF and EHF ranges based on ASHA criteria. DPOAE levels showed faster decline at higher frequencies. Speech-in-noise perception remained stable.
Conclusions:
- Proton radiotherapy (PRT) maintained normal hearing in the conventional frequency range at a median 2-year follow-up.
- Subclinical hearing decreases were detected, particularly in the extended high-frequency range and DPOAE levels.
- Long-term follow-up is recommended to monitor for potential late auditory effects of PRT in pediatric patients.
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