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Updated: Dec 22, 2025
Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity
Published on: March 16, 2018
Clinical trials evaluating transtympanic otoprotectants for cisplatin-induced ototoxicity: what do we know so far?
1Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile. sofia.waissbluth@mail.mcgill.ca.
Background:
Cisplatin (CDDP) chemotherapy can cause serious side effects including irreversible and progressive hearing loss. Studies have aimed to assess potential protective strategies; however, systemic treatments have presented variable results, and potential interactions with CDDP have limited clinical trials.
Methods:
A review of the literature was performed in order to evaluate clinical trials that have studied a transtympanic approach as an otoprotectant strategy.
Results:
Six clinical trials were included. While a transtympanic approach can limit side effects and avoid interactions with CDDP, recurrent issues have been expressed including which otoprotectant to test, time delays between CDDP treatment and transtympanic injections, side effects such as pain and dizziness, concentrations, and number of injections. Clinical trials have used sodium thiosulfate, N-acetylcysteine and dexamethasone.
Conclusions:
While a transtympanic approach seems like an attractive strategy, further research is needed to clarify which is the optimal otoprotectant, its dosage, and the number of injections.
Insights
Transtympanic otoprotectants show promise in preventing cisplatin-induced hearing loss. Further research is needed to optimize otoprotectant choice, dosage, and timing for this chemotherapy side effect.
Area of Science:
- Ototoxicity research
- Chemotherapy side effect management
- Clinical trial analysis
Background:
- Cisplatin (CDDP) chemotherapy is associated with significant, irreversible hearing loss.
- Systemic otoprotective strategies have yielded inconsistent results and pose interaction risks with CDDP.
- Limited clinical trials have explored alternative otoprotection methods.
Purpose of the Study:
- To evaluate the efficacy and challenges of transtympanic otoprotectant strategies in clinical trials.
- To identify key variables requiring further investigation for optimal transtympanic otoprotection.
- To synthesize findings from existing literature on this emerging therapeutic approach.
Main Methods:
- A comprehensive literature review was conducted.
- Focused on clinical trials investigating the transtympanic administration of otoprotectants.
- Six relevant clinical trials were identified and analyzed.
Main Results:
- Transtympanic delivery potentially mitigates CDDP-induced ototoxicity and avoids systemic interactions.
- Several challenges persist, including selection of the optimal otoprotectant (e.g., sodium thiosulfate, N-acetylcysteine, dexamethasone).
- Unresolved issues include optimal timing of injections relative to CDDP treatment, dosage, number of administrations, and associated side effects like pain and dizziness.
Conclusions:
- The transtympanic approach presents a promising strategy for otoprotection against cisplatin-induced hearing loss.
- Further research is essential to determine the ideal otoprotectant, its precise dosage, and the optimal injection regimen.
- Standardization of protocols is necessary to maximize the clinical utility of this approach.
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