Changes in Vestibular Function in Patients With Head-and-Neck Cancer Undergoing Chemoradiation

Area of Science:

• Oto-neuroscience
• Oncology
• Vestibular System Research

Background:

• Cisplatin is a common chemotherapy drug with known cochleotoxicity.
• The effects of cisplatin on the vestibular system are less understood, with limited prospective studies.
• Head and neck cancer patients undergoing chemoradiation are at risk for platinum-induced ototoxicity.

Purpose of the Study:

• To investigate the vestibulotoxic effects of cisplatin in patients with head and neck tumors undergoing chemoradiation.
• To assess the impact of cisplatin on both semicircular canals and otolith organs using modern vestibular testing.
• To establish a baseline for future research into cisplatin-induced vestibulotoxicity.

Main Methods:

• Prospective study involving 45 head and neck cancer patients undergoing cisplatin-based chemoradiation.
• Comprehensive vestibular assessment including video head impulse test (vHIT), vestibular evoked myogenic potentials (VEMPs), and pure tone audiometry.
• Testing performed before therapy, 6 weeks post-therapy, and 3 months post-therapy.

Main Results:

• Significant reduction in horizontal vHIT gain observed 6 weeks after chemoradiation.
• Increased incidence of refixational saccades post-therapy, indicating vestibular dysfunction.
• Significant changes detected in VEMP testing, while audiometry showed no significant changes.
• No patients reported dizziness during follow-up, despite objective vestibular impairment.

Conclusions:

• Cisplatin-based chemoradiation demonstrates a vestibulotoxic effect in head and neck cancer patients.
• Further research is needed to elucidate mechanisms and identify vestibuloprotective agents.
• Routine vestibular testing alongside audiometry is recommended before and after chemoradiation to detect and manage vestibular loss promptly, enabling early physiotherapy intervention.