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Preventing Hearing Loss in Children Receiving Cisplatin: A Systematic Review and Meta-Analysis
Ethan M Kallenberger1, Erin E Briggs1,2, Shaun A Nguyen1
1Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Insights
Preventing cisplatin-induced hearing loss in children shows mild success with interventions like sodium thiosulfate or amifostine. Further research is needed due to limited literature on ototoxicity prevention.
Area of Science:
- Pediatric Oncology
- Ototoxicology
- Clinical Pharmacology
Background:
- Cisplatin chemotherapy is a critical treatment for pediatric cancers.
- Cisplatin-induced hearing loss (ototoxicity) causes significant long-term neurologic, social, and behavioral deficits in children.
- Effective preventive strategies for cisplatin ototoxicity are crucial for improving quality of life.
Purpose of the Study:
- To review and characterize available interventions for preventing cisplatin-induced hearing loss in pediatric patients.
- To identify gaps in the current scientific literature regarding ototoxicity prevention in children receiving cisplatin.
Main Methods:
- A systematic literature search was conducted across CINAHL, Cochrane Library, PubMed, and Scopus databases from 1990 to 2024.
- Studies evaluating interventions to prevent hearing loss in children undergoing cisplatin treatment were included.
- Audiometric data, including pure tone thresholds and hearing loss incidence, were extracted and analyzed.
Main Results:
- Six studies (N=760) involving four randomized controlled trials, one non-randomized controlled trial, and one prospective cohort study were analyzed.
- Intravenous sodium thiosulfate or amifostine were the primary interventions examined.
- Interventions showed a reduced relative risk of hearing loss (0.78) and significantly increased the proportion of patients with no hearing impairment (Brock grade zero: 36.3% vs. 15.5%).
Conclusions:
- Available evidence suggests mild success in mitigating cisplatin-induced hearing loss in children.
- The current body of literature is limited, underscoring the need for more robust clinical trials.
- Further investigation is warranted to establish definitive preventive strategies for pediatric cisplatin ototoxicity.
Objective:
Cisplatin-induced hearing loss leads to significant neurologic, social, and behavioral impairment in children. The goal of this study is to characterize options available to prevent cisplatin-induced hearing loss and to identify gaps in the literature.
Data Sources:
CINAHL, Cochrane Library, PubMed, Scopus.
Review Methods:
Literature was searched between 1990 and 2024. Studies evaluating interventions to prevent hearing loss in children receiving cisplatin were included. Audiometric data including pure tone threshold, pure tone average, and incidence of hearing loss were extracted from included studies.
Results:
Six studies (N = 760) pertaining to cisplatin-induced hearing loss in children were included. This includes four randomized control trials (N = 652), one nonrandomized control trial (N = 97) and one prospective cohort study (N = 11). The studies examined sodium thiosulfate or amifostine, both given intravenously. The relative risk of hearing loss between intervention and control groups was 0.78 (95% CI 0.71-0.85). The proportion of patients in the treatment group categorized as grade zero on the Brock ototoxicity grading scale was significantly higher (p < 0.0001) than in the control group (36.3% vs. 15.5%). The change in pure tone average after chemotherapy was significantly higher in the control group compared to the intervention group (5.2 vs. -1.2 dB, 95% CI 5.53-7.25).
Conclusions:
These results show mild success in reducing the incidence of hearing loss in children undergoing chemotherapy with cisplatin. However, the literature is limited, and further investigation is warranted.
