Pre-treatment audiological and vestibular assessment in adults starting platinum-based chemotherapy

To evaluate the feasibility of incorporating both standard and novel audiological and vestibular assessments into routine oncology care. A secondary objective was to characterize audiovestibular status prior to platinum-based chemotherapy and identify potential risk factors for cochleotoxicity and vestibulotoxicity.

This single-center, cross-sectional prospective study enrolled 110 adults scheduled for their first platinum-based chemotherapy cycle. All assessments were performed at one time point prior to treatment initiation. Pre-treatment assessments included tympanometry, pure-tone audiometry, speech audiometry in quiet and noise (SPIQ and SPIN), distortion product otoacoustic emissions (DPOAEs), auditory brainstem responses (ABRs), envelope following responses (EFRs), video head impulse testing (vHIT), and cervical vestibular evoked myogenic potentials (cVEMP).

All patients underwent tympanometry and pure-tone audiometry. A broader audiological test battery was completed in 96 patients (87.3%). At least one vestibular assessment was performed in 65 patients (59.1%). Completion of the protocol was limited by age, fatigue, or logistical constraints. Vestibular assessments were sometimes hindered by physical and time limitations. Before the start of chemotherapy, hearing loss was present in 44.5% of patients (30.9% bilateral, 13.6% unilateral), while 9.1% reported tinnitus and 34.5% reported difficulty understanding speech in noise. Speech audiometry (SPIQ and SPIN SRTs) revealed significant differences between age groups, with post-hoc analysis showing differences between the 34-57 group and the older groups. DPOAE amplitudes were significantly different across age groups at 1500 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz. EFR magnitudes, as well as ABR amplitudes and latencies, did not differ significantly between age groups. At baseline, three patients were diagnosed with benign paroxysmal positional vertigo (BPPV). vHIT revealed vestibulo-ocular reflex (VOR) gain deficits in three patients. cVEMP responses were absent bilaterally in three patients and unilaterally in one.

Audiological assessments were largely feasible, even in older adults, and revealed pre-existing audiovestibular deficits including high-frequency hearing loss and BPPV. Given risk factors such as advanced age, baseline hearing deficits, and planned type of platinum-based chemotherapy, this population is particularly vulnerable to cochleotoxicity. These findings support implementing a pre-treatment audiovestibular protocol that can serve as a baseline for subsequent longitudinal ototoxicity monitoring, with individualized adaptations to optimize feasibility and to support early detection of ototoxic changes and timely intervention during follow-up.