Longitudinal Audiological and Vestibular Follow-up in Adult Cancer Patients Receiving Platinum-Based Chemotherapy

Platinum-based chemotherapy is widely used in cancer care but carries a substantial risk of cochleotoxicity and vestibulotoxicity. This study aimed to characterize early (3-month) and long-term (1-year) auditory and vestibular effects of platinum derivatives in adults, with the goal of improving monitoring strategies.

A total of 110 adults (34-81 years; 63 female) received cisplatin (n = 73), carboplatin (n = 22), or sequential cisplatin followed by carboplatin (ciscarbo; n = 15). Assessments at baseline, 3 months, and 1 year included conventional and extended high-frequency (EHF) audiometry, distortion product otoacoustic emissions (DPOAEs), speech perception, auditory brainstem response (ABR), and envelope following response (EFR). Vestibular testing comprised vHIT and cVEMP. Ototoxicity was classified using ASHA (1994) and graded with TUNE. Linear mixed models assessed treatment- and time-related changes.

Cisplatin induced significant threshold shifts across the audiogram, including low, mid, high, and extended high frequencies, with progression up to 1 year. Low- and mid-frequency thresholds remained largely stable in the carboplatin group, while the ciscarbo group showed early mid- and EHF deterioration. EHF thresholds increased across all groups. ASHA-defined ototoxicity was present in 73.5% at 3 months and > 90% at 1 year. DPOAEs revealed early, progressive OHC dysfunction, and ABR and EFR indicated neural involvement, particularly after cisplatin. Speech perception remained stable, and no significant vestibular deficits were detected.

Cisplatin induces broad, progressive cochleotoxicity, while carboplatin produces milder, delayed effects. EHF audiometry, DPOAEs, and electrophysiological measures enhance early detection. Combining behavioral and objective markers with standardized grading supports comprehensive ototoxicity monitoring.