Intratympanic Steroid Regimen For Prevention Of Cisplatin-Induced Hearing Loss: A Systematic Review

Area of Science:

• Otolaryngology
• Medical Oncology
• Pharmacology

Background:

• Cisplatin is a potent chemotherapy agent with a steep dose-response curve.
• Higher cisplatin doses increase efficacy but are limited by severe ototoxicity, causing permanent hearing loss.
• Intratympanic steroid administration (ITD) is being investigated as a potential otoprotective strategy.

Purpose of the Study:

• To systematically review the evidence on the efficacy of intratympanic steroids in preventing cisplatin-induced hearing loss (CiHL).
• To evaluate the quality of evidence from randomized controlled trials (RCTs) assessing ITD for CiHL.

Main Methods:

• Systematic literature search of PubMed, Cochrane Library, and Scopus (Jan 2004 - Jul 2023).
• Inclusion of RCTs evaluating ITD for patients receiving cisplatin.
• Adherence to PRISMA guidelines with PICOS criteria for study selection.

Main Results:

• Four RCTs were included for qualitative synthesis after screening 383 records.
• High risk of bias was noted in allocation concealment (all studies) and detection bias (three studies).
• The quality of evidence ranged from low to high (GRADE framework), with inconsistent findings.

Conclusions:

• Intratympanic steroid administration did not demonstrate a consistent otoprotective benefit against cisplatin-induced hearing loss.
• Current RCTs provide insufficient high-quality evidence to support ITD for mitigating cisplatin ototoxicity.
• Further rigorously designed RCTs with standardized protocols are needed to clarify the role of ITD.