High-frequency testing techniques and instrumentation for early detection of ototoxicity

Veteran patients with certain types of infections and cancers are routinely treated with therapeutic agents having ototoxic potential, thus threatening loss of hearing sensitivity which preexists in the majority of these patients. To prevent communication deficits requiring intervention, this laboratory is developing instrumentation and techniques for early detection of ototoxicity. For this study, conventional (< or = 8 kHz) and high-frequency (> or = 8 kHz) hearing thresholds were monitored behaviorally in hospitalized veterans receiving treatment with ototoxic drugs. Data analysis revealed that monitoring only the high-frequency range would have identified 67% of ears showing change. A five-frequency range of hearing, specific to each individual, was identified for its high sensitivity to early ototoxic change. Monitoring of only these five frequencies in each patient would have identified 82% of ears that showed behavioral change. Auditory brainstem responses (ABR) were obtained in a subgroup using clicks and high-frequency (8-14 kHz) tone bursts. ABR latency/morphology changes were observed in 95% of ears demonstrating behavioral change. High-frequency tone-burst-evoked ABRs alone would have identified 93% of initial changes. Monitoring of high-frequency audition using these techniques shows promise for early detection of ototoxicity with potential for prevention of hearing loss in frequencies essential for verbal communication.