SENSORINEURAL HEARING-LOSS IN PATIENTS TREATED FOR NASOPHARYNGEAL CARCINOMA - A PROSPECTIVE-STUDY OF THE EFFECT OF RADIATION AND CISPLATIN TREATMENT

Purpose: The pattern of sensorineural hearing loss (SNHL) after primar y treatment for nasopharyngeal carcinoma (NPC) was studied, and the ef fect of cisplatin, radiotherapy dose, and fractionation were evaluated . Methods and Materials: One hundred thirty-two patients, 227 ears, an d 1100 audiogram reports were analyzed. Radiotherapy dose ranged from 59.5 to 76.5 Gy. Fifty-two patients received preirradiation cisplatin, total dose 100-185 mg/m(2). Serial postirradiation bone conduction th resholds at 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz were compared with pretre atment thresholds at respective frequencies. Increase of at least 15 d B was considered as significant and was further grouped as transient o r persistent SNHL. Univariate and multivariate analyses were performed to identify predicting factors for persistent SNHL. Results: At media n follow-up of 30 months, 24.2% of ears developed persistent SNHL. Hig h frequency was more affected than low frequencies, 22 vs. 5.3%. Males were more affected than females, 29.4 vs. 15.5%, p = 0.0132. Incidenc e of persistent SNHL increased with age, with 0, 17.2, and 37.4% of pa tients aged under 30, between 30-50 and over 50 affected, respectively , p = 0.0001. High incidence was found in patient with postirradiation serous otitis media (SOM), 46.9%. Chemotherapy with cisplatin and rad iation dose or fractionation had no significant effect. Multivariate a nalysis confirmed age, sex, and postirradiation SOM as significant pro gnostic factors for persistent SNHL. Conclusions: Transient and persis tent SNHL occurred after radiotherapy, more commonly affecting high fr equency, A low dose of preirradiation cisplatin did not increase the r isk. A dose fractionation effect of radiotherapy was not confirmed in this study. Copyright (C) 1996 Elsevier Science Inc.