RISK-FACTORS FOR OTOTOXICITY DUE TO CISPLATIN

Objective: To determine whether abnormalities in routine blood tests w ere associated with increased susceptibility to hearing loss induced b y cisplatin chemotherapy. Design: Cohort study of patients with head a nd neck cancer receiving cisplatin chemotherapy who underwent audiomet ric testing. Setting: A large, university-based hospital; part of a la rger study regarding rehabilitation of patients with cancer. Patients: Forty-two patients with head and neck cancer who agreed to participat e underwent at least three serial treatments with high-dose cisplatin therapy. Routine blood tests and audiometric testing were performed be fore each course of chemo therapy. One hundred eighty audiograms were performed. Outcome Measures: A deterioration of auditory threshold of 15 dB or more at one frequency or of 10 dB or more at three or more fr equencies was considered a significant loss. Only frequencies at and b elow 4000 Hz were considered. Results: Multiple analysis of variance r esults indicated that decreased serum albumin level, hemoglobin level, red blood cell count, and hematocrit were associated with an increase d likelihood of significant hearing loss during chemotherapy. Conclusi ons: Patients in poor general medical condition with low levels of red blood cells or serum proteins are at increased risk for development o f hearing loss from cisplatin chemotherapy. We recommend that hearing be tested before chemotherapy begins and after the first course of cis platin. If there is no significant hearing loss at or below 4000 Hz at that time, then subsequent audiometric testing is required only if sy mptoms of hearing loss develop.