Objective: The characteristics and risk factors of the long-term ototoxic effect of cisplatin in testicular cancer patients was studied by measuring distortion product otoacoustic emissions (DPOAEs), which is a highly sensitive, new method for detecting high-frequency hearing loss. Methods: 223 patients with a median follow-up time of 4.27 years (range 0.5–20 years) and a median age of 37 years (range 18–55 years) were assessed by DPOAE. 100 mg/m² cisplatin were administered per cycle, in EP, BEP, VeIP, VIP or VPB regimens. The control group consisted of 40 testicular cancer patients without chemotherapy (median age 35 years, range 16–54 years). A detailed medical history evaluated audiological risk factors and hearing complaints. DPOAE was measured in eight frequencies from 750 to 8,000 Hz. Paired t test and Mann-Whitney test were used for statistical evaluation. Results: Symptomatic ototoxicity was observed in 20% of the patients. In patients receiving ≤300 mg/m² cisplatin, no amplitude changes were detected. Beyond this dose, hearing impairment proved to be dose dependent. Contrary to the literature, not only high frequencies were affected. In patients receiving ≧400 mg/m², our method could detect significant hearing impairment at lower frequencies that are important for speech perception. At 400 mg/m², significant amplitude change was detected at 3,000 Hz (p = 0.01); at 500–600 mg/m², significant amplitude change was detected at 1,500, 2,000 and 3,000 Hz (p = 0.004, 0.0001 and 0.0002, respectively), and at 700 mg/m² significant amplitude change was detected at 3,000 Hz (p = 0.01). We detected the lowest amplitudes in those 44 patients who had symptomatic ototoxicity. The only statistically significant risk factor was the cumulative dose of cisplatin; neither smoking nor noise exposure were independent risk factors. Conclusion: DPOAE is a fast, noninvasive and reliable method in detecting late ototoxicity in testicular cancer patients. Contrary to the literature, not only high frequencies are affected. In patients receiving at least 400 mg/m², using DPOAE we were able to detect significant hearing impairment at lower frequencies that are important for speech perception.

Purpose The presence of cervical lymph node metastases is one of the most influential prognostic factors in head and neck squamous cell carcinomas. The management of clinically N0 neck in patients with head and neck cancer remains controversial: elective neck dissection has relatively high morbidity, adversely affecting the quality of life, however, abandoning elective neck dissection is known to compromise overall survival in numerous primaries. The purpose of this study was to evaluate the accuracy of the conventional imaging modalities (CT, MRI, US) and fine-needle aspiration cytology (FNAC) in the detection of lymph node metastases in the neck. Methods Sixty two patients were included in the study, who underwent primary tumor resection and neck dissection. Preoperative nodal status was compared with postoperative histopathology nodal status. In our retrospective study, we reviewed the patient documentation. Statistical analysis of the data-with descriptive statistics and correlation analysis-was performed with Chi-square test. Results The sensitivity of conventional imaging modalities and FNAC were 82.8% and 81.8%, respectively, while specificity were 73.9% and 100%, respectively. Positive predictive value calculated for imaging modalities and FNAC were 82.8%, 100%, respectively, while negative predictive values were 73.9% and 66.6%, respectively. Conclusion Neither the sensitivity of imaging modalities (CT, MRI, US) nor FNAC reached 100%, none of these methods can definitively exclude the presence of regional tumor metastasis. According to these data, no permissive alteration should be allowed from the current guidelines (e.g. NCCN) based on imaging/FNAC examinations regarding the need for elective neck dissection.

Preventing the ototoxicity caused by cisplatin is a major issue yet to be overcome. Useful preventive treatments will soon be available. Consequently, the next step is to filter out those patients who are more prone to develop ototoxicity. The aim of this study was to prospectively evaluate potential predictive markers of acute ototoxicity as determined by measures of distortion product otoacoustic emissions (DPOAEs). A total of 118 patients from our previous DPOAE analysis were put under evaluation. Ototoxic cases were divided according to unilateral (n = 45) or bilateral (n = 23) involvement. The clinicopathological characteristics, hearing test results, germline GSTT1, GSTM1, and GSTP1 polymorphisms, and common laboratory parameters were included in the new analysis. Univariate and multivariate statistical tests were applied. According to multivariate logistic regression, the only independent predictor of unilateral ototoxicity (vs. non-affected) was a GSTM1 null genotype (OR = 4.52; 95%CI = 1.3-16.3), while for bilateral damage, the GSTT1 null genotype (OR = 4.76; 1.4-16) was a predictor. The higher starting serum urea level was characteristic of bilateral ototoxicity; however, the only independent marker of bilateral (vs. unilateral) ototoxicity was the presence of GSTT1 null genotype (OR = 2.44; 1.23-4.85). Different processes, involving the GSTM1 and GSTT1 genotypes, respectively, govern the development of acute unilateral and bilateral ototoxicities. Further research is needed to clarify these processes. Based on the above findings, patients whom are at risk may be selected for otoprotective therapies. Key messages & The acute ototoxicity was determined by DPOAE in 118 testicular cancer patients. & GSTM1 null was the only marker of unilateral ototoxicity (vs. non-affected). & The only marker of bilateral hearing loss (vs. non-affected) was the GSTT1 null. & GSTT1 null was also the marker of bilateral vs. unilateral ototoxicity. & A high-risk group may be selected for new, individualized otoprotective treatment.

4. Laryngoscope, 127:1909-1915, 2017.

15581 Background: We studied the acute ototoxic effect of cisplatin in testicular cancer patients with two highly sensitive new methods for detecting high frequency hearing loss: distorsion product otoacoustic emissions (DPOAE), and spontaneous otoacoustic emissions (SOAE). Methods: Checking the acute effect, 32 (63 ears) testicular cancer patients (median age: 33 years, range: 16–59 years) were measured on the first day of their first cycle and after one week of their last cycle of cisplatin treatment. 20 mg/m2 cisplatin was administered for five days, in BEP chemotherapy regimen. The patients got on the average 2.19 cycles (2–3 cycles). We also measured the SOAE of ten healthy control persons (without chemotherapy) matching sex and age distribution of this group. A detailed medical history evaluated audiological risk factors and hearing problems. Tympanometry, DPOAE and SOAE were measured, to detect the acute changes in the inner ear after low cumulative dose of cisplatin treatment. Paired t-test, and sign test was used for statistical analysis. Results: The DPOAE did not show any changes close after cisplatin treatment (average: 2.19 cycles, 2–3 cycles), similarly to our earlier results with pure tone audiometry (PTA) and transiently evoked otoacoustic emission (TOAE). But the SOAE showed significant, early changes in incidence, shape and amplitude, in the treated group. 66% of the SOAE changed after treatment (p=0,006). In the control group (20 ears) the SOAE never changed in a three months period. (It behaves as a fingerprint) Conclusions: DPOAE did not change significantly after 2 or 3 cycles of cisplatin treatment, similarly to our earlier results with PTA, and TOAE, but the change of the SOAE-incidence, shape and amplitude close after cisplatin treatment shows acute changes in the inner ear function (first described in the literature) after administration of low cumulative dose of cisplatin. This case is the first indication of the possible clinical relevance of SOAE. Our observation has to be confirmed in further studies, with larger number of patients. No significant financial relationships to disclose.

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Bevezetés: A halláscsökkenés olyan érzékszervi károsodás, mely a beszédértést, a kommunikációt, így az életminőséget is rontja. Előfordul, hogy a beteg által megélt funkcióvesztés túlzó, a mérések során a szubjektív és az objektív vizsgálati eredmények ellentmondásosak, a szubjektíven jelzett halláscsökkenés mértéke jelentősebb; ezen esetekben felmerül a funkcionális halláscsökkenés véleményezése. Célkitűzés: Célul tűztük ki funkcionális halláscsökkenés diagnózisú eseteink összegyűjtését és retrospektív elemzését, melyek alapján következtetéseket vonhatunk le a funkcionális halláscsökkenés jellemzőiről, a figyelemfelhívó jelekről, állapotokról és a megfelelő rehabilitáció mérlegeléséről. Módszerek: A szubjektív vizsgálatok a tisztahang-hallásküszöb, a beszédértés és a kommunikáció vizsgálatával történtek, majd ezeket összevetettük az objektív impedanciaméréssel, a stapediusreflex-vizsgálattal, az otoakusztikus emisszió mérésével, az agytörzsi kiváltott válaszok regisztrálásával nyert eredményekkel. Képalkotó vizsgálatok, pszichológus, pszichiáter, szurdopedagógus, neurológus, illetve további társszakmák bevonása történt szükség szerint. Kizártuk a szándékosan anyagi vagy egyéb előnyszerzésre irányuló megtévesztés eseteit. Eredmények: 2007 és 2022 között 19 beteg esetében diagnosztizáltunk funkcionális halláscsökkenést. A betegségben többségében (17 eset) nők érintettek, jellemzőek a fiatal életkorban (10–41 év) jelentkező panaszok; az átlagéletkor a vizsgált beteganyagban 19,6 év, az érintett páciensek nagyobb része (13 eset) 10–17 év közötti gyermek volt. Organikus okot 11 esetben nem találtunk, a többi esetben kimutatható organikus eltérés sem magyarázza a beteg által megélt halláscsökkenés mértékét. A funkcionális hallásveszteség mértéke különböző (35–120 dB) volt, átlagosan 60,2 dB. Következtetés: A funkcionális halláscsökkenés felismerése és diagnosztikája nagyon nehéz, komplex vizsgálati sort, szakmai együttműködést igényel. Felismerés nélkül a beteg indokolatlan, akár számára káros, anyagilag is megterhelő ellátásban részesülhet, mely állapotának romlását is okozhatja. Orv Hetil. 2023; 164(8): 283–292.

Pathophysiological alterations in the cochlea and functional tests of the auditory pathway support that in diabetes both vasculopathy and neural changes could be present. The aim of our research was to study the differential effect of type 1 diabetes mellitus (T1DM) on two different age groups. Audiological investigation was carried out in 42 patients and 25 controls at the same age groups. Investigation of the conductive and sensorineural part of the hearing system by pure tone audiometry, distortion product otoacoustic emission measurement and acoustically evoked brainstem response registration were evaluated. Among the 19-39-year-old people the incidence of hearing impairment was not different in the diabetes and control groups. Among the 40-60-year-old people hearing impairment was more common in the diabetes group (75%) than in the control group (15,4%). Among patients with type 1 diabetes, the mean threshold values were higher in both age groups at all frequencies although significant difference was in 19–39 years old group: 500-4000Hz right ear, 4000Hz left ear, in 40–60 years old group: 4000–8000 Hz both ears. In the 19–39 years old diabetes group only at 8000 Hertz on the left side was a significant (p<0,05) difference in otoacoustic emissions. In the 40–60 years old diabetes group significantly less otoacoustic emissions at 8000 Hz on the right side (p<0,01) and at 4000-6000-8000 Hertz on the left side, (p<0,05, p<0,01, p<0,05 respectively) was present compared to the control group. According to ABR (auditory brainstem response) latencies and wave morphologies, a possible retrocochlear lesion arose in 15% of the 19–39 years old and 25% of the 40–60 years old diabetes group. According to our results, T1DM affects negatively the cochlear function and the neural part of the hearing system. The alterations are more and more detectable with aging.