Ototoxicity after chemoradiotherapy for nasopharyngeal carcinoma

Ototoxicity in Cisplatin-treated nasopharyngeal carcinoma in children

“…They found that cisplatin alone and radiation alone could have an independent negative effect on patients. Dose-dependent ototoxicity from cochlear radiation was not increased by the induction and concurrent doses of cisplatin [32]. A previous trial reported that the overall toxicity of concurrent chemo-radiotherapy was significantly higher than the toxic effect of RT alone [33].…”

Changes in vestibular and cochlear function following platinum-based chemotherapy: A preliminary report

“…Moreover, normal auditory function does not imply that vestibular function is also unimpaired. 8 Further research with larger sample sizes is required to confirm if hearing dysfunction can serve as a proxy for vestibular dysfunction during ototoxicity monitoring. Both cochleotoxicity and vestibulotoxicity (including at minimum patient self-report of symptoms) should be included when testing patients being treated with platinum-based agents at the treatment venue or hospital ward.…”

“…Vestibulotoxicity may well follow a similar trajectory because of the shared blood, nerve and fluid sources. 8 Hypothetical explanations for unilateral involvement in ototoxicity include the fact that asymmetry and the genetic difference of bilateral organs are well-known; therefore, a correlation of a genotype with unilateral ototoxicity is possible. It is assumed that two molecular mechanisms with different speeds may cause ototoxicity.…”

“…4 Therefore, considering this shared anatomy and physiology of the inner ear structures, ototoxicity is not limited to alterations in cochlear functioning. 4 The monitoring of cochleotoxicity in platinum-based chemotherapy is well established; however, there are no universally accepted guidelines for vestibulotoxicity monitoring and it is rarely conducted in patients who are critically ill. 4,5,8 Furthermore, present ototoxicity testing recommendations include detailed test protocols. 9 The biggest challenge in monitoring vestibulotoxicity is the detection of symptoms that are only visible when patients are mobilised, which can also be falsely attributed to the patient's weakened state.…”

“…Both cVEMP and oVEMP results showed extended latencies at follow-up testing; however, these were not statistically significant. 8 Dynamic visual acuity (DVA) assesses the vestibulo-ocular reflex (VOR), which is most helpful for diagnosing ototoxicity and other bilateral vestibular pathologies. DVA as a vestibular screening test showed abnormal results (28%) in paediatric head and neck cancer patients receiving platinum-based chemotherapy.…”