Long-term auditory follow-up in counteracting platinum-induced ototoxicity in paediatric oncology

Background: Irreversible bilateral sensorineural hearing loss is a common side effect of platinum compounds. Because of extended overall survival period of children, a prolonged hearing surveillance and management of hearing impairments are emerging concerns for pediatric oncology. Methods. In this retrospective observational study we enrolled 38 children out of 116 treated at our institution by chemotherapy (cisplatin and/or carboplatin) with or without irradiation between 2007–2014, and submitted to hearing monitoring before every cycle of chemotherapy and that completed a 5 years long-term follow-up. Chemotherapy regimens, demographic findings, cumulative doses and cranial irradiation were compared. Results. At the end of 5-years follow-up ototoxicity was significantly increased compared to that at observed the end of chemotherapy (52.5% vs 39.5%, p<0.001). A late onset of hearing loss was experienced in 13.1% of children while in 26.3% progressive hearing loss was measured. Deafness at the end of chemotherapy and irradiation was significant prognostic factor for late ototoxicity outcomes (Odds Ratio 7.2 – CI:1.67–31.1 – p<0.01 and 5.25 – CI:1.26–21.86 – p<0.01 respectively). No significant differences were found between cisplatin and combined treatment (i.e. cisplatin shifted to carboplatin during monitoring for the onset of ototoxicity) and ototoxicity was not associated with platinum compounds cumulative dose (p>0.05). 13.1% of children needed hearing aids at the end of follow-up. Conclusions. Our study confirms the effectiveness of long-term follow-up in identifying late onset/progressive hearing loss after platinum compound chemotherapy and allows us to avoid the harmful effects of hearing deprivation with hearing aid intervention.