Cisplatin-induced ototoxicity in 401 consecutive Geneva cancer patients

Objective: Robust epidemiological and audiological data are needed to prepare for future clinical trials aiming at preventing cisplatin-induced ototoxicity in this suffering cancer population. We precisely assessed the incidence, severity and potential risk factors of symptomatic cisplatin-induced ototoxicity in a large cohort of adults. Methods Retrospective cohort study at a tertiary care university hospital. Study group included 401 consecutive patients over 18 years old treated with cisplatin-based chemotherapy, without concomitant inner ear radiotherapy nor other ototoxic medication. Every participant underwent baseline pre-treatment audiometry and were asked for otological symptoms (tinnitus, hearing loss). If symptomatic, comparative audiometry was performed. Ototoxicity was defined by a threshold shift ≥ 15 dB HL in at least one of the tested frequencies. Results A total of n = 401 cancer patients (59% males) with a mean age of 56 years (range 18–80 years). N = 81 patients (20%) developed symptomatic ototoxicity, affecting predominantly the high frequencies from 4 to 8 kHz. Among the patients with cisplatin-induced hearing loss, n = 49 (60%) experienced simultaneous tinnitus, occurring in over half of them after the first cycle of chemotherapy. None of the analyzed potential risk factors age, gender, smoking, hypertension, diabetes, vasculopathy, dyslipidemia, chemotherapeutic regimen and cumulative cisplatin dose was statistically correlated with the occurrence or severity of cisplatin-induced hearing loss. Conclusion One out of five adult cancer patients treated with cisplatin chemotherapy developed a symptomatic and predominant high-frequency hearing loss, with simultaneous occurrence of tinnitus in over half of them. Standardized audiological monitoring before and during cisplatin chemotherapy allows to quantitatively assess early and objective signs of ototoxicity and offers to optimize anticancer therapy while minimizing morbidity in a multidisciplinary setting.