An individualized, sensitive frequency range for early detection of ototoxicity.
OBJECTIVE
The aim of this study was to identify auditory frequencies at which serial threshold testing would provide the greatest sensitivity for early detection of ototoxicity. The overall objective is to develop a more time-efficient ototoxicity monitoring protocol.


METHODS
Threshold data were analyzed from 370 hospitalized patients treated with aminoglycoside antibiotics (AMGs) or cisplatin (CDDP) who received serial auditory monitoring before, during, and after treatment at conventional (0.25 to 8 kHz) and high (9 to 20 kHz) frequencies.


RESULTS
For patients showing hearing changes due to ototoxicity, a frequency range was identified for its apparent high sensitivity to initial ototoxicity. This sensitive range is identified according to an individual's hearing threshold configuration, and is, therefore, unique for each patient. The range consists of five frequencies, generally separated by 1/6 octave, e.g., 8, 9, 10, 11.2, and 12.5 kHz. To determine frequencies and combinations of frequencies that were most often involved in ototoxicity detection, threshold data in the sensitive range were analyzed in detail. This analysis suggests that patients receiving treatment with AMG or CDDP can be monitored for hearing thresholds at only five frequencies, resulting in an 84% detection rate for AMG and 94% for CDDP compared with monitoring at all conventional and high frequencies.


CONCLUSIONS
This comprehensive analysis supports earlier observations that a sensitive, limited frequency range exists in which serial threshold monitoring will provide early warning of ototoxicity before effects in the speech frequency range. This finding is now being evaluated in a prospective investigation.
Fausti
S A
SA
VA RR&D National Center for Rehabilitative Auditory Research, Department of Veterans Affairs Medical Center, Portland, Oregon.
Henry
J A
JA
Helt
W J
WJ
Phillips
D S
DS
Frey
R H
RH
Noffsinger
D
D
Larson
V D
VD
Fowler
C G
CG
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001299:Audiometry / Q000379:methods; D001309:Auditory Threshold / Q000187:drug effects / Q000502:physiology; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013067:Speech Perception / Q000187:drug effects; D013997:Time Factors
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents