title: Transtympanic injections of N-acetylcysteine for the prevention of cisplatin-induced ototoxicity: a feasible method with promising efficacy.
abstract: OBJECTIVE
  Ototoxicity is a common and irreversible adverse effect of cisplatin treatment with great impact on the patients' quality of life. N-acetylcysteine is a low-molecular-weight agent which has shown substantial otoprotective activity. The role of transtympanic infusions of N-acetylcysteine was examined in a cohort of patients treated with cisplatin-based regimens.
  
  
  METHODS
  Twenty cisplatin-treated patients were subjected, under local anesthesia, to transtympanic N-acetylcysteine (10%) infusions in 1 ear, during the hydration procedure preceding intravenous effusion of cisplatin. The contralateral ear was used as control. The number of transtympanic infusions was respective to the number of administered cycles. Hearing acuity was evaluated before each cycle with pure tone audiometry by an audiologist blinded to the treated ear.
  
  
  RESULTS
  A total of 84 transtympanic infusions were performed. In treated ears, no significant changes in auditory thresholds were recorded. In the control ears cisplatin induced a significant decrease of auditory thresholds at the 8000 Hz frequency band (P=0.008). At the same frequency (8000 Hz), the changes in auditory thresholds were significantly larger for the control ears than the treated ones (P=0.005). An acute pain starting shortly after the injection and lasting for a few minutes seemed to be the only significant adverse effect.
  
  
  CONCLUSIONS
  Transtympanic injections of N-acetylcysteine seem to be a feasible and effective otoprotective strategy for the prevention of cisplatin-induced ototoxicity. Additional studies are required to further clarify the efficiency of this treatment and determine the optimal dosage and protocol.
authors: Department of ENT, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. mariariga@hotmail.com
authors: Maria G
authors: MG
authors: Riga
authors: Leonidas
authors: L
authors: Chelis
authors: Stylianos
authors: S
authors: Kakolyris
authors: Stergios
authors: S
authors: Papadopoulos
authors: Sofia
authors: S
authors: Stathakidou
authors: Eleni
authors: E
authors: Chamalidou
authors: Nikolaos
authors: N
authors: Xenidis
authors: Kyriakos
authors: K
authors: Amarantidis
authors: Prokopios
authors: P
authors: Dimopoulos
authors: Vasilios
authors: V
authors: Danielides
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects*; D004423:Ear; D005240:Feasibility Studies; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage*; D034381:Hearing Loss / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014432:Tympanic Membrane / Q000187:drug effects; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D016166:Free Radical Scavengers; D002945:Cisplatin; D000111:Acetylcysteine