Cisplatin otoprotection using transtympanic L-N-acetylcysteine: a pilot randomized study in head and neck cancer patients.
OBJECTIVE
To evaluate the feasibility and efficacy of transtympanic L-N-Acetylcysteine (L-NAC) administration in patients receiving cisplatin chemotherapy for head and neck cancer.


METHODS
Prospective randomized nonblinded open-label clinical trial.


METHODS
Transtympanic 2% L-NAC was administered to one randomly selected ear with the other ear as control in each patient. Primary outcome parameter was the difference in the loss of pure tone averages (PTA) at 2, 4, and 8 kHz between the L-NAC and control ear at 1 to 2 months following chemotherapy.


RESULTS
Eleven patients completed the study, with two patients demonstrating significantly better hearing in the L-NAC treated ear (18.2%). However, for the overall group, the difference in hearing preservation did not reach significance. Two percent L-NAC administration was well tolerated in this patient population. There were no adverse effects associated with L-NAC.


CONCLUSIONS
Although the study did not demonstrate a significant benefit overall, transtympanic L-NAC was associated with significantly better hearing in two patients. Better delivery methods may improve the efficacy of this treatment. L-NAC remains a promising drug in preventing cisplatin-induced ototoxicity.
Department of Audiology, London Health Sciences Centre, London, Ontario, Canada.
John
J
Yoo
Scott J
SJ
Hamilton
Douglas
D
Angel
Kevin
K
Fung
Jason
J
Franklin
Lorne S
LS
Parnes
Denise
D
Lewis
Varagur
V
Venkatesan
Eric
E
Winquist
D000111:Acetylcysteine / Q000008:administration & dosage*; D000328:Adult; D001299:Audiometry / Q000379:methods; D001309:Auditory Threshold / Q000187:drug effects; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000187:drug effects
D002945:Cisplatin; D000111:Acetylcysteine
Cisplatin; L-N-Acetylcysteine; otoprotection; ototoxicity; transtympanic