title: A new grading system for ototoxicity in adults.
abstract: OBJECTIVE
  This study aimed to propose an ototoxicity grading system sensitive to the effect of ototoxicity on specific daily life situations like speech intelligibility and the perception of ultra-high sounds and to test its feasibility compared to current criteria.
  
  
  METHODS
  Pure tone averages (PTAs) for speech perception (1-2-4 kHz) and ultra-high frequencies (8-10-12.5 kHz) were incorporated. Threshold shift and hearing level posttreatment were taken into account. Criteria were tested on head and neck cancer patients treated with (chemo-)radiotherapy ([C]RT) and compared with the Common Terminology Criteria for Adverse Events version 4 (CTCAEv4) and the American Speech-Language-Hearing Association criteria (ASHA).
  
  
  RESULTS
  Grades 1 and 2 were based on threshold shifts from baseline (in dB) and subjective complaints. Grades 3 and 4 were defined as treatment-induced hearing loss of ≥ 35 dB at PTA 1-2-4 kHz and ≥ 70 dB at PTA 1-2-4 kHz, respectively. In high-dose cisplatin CRT incidences by the new criteria, CTCAEv4 and ASHA were comparable (78%-88%). In RT and low-dose cisplatin CRT, incidences were 36% to 39% in the new criteria versus 22% to 53% in CTCAEv4 and ASHA.
  
  
  CONCLUSIONS
  The new criteria show an increased sensitivity to ototoxicity compared to CTCAEv4 and ASHA and provide insight into the effect of hearing loss on certain daily life situations. The new grading system seems feasible for clinic and research purposes.
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands n.theunissen@nki.nl.
authors.forename: Eleonoor A R
authors.initials: EA
authors.lastname: Theunissen
authors.affiliation: Department of Audiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wouter A
authors.initials: WA
authors.lastname: Dreschler
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Merel N
authors.initials: MN
authors.lastname: Latenstein
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Coen R N
authors.initials: CR
authors.lastname: Rasch
authors.affiliation: Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Sieberen
authors.initials: S
authors.lastname: van der Baan
authors.affiliation: Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: de Boer
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Alfons J M
authors.initials: AJ
authors.lastname: Balm
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Zuur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold / Q000502:physiology; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000009:adverse effects; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D034381:Hearing Loss / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012720:Severity of Illness Index; D013067:Speech Perception / Q000502:physiology
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: grading criteria; grading scales; hearing loss; ototoxicity