title: Hearing and tinnitus in head and neck cancer patients after chemoradiotherapy.
abstract: Head and neck cancer patients treated with high-dose cisplatin and radiotherapy will suffer from hearing deficits. The current low-dose regimen seldom causes hearing threshold decrease. Tinnitus in this patient population has not been investigated earlier. We aimed to evaluate the possible ototoxicity of low-dose (40 mg/m(2)) weekly administered cisplatin with concomitant radiotherapy. Twenty-two patients with locally advanced head and neck cancer were prospectively recruited to participate the study after treatment recommendation for chemoradiotherapy with low-dose cisplatin and intensity-modulated radiotherapy. They filled in a Tinnitus Handicap Inventory and undertook audiologic evaluations before and after treatment. Ototoxicity was determined by >10 dB threshold shift at frequencies 4 and 8 kHz or in pure tone average. A historical cohort of nine patients treated with high-dose (100 mg/m(2)) cisplatin and radiotherapy was used for comparison. After treatment, study patients demonstrated no significant changes in their hearing over frequencies 0.5-4 kHz, and the threshold shifts were minor at 4 and 8 kHz. More than 50 % of patients reported no tinnitus after treatment and the remainder only had slight to moderate tinnitus causing no interference with their daily activities. In contrast, five of the nine patients having received high-dose cisplatin reported disturbing tinnitus. Further, changes in pure tone averages were exhibited in three of these patients and six had significant threshold shifts at 4 and 8 kHz. Head and neck cancer patients treated with concomitant intensity-modulated radiotherapy and low-dose cisplatin seem to experience only minor audiological sequelae and therefore, these patients appear to require no routine audiological monitoring. Such evaluation could be performed only when needed.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital (HUH), P.O.Box 220, 00029, Helsinki, Finland. riina.niemensivu@hus.fi.
authors.forename: Riina
authors.initials: R
authors.lastname: Niemensivu
authors.affiliation: Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Saarilahti
authors.affiliation: Helsinki Ear Institute, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Ylikoski
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital (HUH), P.O.Box 220, 00029, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Aarnisalo
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital (HUH), P.O.Box 220, 00029, Helsinki, Finland.|Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.
authors.forename: A A
authors.initials: AA
authors.lastname: Mäkitie
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated; D014012:Tinnitus / Q000209:etiology*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Chemoradiotherapy; Head and neck cancer; Hearing; Ototoxicity; Tinnitus