From the Guidelines
Treatment for ototoxicity from chemotherapy should not include intratympanic middle ear therapy, as current evidence does not support its effectiveness in preventing or treating cisplatin-induced ototoxicity. This recommendation is based on the findings of a 2020 clinical practice guideline published in The Lancet Child and Adolescent Health 1, which concluded that intratympanic therapy, including the use of acetylcysteine and dexamethasone, does not provide a significant benefit in preventing cisplatin-induced ototoxicity.
The guideline evaluated six randomized trials investigating intratympanic therapy, with results showing inconsistent benefits and most effects not being considered clinically significant 1. Furthermore, concerns regarding the feasibility of repeated administration in pediatric patients and the variability in drug exposure to the cochlea using intratympanic therapy were raised.
Instead, treatment for ototoxicity from chemotherapy primarily focuses on:
- Prevention strategies, such as using alternative chemotherapy agents when possible and implementing dose limitations for ototoxic drugs like cisplatin
- Symptom management, including comprehensive audiological evaluation and appropriate interventions based on the severity of hearing loss
- Management of related symptoms, such as tinnitus and balance problems, using sound therapy, cognitive behavioral therapy, or vestibular rehabilitation exercises.
Regular audiological monitoring during and after chemotherapy is essential to detect any potential hearing loss early on. The use of protective agents, such as sodium thiosulfate or N-acetylcysteine, during treatment is also being investigated as a potential strategy to prevent ototoxicity 1.
From the FDA Drug Label
Ototoxicity has been observed in up to 31% of patients treated with a single dose of cisplatin 50 mg/m 2, and is manifested by tinnitus and/or hearing loss in the high frequency range (4,000 to 8,000 Hz). Audiometric monitoring should be performed prior to initiation of therapy, prior to each subsequent dose, and for several years post therapy There is no information in the provided drug label about treatment for ototoxicity from chemotherapy. The FDA drug label does not answer the question.
From the Research
Treatment for Ototoxicity from Chemotherapy
- Ototoxicity is a common side effect of high-dose cisplatin treatment, leading to hearing loss and other auditory symptoms 2.
- Amifostine, a thiol-containing chemoprotector, has been studied as a potential protector against cisplatin-induced ototoxicity, with mixed results 2, 3, 4.
- In some studies, amifostine has been shown to reduce the risk of severe ototoxicity in patients with average-risk medulloblastoma receiving dose-intense chemotherapy 3, 4.
- However, other studies have found that amifostine may not be effective in preventing ototoxicity in all patients, particularly those with high-risk medulloblastoma 4.
- The use of selective analytical methods for quantifying cisplatin and its metabolites is important for evaluating the efficacy of amifostine and other potential otoprotectors 2.
- Various classification systems are available for grading platinum-induced hearing loss, including the National Cancer Institute criteria, Brock's grading system, and the Chang Ototoxicity Scale 5.
Otoprotection Strategies
- Numerous otoprotection strategies are being investigated to mitigate ototoxicity related to chemotherapy, including the use of amifostine and other chemoprotectors 6.
- The clinical translation of these approaches is crucial for limiting the consequences of ototoxicity in cancer survivors 6.
- Further research is needed to develop effective otoprotection strategies that can be used in conjunction with chemotherapy to prevent or minimize hearing loss 6, 5.