Knight Kristin R, Kraemer Dale F, Winter Christiane, Neuwelt Edward A
Department of Pediatric Audiology, Child Development and Rehabilitation Center, Portland, Oregon, USA.
J Clin Oncol. 2007 Apr 1;25(10):1190-5. doi: 10.1200/JCO.2006.07.9723.
The objective is to describe progressive changes in hearing and cochlear function in children and adolescents treated with platinum-based chemotherapy and to begin preliminary evaluation of the feasibility of extended high-frequency audiometry and distortion product otoacoustic emissions for ototoxicity monitoring in children.
Baseline and serial measurement of conventional pure-tone audiometry (0.5 to 8 kHz) and evoked distortion product otoacoustic emissions (DPOAEs) were conducted for 32 patients age 8 months to 20 years who were treated with cisplatin and/or carboplatin chemotherapy. Seventeen children also had baseline and serial measurement of extended high-frequency (EHF) audiometry (9 to 16 kHz). Audiologic data were analyzed to determine the incidence of ototoxicity using the American Speech-Language-Hearing Association criteria, and the relationships between the different measures of ototoxicity.
Of the 32 children, 20 (62.5%) acquired bilateral ototoxicity in the conventional frequency range during chemotherapy treatment, and 26 (81.3%) had bilateral decreases in DPOAE amplitudes and dynamic range. Of the 17 children with EHF audiometry results, 16 (94.1%) had bilateral ototoxicity in the EHF range. Pilot data suggest that EHF thresholds and DPOAEs show ototoxic changes before hearing loss is detected by conventional audiometry.
EHF audiometry and DPOAEs have the potential to reveal earlier changes in auditory function than conventional frequency audiometry during platinum chemotherapy in children.
本研究旨在描述接受铂类化疗的儿童和青少年听力及耳蜗功能的渐进性变化，并初步评估扩展高频听力测定法和畸变产物耳声发射用于儿童耳毒性监测的可行性。
对32例年龄在8个月至20岁之间接受顺铂和/或卡铂化疗的患者进行常规纯音听力测定（0.5至8kHz）及诱发畸变产物耳声发射（DPOAE）的基线和系列测量。17名儿童还进行了扩展高频（EHF）听力测定（9至16kHz）的基线和系列测量。分析听力学数据，根据美国言语-语言-听力协会标准确定耳毒性发生率，以及不同耳毒性测量指标之间的关系。
32名儿童中，20名（62.5%）在化疗期间在常规频率范围内出现双侧耳毒性，26名（81.3%）的DPOAE振幅和动态范围出现双侧下降。在17名有EHF听力测定结果的儿童中，16名（94.1%）在EHF范围内出现双侧耳毒性。初步数据表明，在常规听力测定检测到听力损失之前，EHF阈值和DPOAE就显示出耳毒性变化。
在儿童铂类化疗期间，EHF听力测定法和DPOAE比传统频率听力测定法有更早发现听觉功能变化的潜力。
