一种针对成人耳毒性的新分级系统。

A new grading system for ototoxicity in adults.

作者信息

Theunissen Eleonoor A R, Dreschler Wouter A, Latenstein Merel N, Rasch Coen R N, van der Baan Sieberen, de Boer Jan Paul, Balm Alfons J M, Zuur Charlotte L

机构信息

Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands

Department of Audiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

出版信息

Ann Otol Rhinol Laryngol. 2014 Oct;123(10):711-8. doi: 10.1177/0003489414534010. Epub 2014 May 12.

DOI:10.1177/0003489414534010

PMID:24820112

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.

CONCLUSION

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.

摘要

目的

本研究旨在提出一种对耳毒性在特定日常生活情境（如言语清晰度和超高音感知）中的影响敏感的耳毒性分级系统，并与现行标准相比测试其可行性。

方法

纳入用于言语感知（1-2-4千赫）和超高频（8-10-12.5千赫）的纯音平均值（PTA）。考虑治疗后的阈值变化和听力水平。对接受（化疗）放疗（[C]RT）的头颈癌患者的标准进行测试，并与不良事件通用术语标准第4版（CTCAEv4）和美国言语-语言-听力协会标准（ASHA）进行比较。

结果

1级和2级基于与基线相比的阈值变化（以分贝为单位）和主观主诉。3级和4级分别定义为在1-2-4千赫PTA时治疗引起的听力损失≥35分贝和在1-2-4千赫PTA时≥70分贝。在高剂量顺铂CRT中，新标准、CTCAEv4和ASHA的发生率相当（78%-88%）。在RT和低剂量顺铂CRT中，新标准的发生率为36%至39%，而CTCAEv4和ASHA为22%至53%。