顺铂相关性听力损失与年龄相关性听力损失的关系：一项长期随访研究。
The Relationship Between Cisplatin-related and Age-related Hearing Loss During an Extended Follow-up.
机构信息
Department of Otolaryngology, Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
出版信息
Laryngoscope. 2020 Sep;130(9):E515-E521. doi: 10.1002/lary.28543. Epub 2020 Feb 17.
OBJECTIVES
Cisplatin-related hearing loss (HL) is claimed to progress after treatment. This controlled longitudinal study with extended follow-up investigates HL in testicular cancer survivors (TCSs) after cisplatin-based chemotherapy (CBCT).
STUDY DESIGN
Controlled longitudinal study.
METHODS
Eighty-two TCSs treated with CBCT between 1980 and 1994 in Norway participated in two surveys (S1/S3), including pure-tone audiograms (0.125-8 kHz) and self-reported HL, 12 and 31 years after treatment, respectively. Hearing thresholds were age-adjusted based on age-matched hearing thresholds from the general population (controls). Hearing loss was defined as thresholds >20 dB at any frequency.
RESULTS
Between the two surveys, the prevalence of high-frequency HL (4, 6, and 8 kHz) increased from 73% to 94% but approached those of the aging general population after age adjustment. In TCSs aged >40 years at first survey, HL at the subsequent survey equaled that of controls. Self-reported HL increased from seven (9%) at S1 to 20 (26%) at S3. At S1, age-adjusted HL was identified in all (seven) TCSs reporting decreased hearing whereas at S3, hearing thresholds did not differ from controls in seven out of 20 patients reporting HL.
CONCLUSION
CBCT-related ototoxicity causes high-frequency HL, but in contrast to reports from follow-up studies from the first post-treatment decade, no major progression was found beyond the first post-treatment decade for frequencies 0.125-8 kHz. Importantly, with extended follow-up, hearing thresholds of patients approach those of the general population, possibly due to a less-than-additive effect with age-related hearing loss (ARHL) in CBCT-treated patients. Age-and sex-matching is strongly advised in long-term follow-up of CBCT-related ototoxicity. Specificity for detecting ototoxicity with self-reported questionnaires decreases with extended follow-up.
LEVEL OF EVIDENCE
3 Laryngoscope, 130:E515-E523, 2020.
目的
顺铂相关性听力损失（HL）据称在治疗后会进展。本项经扩展随访的对照性纵向研究调查了接受顺铂为基础的化疗（CBCT）治疗后的睾丸癌幸存者（TCS）的 HL。
研究设计
对照性纵向研究。
方法
1980 年至 1994 年在挪威接受 CBCT 治疗的 82 例 TCS 参与了两项调查（S1/S3），分别在治疗后 12 年和 31 年时进行纯音测听（0.125-8 kHz）和自我报告的 HL。听力阈值基于年龄匹配的一般人群（对照组）的听力阈值进行年龄调整。将任何频率的听力阈值>20 dB 定义为听力损失。
结果
在两次调查之间，高频 HL（4、6 和 8 kHz）的患病率从 73%增加到 94%，但在年龄调整后接近老龄化一般人群的患病率。在首次调查时年龄>40 岁的 TCS 中，随后的调查中 HL 与对照组相同。自我报告的 HL 从 S1 时的 7 例（9%）增加到 S3 时的 20 例（26%）。在 S1 时，在报告听力下降的所有（7 例）TCS 中均发现了年龄调整后的 HL，而在 S3 时，在报告 HL 的 20 例患者中，有 7 例的听力阈值与对照组无差异。
结论
CBCT 相关性耳毒性导致高频 HL，但与治疗后第一个十年的随访研究报告相反，在治疗后第一个十年之后，0.125-8 kHz 的频率并未发现明显进展。重要的是，随着随访时间的延长，患者的听力阈值接近一般人群，这可能是由于 CBCT 治疗患者的听力损失（ARHL）与年龄相关的听力损失具有非累加效应。在 CBCT 相关性耳毒性的长期随访中强烈建议进行年龄和性别匹配。随着随访时间的延长，自我报告问卷检测耳毒性的特异性会降低。
证据水平
3.喉镜，130：E515-E523，2020 年。
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