Skalleberg J, Myhrum M, Småstuen M C, Osnes T A, Fosså S D, Bunne M
Department of Otolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Acta Oncol. 2021 Apr;60(4):426-433. doi: 10.1080/0284186X.2021.1887514. Epub 2021 Feb 22.
Cisplatin-based chemotherapy (CBCT) can cause high-frequency hearing loss, but little is known about the development and clinical relevance of this hearing loss in survivors of adult-onset cancer with very long-term follow-up. This case-control study investigates hearing and speech perception both in quiet and with background noise 30-years after CBCT.
One-hundred-and-one patients (Cases) who received CBCT for testicular cancer between 1980 and 1994 were assessed with pure-tone audiometry (.125 - 8 kHz) and speech perception tests including hearing in noise test (HINT). Self-reported hearing and tinnitus was scored by participants. Results were compared with 30 age-matched controls.
The median age of Cases and Controls was 60 (46 - 83) and 61 years (51 - 74), respectively. The median observation time for Cases was 30 years (22 - 37). Compared with Controls, Cases had 8 and 19 dB worse age-adjusted high-frequency hearing at 6 and 8 kHz, respectively ( <.05), while thresholds at lower frequencies did not differ. All but four Cases reached 100% speech perception with basic speech audiometry. There was no difference between Cases and Controls in speech perception neither in quiet nor with both speech and background noise from the front, although the within-group variance was greater among Cases. Cases scored slightly worse with speech from front and noise from either side. Self-reported hearing loss (both hearing loss in general and specifically with background noise), and tinnitus were about three times more common among Cases compared with Controls.
Cisplatin causes high-frequency hearing loss, but speech perception tests performed both in quiet and in background noise 30 years post-treatment indicate that the clinical relevance is limited for most patients. Few patients develop severe hearing loss that requires rehabilitation but it is important to identify these patients. Self-reported hearing loss and tinnitus were more common among Cases compared with Controls.
基于顺铂的化疗（CBCT）可导致高频听力损失，但对于成年期癌症幸存者中这种听力损失的发展情况及其临床相关性，在长期随访研究中却知之甚少。本病例对照研究调查了CBCT治疗30年后患者在安静环境及有背景噪声情况下的听力和言语感知情况。
选取1980年至1994年间因睾丸癌接受CBCT治疗的101例患者（病例组），采用纯音听力测定法（0.125 - 8kHz）和言语感知测试，包括噪声中的听力测试（HINT）对其进行评估。参与者对自我报告的听力和耳鸣情况进行评分。将结果与30例年龄匹配的对照组进行比较。
病例组和对照组的中位年龄分别为60岁（46 - 83岁）和61岁（51 - 74岁）。病例组的中位观察时间为30年（22 - 37年）。与对照组相比，病例组在6kHz和8kHz时经年龄调整后的高频听力分别差8dB和19dB（P < 0.05），而低频阈值无差异。除4例患者外，所有病例组患者通过基本言语测听法的言语感知率均达到100%。病例组和对照组在安静环境中以及在前方有言语和背景噪声的情况下，言语感知方面均无差异，尽管病例组内的方差更大。病例组在前方有言语且两侧有噪声时得分略低。与对照组相比，病例组中自我报告的听力损失（包括一般听力损失以及特别是在有背景噪声时的听力损失）和耳鸣的发生率约为对照组的三倍。
顺铂会导致高频听力损失，但治疗30年后在安静环境及有背景噪声情况下进行的言语感知测试表明，对大多数患者而言，其临床相关性有限。很少有患者会出现需要康复治疗的严重听力损失，但识别出这些患者很重要。与对照组相比，病例组中自我报告的听力损失和耳鸣更为常见。
