Yadav Shobit, Patni Digant, Munjal V R
Department of Otorhinolaryngology, Sri Aurobindo University, SAIMS, Indore, India.
Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):1950-1953. doi: 10.1007/s12070-023-03764-8. Epub 2023 Apr 20.
To study effects of chemoradiation therapy on hearing in patients with malignancy of head and neck.
Patients receiving drugs other than cisplatin as well as those with any otology-related pathology or abnormalities were excluded from the study. Patients with primary biopsy-proven malignancy of the Nasopharynx, Oropharynx, Paranasal Sinuses, Oral Cavity, and Parotid with chemoradiation by cisplatin and different radiation modalities were all eligible. Areas of interest and OARs are indicated on CT images. All patients' hearing was assessed using pure tone audiometry at the beginning of treatment, at its conclusion, and six months later. Variations in pure tone thresholds from baseline and CTCAE - Common Terminology Criteria for Adverse Events grading are related to cochlear dose.
The study involves 75 patients. At cochlear dosage levels of more than 40 Gy, significant SNHL (>10 dB loss) is seen. Absolute PTA threshold values do not statistically differ from baseline to completion at any frequency. For 4000 and 8000 Hz, the absolute PTA threshold values differed from baseline to follow-up, but only for 8000 Hz was the difference statistically significant after six months of follow-up. Following treatment, 64% of patients had grade I CTCAE scoring and 16% and 12%, respectively, had otitis media with effusion and Eustachian tube dysfunction.
The inner ear may be harmed in patients receiving radiation to the head and neck. Radiation-induced SNHL typically goes unreported in routine clinical practise because of its long-term nature. In the group of head and neck tumours with high-risk locations, nearly 90% of patients with SNHL were affected. Therefore, it's critical to reduce cochlear dosage in these patient populations. More investigation is needed to distinguish between cochlear and retro-cochlear types of sensorineural hearing loss.
研究放化疗对头颈部恶性肿瘤患者听力的影响。
排除接受除顺铂以外其他药物治疗的患者以及有任何耳科相关病理或异常情况的患者。经活检证实为鼻咽、口咽、鼻窦、口腔和腮腺原发性恶性肿瘤且接受顺铂化疗和不同放疗方式的患者均符合条件。在CT图像上标注感兴趣区域和危及器官（OARs）。在治疗开始时、结束时以及六个月后，使用纯音听力测定法对所有患者的听力进行评估。纯音阈值相对于基线的变化以及不良事件通用术语标准（CTCAE）分级与耳蜗剂量相关。
该研究纳入75例患者。在耳蜗剂量水平超过40 Gy时，可见明显的感音神经性听力损失（SNHL，听力损失>10 dB）。在任何频率下，绝对纯音听阈（PTA）值从基线到治疗结束时在统计学上无差异。对于4000 Hz和8000 Hz，绝对PTA阈值从基线到随访时有差异，但仅在随访六个月后，8000 Hz的差异具有统计学意义。治疗后，64%的患者CTCAE评分为I级，分别有16%和12%的患者出现中耳积液和咽鼓管功能障碍。
接受头颈部放疗的患者内耳可能会受到损害。由于辐射诱发的SNHL具有长期性，在常规临床实践中通常未被报告。在高危部位的头颈部肿瘤组中，近90%的SNHL患者受到影响。因此，在这些患者群体中降低耳蜗剂量至关重要。需要更多研究来区分耳蜗性和蜗后性感音神经性听力损失类型。
