Gupta Dipti, Singh Gurbax, Garg Pardeep, Dey Ratul, Singh Baltej
Ear, Nose, and Throat (ENT), Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, IND.
Otolaryngology - Head and Neck Surgery, Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, IND.
Cureus. 2023 Aug 28;15(8):e44299. doi: 10.7759/cureus.44299. eCollection 2023 Aug.
Introduction The study aims to determine the role of intratympanic dexamethasone (ITD) on the hearing profile of patients with head and neck cancer post-chemoradiotherapy. Study design This study employs a prospective case-control design. Subjects and methods In total 834 patients were evaluated for eligibility. Seven hundred and eleven were excluded because they didn't meet the inclusion criteria. A hundred cases out of 123 were diagnosed with head and neck cancer for which the treatment protocol included cisplatin concurrent to radiotherapy recruited. Before each cisplatin treatment session, ITD was injected into one ear (experimental ear) while the other ear of the same patient served as the control. Pure-tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAE) test results of the baseline and follow-up examinations in the sixth and 12th weeks were compared within and between the study and control ears. Results For pure tone thresholds, significant hearing threshold change was noticed at 8 kHz in the experimental group at six weeks and at ≥ 6 kHz in the control group. At 12 weeks, high frequencies were significantly affected at ≥ 4 kHz in the control group. When the baseline was compared across the groups in the 12th week, for otoacoustic emissions, high frequencies showed a loss in the control group more compared to the experimental side (Wilcoxon signed-rank test). Conclusion ITD functions less effectively at higher frequencies because the basal turn of the cochlea is more susceptible to cisplatin ototoxicity. ITD might have potential in the reduction of cisplatin-induced hearing loss.
引言 本研究旨在确定鼓室内注射地塞米松（ITD）对接受放化疗后的头颈癌患者听力状况的作用。
研究设计 本研究采用前瞻性病例对照设计。
研究对象与方法 共评估了834例患者的入选资格。711例因不符合纳入标准而被排除。在123例患者中，有100例被诊断为头颈癌，其治疗方案包括顺铂同步放疗。在每次顺铂治疗前，将ITD注射到一只耳朵（实验耳），而同一名患者的另一只耳朵作为对照。比较研究耳和对照耳在基线以及第6周和第12周随访检查时的纯音听力测定（PTA）和畸变产物耳声发射（DPOAE）测试结果。
结果 对于纯音阈值，实验组在6周时8kHz处以及对照组在≥6kHz处出现了显著的听力阈值变化。在12周时，对照组≥4kHz的高频受到显著影响。在第12周跨组比较基线时，对于耳声发射，与实验侧相比，对照组高频损失更多（Wilcoxon符号秩检验）。
结论 ITD在较高频率下作用效果较差，因为耳蜗底转对顺铂耳毒性更敏感。ITD在减少顺铂诱导的听力损失方面可能具有潜力。
