Courbon Guillaume, Lugnier Laurie, Bass Johnnie K, Merchant Thomas E, Morlet Thierry, Richard Celine
Sainbiose U1059, Inserm, University of Saint Etienne, Mines Saint Etienne, 42023 Saint Etienne, France.
Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Curr Oncol. 2025 Sep 13;32(9):509. doi: 10.3390/curroncol32090509.
Childhood cancer treatments, including chemotherapy, radiation therapy, and combined modalities, pose significant risks to auditory function due to their ototoxic effects. Cisplatin, a chemotherapeutic agent commonly used in pediatric oncology, causes dose-dependent irreversible sensorineural hearing loss by damaging the inner ear structures, primarily through the generation of reactive oxygen species and the activation of apoptotic pathways. Radiation therapy exacerbates these effects, contributing to both sensorineural and conductive hearing loss via mechanisms such as vascular injury, inflammation, and fibrosis. The severity of hearing loss is influenced by the treatment timing, the cumulative dose, patient age, genetics, and concurrent therapies. The damaging effects of chemotherapy and radiation extend beyond the cochlea, involving the surrounding temporal bone as well as multiple levels of the auditory pathway. While pediatric patients may be candidates for bone-anchored hearing devices or cochlear implants, the need for serial imaging and the potential for implant-related MRI artifacts can complicate the timing of hearing rehabilitation. Moreover, the impact on the subcortical and cortical auditory structures may further influence the rehabilitation outcomes. This scoping review lays the foundation for future clinical and research efforts focused on the development of comprehensive pediatric guidelines for hearing preservation, monitoring, and rehabilitation, while also fostering multidisciplinary collaboration.
儿童癌症治疗，包括化疗、放疗及联合治疗方式，因其耳毒性作用，对听觉功能构成重大风险。顺铂是儿科肿瘤学中常用的一种化疗药物，通过损伤内耳结构，主要是通过产生活性氧和激活凋亡途径，导致剂量依赖性不可逆感音神经性听力损失。放疗会加剧这些影响，通过血管损伤、炎症和纤维化等机制，导致感音神经性和传导性听力损失。听力损失的严重程度受治疗时机、累积剂量、患者年龄、遗传因素及同时进行的其他治疗影响。化疗和放疗的损害作用不仅限于耳蜗，还涉及周围颞骨以及听觉通路的多个层面。虽然儿科患者可能适合骨锚式助听器或人工耳蜗，但需要进行系列成像检查以及植入相关的MRI伪影可能性会使听力康复的时机变得复杂。此外，对皮质下和皮质听觉结构的影响可能会进一步影响康复效果。本综述为未来临床和研究工作奠定了基础，这些工作将专注于制定全面的儿科听力保护、监测和康复指南，同时促进多学科合作。
