Risk factors for ototoxicity due to cisplatin.

OBJECTIVE

To determine whether abnormalities in routine blood tests were associated with increased susceptibility to hearing loss induced by cisplatin chemotherapy.

DESIGN

Cohort study of patients with head and neck cancer receiving cisplatin chemotherapy who underwent audiometric testing.

SETTING

A large, university-based hospital; part of a larger study regarding rehabilitation of patients with cancer.

PATIENTS

Forty-two patients with head and neck cancer who agreed to participate underwent at least three serial treatments with high-dose cisplatin therapy. Routine blood tests and audiometric testing were performed before each course of chemotherapy. One hundred eighty audiograms were performed.

OUTCOME MEASURES

A deterioration of auditory threshold of 15 dB or more at one frequency or of 10 dB or more at three or more frequencies was considered a significant loss. Only frequencies at and below 4000 Hz were considered.

RESULTS

Multiple analysis of variance results indicated that decreased serum albumin level, hemoglobin level, red blood cell count, and hematocrit were associated with an increased likelihood of significant hearing loss during chemotherapy.

CONCLUSIONS

Patients in poor general medical condition with low levels of red blood cells or serum proteins are at increased risk for development of hearing loss from cisplatin chemotherapy. We recommend that hearing be tested before chemotherapy begins and after the first course of cisplatin. If there is no significant hearing loss at or below 4000 Hz at that time, then subsequent audiometric testing is required only if symptoms of hearing loss develop.