Clinically accurate assessment and grading of ototoxicity

Abstract

Objectives/hypothesis: To design a grading scale and audiologic protocols to better reflect clinical impact than the currently widely used classifications.

Study design: Retrospective.

Methods: Audiologic studies from 130 patients receiving cisplatin chemotherapy were analyzed. Pure-tone audiograms were evaluated using the newly proposed grading criteria, Brock criteria, and Common Terminology Criteria for Adverse Events (CTCAE). The resulting grades were then compared to recommended audiologic interventions. Auditory brainstem response (ABR) data and data on incidences of conductive hearing loss from other multi-institutional studies that the author participated in were compared to data from this cohort.

Results: Although the newly proposed, Brock, and CTCAE ototoxicity grades were significantly related to audiologist recommendations for assistive devices (P < .0001), the newly proposed criteria were more specific and allowed better delineation of different patients into distinct subgroups requiring either FM system (grade 2a) or hearing aid (grade 2b or higher). Multi-institutional data review indicated significant problems with ABR evaluations and separating out conductive hearing losses from ototoxicity.

Conclusions: The newly proposed grading system needs to be paired with specific recommendations regarding audiologic monitoring protocols as well as active participation by the audiologists implementing the protocol to provide clinically accurate assessment and grading of ototoxicity.