Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment

Katharine Fernandez¹, Alex Hoetink^{2

3

4

5}, Dawn Konrad-Martin^{6

7}, Deborah Berndtson⁸, Khaya Clark^{6

7

9

10}, Laura Dreisbach¹¹, James I Geller¹², Maria Valeria Goffi-Gomez¹³, Amy Grosnik¹², Carmen Jamis¹⁴, Kristin Knight¹⁵, David S Lee¹⁶, John Lee¹, Patricia Helena Pecora Liberman¹³, Trisha Milnes¹⁷, Annelot J M Meijer^{4

5}, Candice E Ortiz¹⁸, Jennessa Rooker¹⁹, Victoria A Sanchez²⁰, Mary M van den Heuvel-Eibrink^{4

5}, Carmen C Brewer¹, Gayla L Poling²¹

Affiliations

¹ Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA.
² Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
³ Audiology, Utrecht Medical Center Utrecht Brain Center, Utrecht, the Netherlands.
⁴ Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
⁵ Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
⁶ National Center for Rehabilitative Auditory Research, Veterans Affairs Rehabilitation Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA.
⁷ Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.
⁸ International Ototoxicity Management Group, Cancer Survivor and Advocate, Vienna, Virginia, USA.
⁹ Veterans Affairs Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon, USA.
¹⁰ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.
¹¹ School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California, USA.
¹² Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹³ Division of Audiology, AC Camargo Cancer Center, São Paulo, Brazil.
¹⁴ Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁵ Department of Audiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
¹⁷ Department of Audiology, Veterans Affairs Augusta Health Care System, Augusta, Georgia, USA.
¹⁸ Capital Institute of Hearing & Balance, Silver Spring, Maryland, USA.
¹⁹ College of Nursing, University of South Florida, Tampa, Florida, USA.
²⁰ Department of Otolaryngology-Head & Neck Surgery, University of South Florida, Tampa, Florida, USA.
²¹ Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 39261989
PMCID: PMC11832334 (available on 2026-01-01)
DOI: 10.1097/AUD.0000000000001592

Review

Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment

Katharine Fernandez et al. Ear Hear. 2025 Mar-Apr.

. 2025 Mar-Apr;46(2):286-297.

doi: 10.1097/AUD.0000000000001592. Epub 2024 Sep 12.

Authors

Affiliations

¹ Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA.
² Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
³ Audiology, Utrecht Medical Center Utrecht Brain Center, Utrecht, the Netherlands.
⁴ Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
⁵ Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
⁶ National Center for Rehabilitative Auditory Research, Veterans Affairs Rehabilitation Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA.
⁷ Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.
⁸ International Ototoxicity Management Group, Cancer Survivor and Advocate, Vienna, Virginia, USA.
⁹ Veterans Affairs Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon, USA.
¹⁰ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.
¹¹ School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California, USA.
¹² Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹³ Division of Audiology, AC Camargo Cancer Center, São Paulo, Brazil.
¹⁴ Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁵ Department of Audiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
¹⁷ Department of Audiology, Veterans Affairs Augusta Health Care System, Augusta, Georgia, USA.
¹⁸ Capital Institute of Hearing & Balance, Silver Spring, Maryland, USA.
¹⁹ College of Nursing, University of South Florida, Tampa, Florida, USA.
²⁰ Department of Otolaryngology-Head & Neck Surgery, University of South Florida, Tampa, Florida, USA.
²¹ Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 39261989
PMCID: PMC11832334 (available on 2026-01-01)
DOI: 10.1097/AUD.0000000000001592

Abstract

Ototoxicity is among the adverse events related to cancer treatment that can have far-reaching consequences and negative impacts on quality-of-life for cancer patients and survivors of all ages. Ototoxicity management (OtoM) comprises the prevention, diagnosis, monitoring, and treatment, including rehabilitation and therapeutic intervention, of individuals who experience hearing loss, tinnitus, or balance/vestibular difficulties following exposures to ototoxic agents, including platinum chemotherapy (cisplatin, carboplatin) and cranial radiation. Despite the well-established physical, socioeconomic, and psychological consequences of hearing and balance dysfunction, there are no widely adopted standards for clinical management of cancer treatment-related ototoxicity. Consensus recommendations and a roadmap are needed to guide development of effective and feasible OtoM programs, direct research efforts, address the needs of caregivers and patients at all stages of cancer care and survivorship. Here we review current evidence and propose near-term to longer-term goals to advance OtoM in five strategic areas: (1) beneficiary awareness, empowerment, and engagement, (2) workforce enhancement, (3) program development, (4) policy, funding, and sustainability, and (5) research and evaluation. The goal is to identify needs and establish a roadmap to guide worldwide adoption of standardized OtoM for cancer treatment and improved outcomes for patients and survivors.

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Conflict of interest statement

C. C. B. and G. L. P. are co-chairs of the IOMG Ototoxicity of Cancer Treatment Focus Area and D. K. M. is overall Chair of IOMG. D. K. M. is listed as a co-inventor on two patents related to an ototoxicity monitoring test method and equipment but receives no remuneration for this intellectual property. V. A. S. reports industry-sponsored clinical research contract (to institution) to support research activity from Otonomy Inc., Frequency Therapeutics., Pipeline Therapeutics, Aerin Medical, Oticon Medical, Helen of Troy Ltd., consulting fees from Autifony Therapeutics, and Boehringer Ingelheim. There are no additional conflict of interests to disclose.

References

1. Al-Malky G, Dawson SJ, Sirimanna T, et al. (2015). High-frequency audiometry reveals high prevalence of aminoglycoside ototoxicity in children with cystic fibrosis. J Cyst Fibros, 14(2), 248–254. - PubMed
1. American Academy of Audiology (AAA). (2009). Position Statement and Clinical Practice Guidelines: Ototoxicity Monitoring. Last accessed May 31, 2024, from: https://www.audiology.org/guideline-topic/ototoxicity-monitoring/
1. American Speech-Language-Hearing Association (ASHA). (1994). Guidelines for the Audiologic Management of Individuals Receiving Cochleotoxic Drug Therapy. ASHA, 36, 11–19.
1. Ardeshirrouhanifard S, Fossa SD, Huddart R, et al. (2022). Ototoxicity After Cisplatin-Based Chemotherapy: Factors Associated With Discrepancies Between Patient-Reported Outcomes and Audiometric Assessments. Ear Hear, 43(3), 794–807. - PMC - PubMed
1. Arora R, Thakur JS, Azad RK, et al. (2009). Cisplatin-based chemotherapy: Add high-frequency audiometry in the regimen. Indian J Cancer, 46(4), 311–317. - PubMed

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Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment

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Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment

Authors

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Conflict of interest statement

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