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Observational Study
. 2025 Apr;201(4):438-451.
doi: 10.1007/s00066-024-02308-5. Epub 2024 Oct 25.

Risk factors for treatment-related sensorineural hearing loss and hearing aid use in medulloblastoma patients: an observational cohort study

Fabian M Troschel  1 , David Rene Steike  1 , Julian Roers  1 , Christopher Kittel  1 , Jan Siats  1 , Ross Parfitt  2 , Amélie E Hesping  2 , Antoinette Am Zehnhoff-Dinnesen  2 , Katrin Neumann  2 , Hans Theodor Eich  1 , Sergiu Scobioala  3
Affiliations
Observational Study

Risk factors for treatment-related sensorineural hearing loss and hearing aid use in medulloblastoma patients: an observational cohort study

Fabian M Troschel et al. Strahlenther Onkol. 2025 Apr.

Abstract

Purpose: This study aimed to analyze treatment-related risk factors for sensorineural hearing loss (SNHL) and an indication for hearing aids (IHA) in medulloblastoma patients after craniospinal radiotherapy (CSRT) and platin-based chemotherapy (PCth).

Methods: A total of 58 patients (116 ears) with medulloblastoma and clinically non-relevant pre-treatment hearing thresholds were included. Cranial radiotherapy and PCth were applied sequentially according to the HIT 2000 study protocol or post-study recommendations, the NOA-07 protocol, or the PNET (primitive neuroectodermal tumor) 5 MB therapy protocol. Audiological outcomes up to a maximum post-therapeutic follow-up of 4 years were assessed. The incidence, post-treatment progression, and time-to-onset of SNHL, defined as Muenster classification grade ≥MS2b, were evaluated. Risk factors for IHA were analyzed separately.

Results: While 39 patients received conventionally fractionated RT (CFRT; group 1), 19 patients received hyperfractionated RT (HFRT; group 2). Over a median follow-up of 40 months, 69.2% of ears in group 1 experienced SNHL ≥MS2b compared to 89.5% in group 2 (p = 0.017). In multivariable Cox regressions analysis, younger age and increased mean cochlear radiation dose calculated as the equivalent dose in 2‑Gy fractions (EQD2) were associated with time-to-onset of SNHL ≥MS2b (p = 0.019 and p = 0.023, respectively) and IHA (p < 0.001 and p = 0.016, respectively). Tomotherapy and supine positioning were associated with a lower risk for IHA in univariable modelling only (p = 0.048 and p = 0.027, respectively).

Conclusion: Young age and cochlear EQD2 Dmean ≥40 Gy are significant risk factors for the incidence, degree, and time-to-event of SNHL as well as for IHA in medulloblastoma patients.

Keywords: Chemotherapy; Cochlea; Craniospinal irradiation; Pediatric cancer; Radiotherapy.

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Conflict of interest statement

Declarations. Conflict of interest: F.M. Troschel, D.R. Steike, J. Roers, C. Kittel, J. Siats, R. Parfitt, A.E. Hesping, A. am Zehnhoff-Dinnesen, K. Neumann, H.T. Eich, and S. Scobioala declare that they have no competing interests. Ethical standards: All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional committee of the University Hospital of Münster and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article´s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article´s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Figures

Fig. 1
Fig. 1
Inclusion and exclusion criteria for the cohort
Fig. 2
Fig. 2
Time-to-onset analysis showing the cumulative percentage of patients with hearing loss ≥ 2b (Muenster classification) over time following the completion of radiation treatment in relation to the extent of tumor resection (a), radiation technique (b), radiation positioning (c), and fraction dose (d). Calculations were performed individually for each ear, and “numbers at risk” are given below the graphs. 2D/3D CRT 2-dimensional/3-dimensional conventional radiotherapy, IMRT intensity-modulated radiation therapy, CFRT conventionally fractionated radiotherapy, HFRT hyperfractionated radiotherapy
Fig. 3
Fig. 3
Time-to-onset analysis showing the cumulative percentage of patients with hearing loss ≥ 2b (Muenster classification) over time following the completion of radiation treatment in relation to cochlear mean radiation dose (Dmean) according to equivalent dose in 2‑Gy fraction (EQD2) calculations (a), cochlear maximal radiation dose (Dmax) according to EQD2 calculations (b), and age (c). Calculations were performed individually for each ear, and “numbers at risk” are given below the graphs
See this image and copyright information in PMC

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