A Tale of Two Susceptibilities: Cisplatin Ototoxicity Variability in Similar Patients

Abstract

Purpose: There are well-known risk factors that contribute to cisplatin-induced ototoxicity. The purpose of this clinical focus article is to highlight differences in susceptibility to cisplatin-induced ototoxicity for patients with similar risk factors. Method: Case examples are described to illustrate the variability in audiologic outcomes following treatment for two patients with similar demographic factors and similar risk factors for cisplatin ototoxicity who received nearly the same treatment for the same type of cancer. Conclusions: Before cisplatin treatment, both patients exhibited normal hearing thresholds and denied tinnitus. Following completion of treatment, one patient experienced minimal ototoxic effects in the form of an American Speech-Language-Hearing Association (1994) significant threshold shift for the extended high frequencies above 8000 Hz for the right ear. The other patient experienced severe ototoxic effects in the form of a NCI CTCAE v5.0 Grade 3 change in hearing status and bilateral tinnitus. Possible contributors to the difference in cisplatin ototoxicity susceptibility include a difference in baseline cochlear health, a difference in genetic predisposition for cisplatin ototoxicity, or other individualized susceptibilities. Though the established risk factors serve as an informative guide, they are not intended to predict each patient's audiologic outcome or determine which patients to include in an ototoxicity monitoring program. Therefore, all patients who receive cisplatin should be enrolled in a cisplatin ototoxicity monitoring program so that any changes in hearing can be detected as early as possible.