Assessment of Hearing Loss in Patients Receiving Chemoradiotherapy in Adjuvant Setting for Head and Neck Malignancy

Abstract

Abstract Introduction The aim of the study is to assess the hearing loss in patients who receive chemoradiation (chemoradiotherapy or CTRT) for head and neck malignancies. Materials and Methods Prospective study was conducted in the Department of ENT of a tertiary care center from September 2013 to August 2014. Forty patients suffering from head and neck malignancies (histologically proven) were included in the study. Patients with pre-existing hearing loss were excluded. All patients received radiotherapy dose of 66 to 70 Gy given as 2 Gy/d, 5 d/wk and chemotherapy dose of cisplatin 35 mg/m2 once a week for 6 weeks. Hearing was assessed by pure tone audiometry (PTA) and impedance audiometry conducted at regular intervals. Mcnemars chi-square test was used to compare the impedance and paired t-test and Pearson’s correlation were used to compare PTA at various stages. Results Predominantly male patients (28) falling in the age group of 40 to 60 years, suffered from various head and neck cancer, most common being oropharynx (14). Twenty patients developed sensorineural hearing loss (SNHL)—11(55%) had mild, seven (35%) had moderate, and two (10%) had severe grade of SNHL. Majority of these patients, 12 (60%) started developing SNHL mid-therapy, five (25%) at the completion of therapy and three (15%) 3 months post-therapy. Hearing loss was found to be more with two-dimensional radiotherapy (2DRT) and three-dimensional radiotherapy (3DRT) than with intensity-modulated radiotherapy (IMRT) as assessed by serial PTA. The average dose of radiation to right and left ears, respectively were 27.10 and 24.66 Gy. The incidence of otitis media with effusion increased during the treatment accounting for the conductive hearing loss irrespective of the modality of radiation used. Conclusion CTRT causes significant hearing loss in patients suffering from head and neck malignancies leading to further increase in the morbidity. Screening audiological assessment would be helpful to know the pretherapy status of the ear. Using newer modalities like IMRT can reduce hearing loss. Regular audiological screening can catch it at its onset and help in early use of hearing aids.