Prevention of Cisplatin-Induced Hearing Loss by Intratympanic Dexamethasone

Abstract

Objective To examine the role of intratympanic Dexamethasone (ITD) in the prevention of Cisplatin-induced hearing loss. Study Design Prospective randomized controlled clinical trial. Setting Tertiary referral center. Subjects and Methods Twenty-six patients suffering from a neoplastic disease for which the treatment protocol included Cisplatin were recruited. Prior to each Cisplatin treatment session ITD was injected to the baseline randomly assigned ear while the other ear of the same patient served as the control. Audiometry and Distortion Product Otoacoustic Emissions (DPOAEs) test results of the baseline and follow-up examinations were compared within and between the study and control ears. Results The cumulative dose of Cisplatin was greater than 400 mg for the 15 subjects who completed the study. The pure tone threshold at 8000 Hz and pure tone average threshold at 4000 to 8000 Hz significantly increased in both the study ( P < .005, P < .03, respectively) and control ears ( P < .01, P < .005, respectively). Significant increase in the pure tone threshold for 6000 Hz was observed in the control ( P < .02) but not in the study group. Within the groups comparison also revealed significant decrease in the DPOAE average signal-to-noise ratio (SNR) for the f2 frequencies 7031 ( P < .04) and 8391 Hz ( P < .04) and SNR average for 4000 to 8000 Hz in the control ( P < .04) but not in the study ears. Conclusions ITD significantly attenuated hearing loss at 6000 Hz and decreased the outer hair dysfunction in the DPOAE f2 range of 4000 to 8000 Hz. ITD might have potential in the reduction of Cisplatin-induced hearing loss.