Ototoxicity and long-term hearing outcome in pediatric patients receiving cisplatin.

BACKGROUND: Hearing is essential in child development. Cisplatin which is a common chemotherapy used in many pediatric solid-tumor protocols cause various degrees of ototoxicity. Several risk factors for cisplatininduced ototoxicity have been reported, including race and age. This study aimed to evaluate the incidence of ototoxicity and its long-term outcome in Thai pediatric solid-tumor patients receiving cisplatin and to determine the risk factors associated with hearing impairment. METHODS: A retrospective study was conducted in solid-tumor patients < 15 years old from 2007 to 2019 at Siriraj Hospital, Bangkok, Thailand. Hearing was evaluated by an audiogram and/or auditory steady-state response and the impairment was graded according to the Common Terminology Criteria for Adverse Events version 5. Grade 2 and above was considered significant hearing loss. RESULTS: In total, the hearing of 47 patients was evaluated. At the end of treatment, hearing impairment and significant hearing loss were found in 66% and 48.9% of patients, respectively. A high median cumulative cisplatin dose was significantly associated with worse hearing impairment (p = 0.039) and a more progressive grading of ototoxicity (p = 0.005). A risk factor for significant hearing loss was a cumulative dose ≥400 mg/m2 (p = 0.014). All 9 patients who received a cumulative dose > 600 mg/m2 and 5 patients who received aminoglycoside developed significant hearing loss. One patient had progressive hearing impairment at 8 months after the end of treatment and 1 patient developed grade 3 ototoxicity which required a hearing aid after bone marrow transplantation. The latter patient received a total cisplatin dose of 708.2 mg/m < sup > 2 < /sup > and carboplatin 1400 mg/m < sup > 2 < /sup > . CONCLUSIONS: The incidence of hearing impairment in pediatric patients receiving cisplatin is high. Regular hearing evaluation is essential for the early detection of ototoxicity. Long-term follow-up is recommended, especially in patients who have a combination of other risk factors for hearing loss.

Multicentre cohort study of cochlear implantation outcomes in Thailand.

OBJECTIVES: To report the status and outcomes of cochlear implantation in Thailand. DESIGN: Cohort study. SETTING: Tertiary care and university hospitals. PARTICIPANTS: Patients who underwent cochlear implant surgery in Thailand. INTERVENTIONS: This project collected data from all government and university hospitals in Thailand where cochlear implant surgery was performed between 2016 and 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Baseline characteristics, operation data, complications, audiological outcomes and quality of life were reported. RESULTS: This study included 458 patients, and nearly half of the patients were children and adolescents (46.94%). The mean age of the patients was 2.96±5.83 years. At 1 year postoperatively, the mean pure tone average of the hearing threshold in the implanted ear significantly improved from unaided preoperative baseline (mean difference (MD) 64.23 dB HL; 95% CI 59.81 to 68.65; p<0.001). The mean speech recognition threshold also improved (MD 55.96 dB HL; 95% CI 49.50 to 62.42, p<0.001). The quality-of-life scores of the EQ-5D-5L, PedsQL and HUI3 questionnaires at 1 year showed improved mobility (range, 0-5; MD 0.65; 95% CI 0.05 to 1.25; p=0.037), hearing (range, 0-6; MD 0.96; 95% CI 0.30 to 1.61; p=0.006) and speech (range, 0-5; MD 0.44; 95% CI 0.04 to 0.84; p=0.031). Common complications included electrode dislodgement (2.18%), vertigo (1.23%) and meningitis (1.93%). CONCLUSIONS: Excellent audiological outcomes and improvement in the quality of life in the mobility, hearing and speech domains were observed in patients who underwent cochlear implantation in Thailand.

A Randomized, Controlled Trial of Notched Music Therapy for Tinnitus Patients.

OBJECTIVE: To compare the tinnitus treatment outcomes of tailor-made notched music therapy and ordinary music. METHODS: A double-blind, randomized, controlled trial was conducted on 104 Thai patients with chronic subjective tinnitus. Tinnitus matching was done on all subjects before they were randomly allocated to one of 2 groups: a treatment group (listening to tailor-made notched music) and a control group (listening to ordinary music). Each participant received their allocated intervention and was assessed at 1, 3, and 6 months. RESULTS: The demographic data of the 2 groups showed no statistically significant differences. The Tinnitus Handicap Inventory and the total Visual Analong Scale also demonstrated no significant differences. However, the treatment group showed a greater reduction in their scores than the control group during the follow-up period. CONCLUSION: Tailor-made notched music therapy is an optional treatment for patients with bothersome subjective tinnitus. However, more research is needed to draw firm conclusions about its benefits and cost-effectiveness.

Video head impulse test and caloric test in definite Ménière's disease.

PURPOSE: The objective of the study was to compare the results of caloric reflex tests and video head impulse tests (vHITs) of lateral semicircular canals (SCCs). METHODS: Patients aged over 18 years diagnosed with definite Ménière's disease (MD) according to the AAO-HNS 1995 criteria were recruited. Audiological tests, caloric tests and vHITs were conducted on all participants. A caloric weakness (canal paresis) of > 25% was considered significant. A VOR gain of < 0.8 in lateral or 0.7 in vertical SCCs was defined as significant. Patients were classified into active (having symptoms during the preceding 3 months) and inactive groups (free of symptoms for over 3 months). RESULTS: 51 patients (13 males and 38 females) participated. Caloric weakness was found in 39 patients (76.5%), while abnormal VOR gain was found in 24 (47.1%). The active group had 40 patients, and the inactive group had 11. There was statistical significance (p, 0.002) for disease duration but not for the caloric weakness and vHIT results of the two groups. Moreover, caloric weakness with an abnormal vHIT was not statistically significant, and there was no correlation between the two tests (r, 0.207) in lateral SCCs. The most common abnormal VOR gain in patients with caloric weakness was found in anterior SCCs. CONCLUSIONS: The caloric test can detect abnormalities of the vestibular function better than vHIT in all stages of MD. However, the vHIT showed more specificity for the detection of abnormal SCC function. The vHIT test can be used as a screening tool and the caloric test should be considered if a vHIT result is normal.

Sensorineural hearing loss after concurrent chemoradiotherapy in nasopharyngeal cancer patients.

BACKGROUND: Sensorineural hearing loss (SNHL) is one of the major long term side effects from radiation therapy (RT) in nasopharyngeal cancer (NPC) patients. This study aims to review the incidences of SNHL when treating with different radiation techniques. The additional objective is to determine the relationship of the SNHL with the radiation doses delivered to the inner ear. METHODS: A retrospective cohort study of 134 individual ears from 68 NPC patients, treated with conventional RT and IMRT in combination with chemotherapy from 2004-2008 was performed. Dosimetric data of the cochlea were analyzed. Significant SNHL was defined as >15 dB increase in bone conduction threshold at 4 kHz and PTA (pure tone average of 0.5, 1, 2 kHz). Relative risk (RR) was used to determine the associated factors with the hearing threshold changes at 4 kHz and PTA. RESULTS: Median audiological follow up time was 14 months. The incidence of high frequency (4 kHz) SNHL was 44% for the whole group (48.75% in the conventional RT, 37% with IMRT). Internal auditory canal mean dose of >50 Gy had shown a trend to increase the risk of high frequency SNHL (RR 2.02 with 95% CI 1.01-4.03, p=0.047). CONCLUSION: IMRT and radiation dose limitation to the inner ear appeared to decrease SNHL.

Midfacial degloving surgical approach: experience at Siriraj Hospital.

Midfacial degloving surgical approach is an excellent alternative to the lateral rhinotomy in exposure to the nasal cavity, paranasal sinuses and the nasopharynx. By lifting the soft tissue from the midportion of the face, many extensive benign tumors such as inverted papilloma, nasopharyngeal angiofibroma and some limited malignant lesions could be safely removed. This procedure could be combined with other approaches such as transtemporal, intracranial approach to resect more extensive tumors around the orbit, central skull base, as well. This technique was applied in 40 cases, ranging from 12-72 years of age and in a variety of diseases in Siriraj Hospital from 1991 to 2000. Fifty five per cent were diagnosed as inverted papilloma and 20 per cent were nasopharyngeal angiofibroma. The surgical technique in this operation was emphasized and it has proved to be an extensively valuable procedure for wide exposure of the operative field without any external scar. Functional outcome was obtained in most of the cases with minimal complications.