Pediatric Cancer

PV QA 3 - Poster Viewing Q&A 3

TU_23_3093 - Proposal of a Comprehensive Ototoxicity Grading Scale for Radiation- and Chemotherapy-Induced Hearing Loss

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Proposal of a Comprehensive Ototoxicity Grading Scale for Radiation- and Chemotherapy-Induced Hearing Loss
T. I. Yock1, and J. K. Bass2; 1Massachusetts General Hospital, Boston, MA, 2St. Jude, Memphis, TN

Purpose/Objective(s): Hearing is critical to normal speech and language development in children but can be adversely affected by exposure to platinum-based chemotherapy or cochlear radiation. Commonly used pediatric ototoxicity scales, such as the POG, Chang, Brock, CTCv4, and SIOP scales, are based on the pattern of high-frequency, sensorineural hearing loss (SNHL) associated with platinum chemotherapy. However, no existing scale sufficiently accounts for SNHL in the lower and middle frequencies that can occur after radiotherapy. Use of current ototoxicity grading criteria in radiation studies can under-report SNHL. We propose a new and comprehensive ototoxicity grading scale for use in children treated with platinum-based chemotherapy and/or cranial radiation.

Materials/Methods: We reviewed the common ototoxicity scales and identified where each fails to grade clinically significant hearing loss defined as > 20dB at frequencies between 250 and 8000 Hz. We have reviewed our clinical datasets and developed an audiogram-based comprehensive ototoxicity scale that encompasses all patterns of SNHL between 250 and 8000 Hz.

Results: The SIOP criteria omit grading of any SNHL >20 dB in the 250-1000 Hz range. The Chang scale is the most comprehensive scale but omits grading of SNHL at ≥ 40 dB below 1000 Hz and < 40 dB at 6000 and 8000 Hz. The Brock scale uses a threshold of 40 dB across all frequencies and does not include a grade for SNHL below 1000 Hz. The POG criteria do not grade SNHL at 250-4000 Hz between 20-40 dB or > 40 dB for 6000-8000 Hz. The CTCv4 scale omits grading of SNHL between 250 and 2000 Hz and at 6000 Hz and incorporates the use/recommendation of hearing aids, cochlear implants, and other hearing services into the grading scheme. The table outlines the new proposed comprehensive grading scale.

Conclusion: There is a critical need for an ototoxicity scale that appropriately reports and grades SNHL across all frequencies of the audiogram while accounting for the severity of impact on the patient. We propose a new comprehensive hearing loss scale that can be used in pediatric patients exposed to ototoxic radiotherapy or chemotherapy. A comprehensive scale will better measure the true incidence of hearing loss in pediatric cancer survivors.
Grade Criteria
0 ≤ 20 dB HL at all frequencies
1 > 20 dB HL at 6 or 8 kHz and/or > 20 dB HL at any one frequency below 6 kHz
2 > 20 dB HL at 4 kHz and above and/or > 20 dB HL at any two frequencies below 4 kHz
3 > 20 dB HL at 2 or 3 kHz and above and/or > 20 dB HL and < 70 dB HL at 3 or more frequencies below 2 kHz
4 > 70 dB HL at 2 kHz and above and/or > 70 dB HL at 3 or more frequencies below 2 kHz

Author Disclosure: T.I. Yock: Research Grant; Industry. Board Member; Ronald McDonald House Charities. J.K. Bass: None.

Johnnie Bass, PhD

Biography:
Johnnie Bass, AuD, PhD is a clinical research audiologist at St. Jude Children's Research Hospital. Her research interests include investigating acute and late auditory effects of ototoxic agents, the efficacy of otoprotective drugs, and the diagnostic techniques used in the detection of ototoxicity. Because her work with pediatric oncology patients treated with ototoxic agents has shown to cause significant auditory impairment, she is also interested in studying the impact ototoxicity has on neurocognitive and quality of life outcomes and methods for improving these outcomes in childhood cancer survivors. She has mentored multiple students and interns from across the country in clinical audiology practice and research. She currently serves as co-chair on national and international committees dedicated to reviewing and developing long-term follow-up guidelines for hearing in survivors of childhood cancer.

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