Cisplatin Induced Hearing Loss in Paediatric Malignancies

Susana, Mathew (2016) Cisplatin Induced Hearing Loss in Paediatric Malignancies. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : The term chemotherapy was coined in the early 1900s and means- 'treating with chemicals'. The Second World War saw the emergence of chemotherapy being used as anti tumour drugs. The initial discovery was that of nitrogen mustard. Cancer chemotherapy can be divided by their mechanism of action into Alkylating agents, Antimetabolites, Anti-microtubule agents, inhibitors of Topoisomerase and Cytotoxic compounds. One such alkylation agent is the platinum compounds which includes Oxaliplatin, Carboplatin and Cisplatin. The most studied and by far the most effective of the lot is Cisplatin, the mechanism of action of which was studied in depth by Rosenberg. Cisplatin has widely been used to treat a lot of head and neck malignancies, osteosarcoma, neuroblastoma, leukemia and much more. Its role is particularly pertinent in paediatric malignancies. Cisplatin with its widely popularized effectiveness in destroying the malignant cells, also comes with its share of side effects, a common one being ototoxicity. Especially in children, this complication can have long lasting consequences in the form of speech delay, poor scholastic performance and poor social integration. OBJECTIVES : To find the incidence of cisplatin induced sensorineural hearing loss, the correlation between cumulative dose of chemotherapy and hearing loss, and the influence of age and time on the same. METHODS : Observational study. Children above 5 years with malignancies other than head and neck malignancies and planned for or undergoing chemotherapy with cisplatin from January 2012 were informed about the study, consented and recruited. They were then followed up for a period of 12 weeks. Before the administration of cisplatin, these patients are seen in the ENT department, a targeted history and examination is done and hearing assessment is performed which includes an Audiogram, Tympanometry and OAE. Cisplatin was administered according to protocol and were called back after 6 weeks and 12 weeks for a repeat evaluation and hearing assessment. RESULTS : By 6 weeks, 17 developed grade 1 hearing loss and 1 developed grade 2 hearing loss. At the end of 3 months, 63% patients developed grade 1 hearing loss , 20 % grade 2 and 5 % grade .40 % of those above 15 years had normal hearing as against only 9% in age group 5-10 years. 10-15 year age group showed a 9.5% incidence of hearing loss. 49% of patients who were exposed to higher doses (34 mg/m2) developed sensorineural hearing loss as against 11 % in other groups. CONCLUSION : Platinum based chemotherapy, especially with cisplatin offers a wonderful cure to many malignancies. However their ototoxic nature limits their use. Our study found a statistically significant relation between time duration and development of hearing loss. There was also a co relation between cumulative dose and hearing loss. It is important to pick up this ototoxicity early so that the academic and social development of these children are not affected. This cohort will need to be followed up for some more period of time to see the complete effects of this drug and to pick out any ototoxicity early.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cisplatin Induced Hearing Loss, Paediatric Malignancies.
Subjects: MEDICAL > Otolaryngology
Depositing User: Subramani R
Date Deposited: 11 Jan 2018 03:20
Last Modified: 11 Jan 2018 03:20

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