To Investigate the Incidence and Severity of Hearing Loss Caused By Chemoradiotherapy in Head and Neck Cancer Cases

Abstract

Background: In head and neck oncology, treatment-induced hearing loss has been reported in patients treated with high-dose cisplatin chemoradiotherapy (CRT). The present study was conducted to investigate the incidence and severity of hearing loss caused by chemoradiotherapy in Head and Neck cancer cases. Materials & Methods: All patients with head and neck cancers who visited the Department of Otorhinolaryngology and Head and Neck surgery and undergone treatment, after histological confirmation, at the Department of Radiation Oncology at Sardar Patel Medical College, Bikaner, Rajasthan from November 2019 to October 2020 were taken up for the study. 80 patients were included in the study out of which 40 undergone concurrent chemoradiation. Patients with concurrent chemoradiotherapy were selected for the study. Data was entered in Microsoft Excel and was subsequently imported to Statistical package for the social sciences (SPSS) free version 21.0 and Epi info version 3.0 for analysis. Results: 80 patients were included in the study out of which 40 undergone concurrent chemoradiation. Hearing levels were documented before starting of treatment, after completion of treatment and 3 months of follow up. Our study consisted of 80 subjects out of which 52 (65%) were male and 28 (35%) females. The age of the subjects ranged from 30 to 60 years, with highest number of patients belonged to the age group of 51-60 (57.5%) years. In our study, majority of the patients had carcinoma oral cavity (35%) followed by Larynx (28.75%), Hypopharynx (16.25%), Oropharynx (8.75%), Nose & PNS (6.25%), Nasopharynx and Occult primary with secondary neck (each 2.5%). In patients having RT+CT , 45% had conductive hearing loss after completion of treatment which declined to 30% after 3 months follow up. Otitis media with effusion and Eustachian tube dysfunction are temporary and reversible side effects of the irradiation of the ear. Conductive hearing loss develops as a reversible side effect of radiation of the ear. The impact of radiation dose on hearing loss was studied and was found that patients with radiation dose less than 60 Gy showed no hearing loss. Dose of the radiation is proportional to development of ototoxicity. Total radiation dose of minimum 60 Gy is required to produce noticeable ototoxic effects.Conclusion: Thus, we conclude that patients who received concomitant chemoradiation experienced greater hearing loss. Hearing loss was evident after 1 month of therapy and was persistent. The incidence and severity of hearing loss increased with time and higher frequencies were affected predominately. High-frequency hearing loss can have a significant impact on quality of life because it affects speech discrimination. It is recommended to perform a pre-treatment and post- treatment audiological evaluation with special emphasis on high frequencies.