Cisplatin ototoxicity in children: A practical grading system

Abstract

A long‐term follow‐up study was carried out to assess ototoxicity in children who had been treated for a malignant tumour with “standard dose” cisplatin (60–;100 mg/m² per course), and were at least 2 years from stopping treatment. The median age at diagnosis was 2 years 2 months (range 1 month to 13.5 years). On the basis of hearing assessment by pure‐tone audiometry, a practical grading system of hearing loss from 0 to 4 is proposed. Moderate to severe high‐frequency hearing loss (grade 2–4) was found in half the children and 10 require appropriate hearing aids. The risk of developing ototoxicity increased significantly with the cumulative cisplatin dose (P = 0.027), although there was considerable individual susceptibility. Serial follow‐up testing, to a median of 4 years after completion of cisplatin treatment, showed no recovery of hearing in any of these children. We suggest careful monitoring of young children by a consultant audiological physician, throughout treatment with cisplatin, particularly when doses of 400 mg/m² and over have been reached. Alternative chemotherapy should be discussed if grade 2 ototoxicity develops.