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Program Number: B129
Session Name: Poster Session

Feasibility and Early Results from a Pilot Study of Automated Tablet-Based Audiometry in the Medical Oncology Clinic for Early Detection of Cisplatin-Induced Hearing Loss

Tammy B Pham, MD¹; Assuntina G Sacco, MD²; Erika Zettner, PhD, CCCA¹; Andres Morales-Morales, BS³; Sandhya Kalavacherla, BS³; Rick A Friedman, MD, PhD¹; Theresa Guo, MD¹; ¹Department of Otolaryngology, University of California San Diego Health; ²Department of Internal Medicine, Division of Hematology-Oncology; ³University of California San Diego School of Medicine

Background: Cisplatin remains a cornerstone in the chemotherapeutic treatment of head and neck cancer (HNCa). However, it is associated with a 5-fold increased risk of ototoxicity. The American Speech-Language-Hearing Association recommends baseline and serial audiograms during treatment; however, due to limited resources, many oncologists only order testing for patients who report symptoms of hearing loss in order to avoid treatment delay. Currently, there is a lack of standardized ototoxicity monitoring for patients receiving cisplatin. Automated tablet-based audiometry (TBA) is emerging as a portable screening tool option for immediate, frequent, and objective hearing assessment.

Objective:

1) To assess the feasibility of tablet-based audiometry (TBA, Figure 1) in the medical oncology (MedOnc) clinic setting for detection of ototoxicity in HNCa patients treated with cisplatin.

2) To assess whether TBA allows for earlier detection of ototoxicity compared to onset of patient-reported symptoms.

Methods:  Patients were evaluated following their MedOnc appointments prior to initiating cisplatin treatment and every 2-3 weeks during treatment. At each visit, patients were given the Hearing Handicap Inventory for Adults (HHIA) survey, and during subsequent visits, patients were asked additional questions regarding feasibility.  Patients then self-performed TBA of standard and ultra-high frequencies (250-16,000 Hz) and results were immediately available to be shared with the patient’s MedOnc physician. Formal audiograms were ordered for patients who either self-reported hearing loss or showed evidence of hearing loss on TBA.

Results:  Eight patients have enrolled thus far. On average, patients spend three minutes on the survey and nine minutes on the audiogram. Overall, 100% of patients rated the survey as “Very Easy,” 75% rated the audiogram as “Very Easy” or “Easy,” and 100% rated the study as “Helpful” or “Very Helpful.” All patients agreed that the study was not a hindrance to receiving their cancer care. The majority (88%) had baseline scores indicating “no hearing handicap” on the HHIA, while one patient had a score indicating “significant handicap.” Two patients (25%) were found to have baseline hearing loss on TBA, though still elected to proceed with  cisplatin therapy. Among those who also received a formal audiogram, all three TBAs agreed with the formal audiogram results. One patient self-noted hearing loss after one treatment and this was confirmed on TBA with a 30-40 dB drop at two frequencies (Figure 2). Conversely, another patient did not self-note any subjective change in hearing, but was found on TBA to have a 15-30 dB drop at two frequencies. 

Conclusions: TBA is a reliable tool for baseline and follow-up hearing assessment. Early data from this study show that use of this technology in the MedOnc clinic setting is feasible, fast, and does not require a separate audiology appointment. Patients overall find the hearing test both easy and helpful and not a hindrance to their cancer care. In one case thus far, TBA has allowed for detection of hearing loss prior to patient-reported subjective symptoms. Recruitment is ongoing, and these findings may help facilitate accessible protocols for monitoring for ototoxicity in patients treated with cisplatin.

 

 

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