Prevalence and risk factors of hearing loss in children with solid tumors treated with platinum-based chemotherapy

Main Article Content

Eka D Edward
Nelly Rosdiana
Farhat Farhat
Olga Rasiyanti Siregar
Bidasari Lubis


Background The platinum-based chemotherapy drugs, cisplatin and carboplatin, are widely used in the treatment of several types of solid tumors. However, the treatment has side effects including hearing loss.
Objective To evaluate the prevalence of hearing loss related to platinum-based chemotherapy and to identify associated factors.
Methods A cross-sectional study was performed in Adam Malik Hospital, Medan, North Sumatera, from April to July 2012. Twenty-two subjects who fulfilled the eligibility criteria underwent otoacoustic emission evaluations. Eleven children had received cisplatin and eleven had received carboplatin. The association between hearing loss and risk factors was assessed using Fisher’s exact and Chi-square tests.
Results Seven subjects with hearing loss were identified. Five of these patients (5 out of 11) had received cisplatin and 2 patients (2 out of 11) had received carboplatin. There was no statistically significant difference between carboplatin- and cisplatin-associated hearing loss (P=0.361). Neither gender (P=0.452) nor age (P=0.212) was related to hearing loss. However, higher cumulative chemotherapy doses (cisplatin >600 mg/m² and carboplatin >1800 mg/m²) were associated with hearing loss (P=0.022 and P=0.004, respectively).
Conclusion Patients who had higher cumulative doses of platinum-based chemotherapy are at risk for developing hearing loss.

Article Details

How to Cite
Edward ED, Rosdiana N, Farhat F, Siregar O, Lubis B. Prevalence and risk factors of hearing loss in children with solid tumors treated with platinum-based chemotherapy. PI [Internet]. 30Jun.2015 [cited 23Sep.2020];55(3):121-. Available from:
Received 2015-12-02
Published 2015-06-30


1. American Academy Pediatrics Section of Hematology/Oncology Children’s Oncology Group. Long-term follow-up care for pediatric cancer survivors. Pediatrics. 2009;123:906-15.
2. Sukardja IDG. Dasar-dasar Kemoterapi Kanker. In: Sukardja IDG, editor. Onkologi Klinik. 2nd ed. Jakarta: Airlangga University Press; 2000. p. 239-55.
3. Schultz C, Goffi-Gomez MV, Liberman PH, Carvalho AL. Report on hearing loss in oncology. Braz J Otorhinolaryngol. 2009;75:634-41.
4. Smits C, Swen SJ, Theo Goverts S, Moll AC, Imhof SM, Schouten-van Meeteren AY. Assessment of hearing in very young children retinoblastoma receiving carboplatin for retinoblastoma. Eur J Cancer. 2006;42:492-500.
5. Kennedy IC, Fitzharris BM, Colls BM, Atkinson CH. Carboplatin is ototoxic. Cancer Chemother Pharmacol. 1990;26:232-4.
6. Yancey A, Harris MS, Egbelakin A, Gilbert J, Pisoni DB, Renbarger J. Risk factors for cisplatin-associated ototoxicity in pediatric oncology patients. Pediatr Blood Cancer. 2012;59:144-8.
7. Li Y, Womer RB, Silber JH. Predicting cisplatin ototoxicity in children: the influence of age and the cumulative dose. Eur J Cancer. 2004;40:2445-51.
8. Simon T, Hero B, Dupuis W, Selle B, Berthold F. The incidence of hearing impairment after successful treatment of neuroblastoma. Klin Padiatr. 2002;214:149-52.
9. Wang LF, Kuo WR, Ho KY, Lee KW, Lin CS. Hearing loss in patients with nasopharyngeal carcinoma after chemotherapy and radiation. Kaohsiung J Med Sci. 2003;19:163-9.
10. Chan SH, Ng WT, Kam KL, Lee MC, Choi CW, Yan TK, et al. Sensorineural hearing loss after treatment of nasopharyngeal carcinoma: a longitudinal analysis. Int J Radiat Oncol Biol Phys. 2009;73:1335-42.
11. Ross CJ, Katzov-Eckert H, Dube MP, Brooks B, Rassekh SR, Barhadi A, et al. Genetic variants in TPMT and COMT are associated with hearing loss in children receiving cisplatin chemotherapy. Nat Genet. 2009:41;1345-9.
12. McHaney VA, Thibadoux G, Hayes FA, Green AA. Hearing loss in children receiving cisplatin chemotherapy. J Pediatr. 1983;102:314-7.
13. Bertolini P, Lassalle M, Mercier G, Raquin MA, Izzi G, Corradini N, et al. Platinum compound-related ototoxicity in children: long-term follow-up reveals continuous worsening of hearing loss. J Pediatr Hematol Oncol. 2004;26:649-55.
14. Stohr W, Langer T, Kremers A, Bielack S, Lamprecht Dinnesen A, Frey E, et al. Cisplatin-induced ototoxicity in osteosarcoma patients: a report from the late effects surveillance system. Cancer Invest. 2005;23:201-7.
15. Kushner BH, Budnick A, Kramer K, Modak S, Cheung NK. Ototoxicity from high-dose use of platinum compounds in patients with neuroblastoma. Cancer. 2006;107:417-22.
16. Lewis MJ, DuBois SG, Fligor B, Li X, Goorin A, Grier HE. Ototoxicity in children treated for osteosarcoma. Pediatr Blood Cancer. 2009;52:387-9.
17. Dean JB, Hayashi SS, Albert CM, King AA, Karzon R, Hayashi RJ. Hearing loss in pediatric oncology patients receiving carboplatin-containing regimens. J Pediatr Hematol Oncol. 2008;30:130-4.
18. Rybak LP. Ototoxicity and antineoplastic drugs. Otolaryngol Head Neck Surg. 1999;7:239-43.
19. Hofstetter P, Ding P, Powers N, Salvi RJ. Quantitative relationship of carboplatin dose to magnitude of inner and outer hair cell loss and the reduction in distortion productotoacoustic emission amplitude in chinchillas. Hear Res. 1997;112:199-215.
20. Laurell G, Bagger-Sjoback D. Dose-dependent inner ear changes after i.v. administration of cisplatin. J Otolaryngol. 1991;20:158-67.
21. Siddik ZH. Cisplatin: mode of cytotoxic action and molecular basis of resistance. Oncogene. 2003;22:7265-79.
22. Garcia-Berrocal JR, Nevado J, Ramirez-Camacho R, Sanz R, Gonzalez-Garcia JA, Sanchez-Rodriguez C, et al. The anticancer drug cisplatin induced an intrinsic apoptotic pathway inside the inner ear. Br J Pharmacol. 2007;152:1012-20.
23. Skinner R. Best practice in assessing ototoxicity in children with cancer. Eur J Cancer. 2004;40:2352-4.
24. Knight KR, Kraemer DF, Neuwelt EA. Ototoxicity in children receiving platinum chemotherapy: underestimating a commonly occurring toxicity that may influence academic and social development. J Clin Oncol. 2005;23:8588-96.
25. Gurney JG, Tersak JM, Ness KK, Landier W, Matthay KK, Schmidt ML. Hearing loss, quality of life and academic problems in long-term neuroblastoma survivors: a report from the Children’s Oncology Group. Pediatrics. 2007;120:1229-36.
26. Bess FH, Dodd-Murphy J, Parker RA. Children with minimal sensorineural hearing loss: prevalence, educational performance and functional status. Ear Hear. 1988;19:339-54.