Ototoxicity after chemoradiotherapy for nasopharyngeal carcinoma

Abstract

: Successful nasopharyngeal carcinoma (NPC) treatment increases the survival rate and increases the late toxicity of chemoradiotherapy in survivors. Ototoxicity is the most common severe late sequelae after treatment. Both cochlear toxicity and vestibular toxicity have a significant negative impact on the quality of life. The hearing loss may begin as early as after the completion of radiotherapy (RT). Determination of rate of hearing loss after treatment completion is varied, depending on many factors, such as ototoxicity grading scales, follow-up period, treatment modalities, RT techniques. Prevalence of vestibular toxicity and tinnitus are also varied, depending on subjective or objective findings, types of vestibular function tests, or questionnaire. Successful ototoxicity monitoring involves the effort of healthcare professional teamwork. Permanent damage to the hearing and balance system can be decreased by early identification and promptly appropriate actions. Currently, there is no otoprotective agent recommended routinely to prevent ototoxicity after chemotherapy or radiation therapy. Rehabilitation options may improve the symptom disability but not restore the damage. The patient care team should be aware of the early identification of the ototoxicity. Effective tools for monitoring reveal abnormalities before the presence of audiovestibular symptoms. Once the ototoxicity was detected, the patient care team should consider starting appropriate actions to prevent progression and permanent damage. This article presents factors associated with an increased risk of hearing loss after treatment, ototoxicity grading scales, and tools of ototoxicity monitoring.