Prevalence of hearing loss among head and neck cancer patients receiving chemotherapy with or without radiation therapy at ORCI

Abstract

Background: Hearing loss affects the quality of life of people in low and middle income countries. Worldwide about 5.3% of people have disabled hearing (WHO, 2012). This population is expected to increase significantly by 2050. (1) It affects all age groups with unequal distribution. (2) Majority of the affected people reside in developing countries. In the past, most cancer patients who survived through treatment with various chemotherapeutic regimes considered themselves serendipitous to be free from this devastating disease. Nevertheless, the outcome of adverse reactions of chemotherapy and/with radiation in relation to the Quality of life (QoF) such as hearing loss was crucial but neglected .(1) Objective: The aim of this study was to determine the prevalence and patterns of hearing loss among head and neck cancer patients receiving chemotherapy with or without radiation therapy at Ocean road cancer institute in Tanzania. Materials and methods: This was a descriptive cross sectional hospital based study conducted at ORCI in 2017. 138 cases who had been on treatment for the period of six weeks were recruited in the study. Patient history was taken, age, body surface area, drug dosage and duration of treatment were asked and crosschecked from the patient’s file. Otoscopic examination was done prior PTA test. PTA was done in a quiet room, at frequency range of 250HZ to 8000HZ using Amplivox 270 audiometer. Data collection was done by using a special designed questionnaire. Data analysis was done using the Statistical Package for Social Sciences version 20 and a p value of <0.05 was considered significant. RESULTS Among 138 patients in the study population, 68(49.3%) were males and 70 (50.7%) were females. Age ranged from 16- 89 years. Mean age was 50.78years with Std deviation of 14.958.Most cases were in the age group of 36-55years 66(47.8%), least cases were above 75years 5(3.6%). Hearing loss was found in 98(71%) cases and was bilateral in most of the patients. Among 98 patients with hearing loss, 93 (95.0%) patients had sensorineural hearing loss which was bilateral with equal severity except for one patient who had unilateral sensorineural hearing loss. 3(3.0%) patients had conductive hearing loss which was bilateral, and 2(2.0%) patients had mixed hearing loss in which one patient had bilateral and the other one had unilateral mixed hearing loss. The most affected age groups were 56-75years and >75years (80.0%) each, the least affected group was 16-35years (45.5%). Increase in age was associated with increased risk of developing hearing loss(P.value=0.029).Males had higher prevalence of hearing loss (76.5%) than females (65.7%).Gender was not associated with increased risk of developing hearing loss.(P.value =0.164).Conductive and mixed hearing loss were seen only in patients with sinonasal and nasopharyngeal cancer respectively. However, there was no statistical significance on the relationship between the site of the tumor and type hearing loss (P.value=0.23).Treatment modality (chemotherapy alone or chemoradiation therapy) had statistical significant effect on the type of hearing loss (P.value =0.045) but it had no statistically significant effect on severity of hearing loss (Pvalue=0.526). Out of 138 patients, 79 patients used chemotherapy alone which consisted of various drug group combinations. Among these patients, 53(67.0%) developed hearing loss. Use of a single drug group or combined drug groups had no statistical difference on severity of hearing loss (P.value=0.603). High cumulative doses of platinum and taxane compounds were associated with increased severity of hearing loss, this association was statistically significant. (P.values=0.003, 0.021). Conclusion Chemotherapy with or without radiotherapy is the main stay in treatment of most malignancies including head and neck cancers, however its ototoxic effect especially hearing loss needs to be checked in order to prevent permanent disability that can occur post treatment. Audiological follow up in cancer patients before, during and after treatment is the main stay for earlier detection of hearing loss and can help to guide the dosage to be delivered according to the patient’s condition, and earlier provision of hearing rehabilitation services