Factors Affecting Permanent Sensorineural Hearing Loss and Bone Conduction in Patients After Receiving Radiotherapy to the Head and Neck Region

Birsen Yücel; Eda Erdiş; Seher Bahar; Ebru Akkaş Atasever; Mustafa Gürol Celasun; Emine Elif Altuntaş

doi:10.4274/tao.2022.2022-6-2

Factors Affecting Permanent Sensorineural Hearing Loss and Bone Conduction in Patients After Receiving Radiotherapy to the Head and Neck Region

Turk Arch Otorhinolaryngol. 2022 Dec;60(4):212-219. doi: 10.4274/tao.2022.2022-6-2. Epub 2023 Jul 7.

Authors

Birsen Yücel¹, Eda Erdiş¹, Seher Bahar², Ebru Akkaş Atasever³, Mustafa Gürol Celasun⁴, Emine Elif Altuntaş⁵

Affiliations

¹ Department of Radiation Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
² Department of Radiation Oncology, University of Health Sciences Turkey, Balıkesir Atatürk City Hospital, Balıkesir, Turkey.
³ Department of Radiation Oncology, University of Health Sciences Turkey, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
⁴ Department of Radiation Oncology, University of Health Sciences Turkey, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkey.
⁵ Department of Otorhinolaryngology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.

Abstract

Objective: This study aimed to investigate the factors affecting permanent sensorineural hearing loss (SNHL) and causing changes in bone conduction (BC) thresholds over time in patients after receiving radiotherapy (RT) or chemoradiotherapy (CRT) to the head and neck region.

Methods: A total of 63 patients with irradiated HNC that were admitted to the Radiation Oncology Department between 2011 and 2018 were included in the study. All patients were assessed with pure tone audiometry at eight different time points (first before RT and last five years after completion of RT). A chi-square test was used to analyze the variables that affected permanent SNHL occurrence. Repeated measure analysis of variance was conducted to investigate the factors affecting change in the BC threshold at pure-tone average (0.5-2 kHz) and the air conduction (AC) threshold at 4 and 6 kHz frequencies over time.

Results: Median follow-up was 52 months (range, 12-110 months). SNHL was found in 18 (14%) of the 126 ears. According to the receiver operating characteristic analysis, the cut-off values of cochlear D_mean and D_max radiation doses were 40 Gy [p=0.017, area under the curve (AUC): 0.676] and 45 Gy (p=0.008, AUC: 0.695). D_mean (≤40 Gy vs. >40 Gy) and D_max (≤45 Gy vs. >45 Gy) cochlear doses and age (≤40 vs. >40 years) were determined as factors affecting SNHL in the chi-square test. Repeated measures showed that BC thresholds between 0.5-2 kHz and AC thresholds at 4 and 6 kHz increased over time. Age (≤40 vs. >40 years), treatment of head and neck cancer (RT vs. CRT), cisplatin use, and D_mean (≤40 Gy vs. >40 Gy) and D_max cochlear dose (≤45 Gy vs. >45 Gy) were important factors affecting the course of BC threshold over time.

Conclusion: D_mean and D_max cochlear doses and age were found to be associated with permanent SNHL. Conduction thresholds worsened over time at all frequencies, and this trend was affected by cochlear doses, age, CRT, and cisplatin use.

Keywords: Head and neck cancer; chemoradiotherapy; hearing loss; radiation dose; radiotherapy; side effect.