Distortion product otoacoustic emission (DPOAE) reveals hearing loss up to 16 kHz in pediatric chemotherapy patients

In pediatric cancer patients, platinum-induced sensory hearing loss (SHL) manifests in bilateral, symmetrical loss of outer hair cells and starts at a frequency range up to 10 kHz. Hearing loss has a significant impact on education, social integration and personality development in childhood cancer survivors. Early reliable detection of hearing loss may prompt attending oncologists to change chemotherapy if a less ototoxic therapeutic alternative is available. Pediatric cancer patients (2-19 years) receiving cisplatin-, carboplatin- or vincristine-containing regimens were eligible. Ultra-high frequency pure tone audiometry (PTA) and ultra-high frequency DPOAE measurements (up to 16 kHz) were compared. A total of 153 examinations were performed in 83 consecutive patients. While only 60 PTAs yielded reliable results, 153 DPOAE examinations up to 16 kHz were informative. Significant findings were observed between 10 and 16 kHz in both PTA and DPOAE assessments. In the cisplatin group, we found a significant reduction in DPOAE levels from 13 to 16 kHz, as well as a significant increase in DPOAE levels at 2.5 kHz and 3 kHz. Treatment with VCR and carboplatin did not result in substantial SHL. Hearing measurements up to 16 kHz can reveal an early ototoxic effect. In pediatric cancer patients, DPOAE measurement (up to 16 kHz) is more feasible and reliable (compared to PTA) and can detect SHL in ultra-high frequencies (10-16 kHz) at an earlier time point.