Comparative analysis of prevalences of sensorineural hearing loss from chemoradiotherapy versus radiotherapy in head and neck cancer patients: a systematic review and meta-analysis

INTRODUCTION: Head and neck cancer (HNC) is the seventh most prevalent cancer globally. Chemoradiotherapy (CRT) and radiotherapy (RT) are the two most common treatment modalities for HNC. However, both treatments are associated with adverse side effects, including hearing loss. This systematic review and meta-analysis aim to evaluate the pooled prevalence of sensorineural hearing loss (SNHL) among HNC patients undergoing CRT versus RT. METHODOLOGY: A comprehensive search of PubMed/MEDLINE, Google Scholar, DOAJ, AJOL, and the Cochrane Library was conducted using predefined key terms to identify original articles reporting the prevalence of SNHL in HNC patients treated with CRT or RT. Additionally, manual Google searches were performed to uncover relevant grey literature. The results were screened and included or excluded according to preset criteria. The Restricted Maximum Likelihood (REML) random-effects model was employed to calculate the overall pooled prevalence and separate prevalences in CRT and RT groups, as well as their respective heterogeneities, using Jamovi 2.3.28 software. Statistical significance was set at p < .05 for all analyses. RESULTS: The overall prevalence of SNHL among HNC patients treated with CRT or RT was 54.5% (95% CI: 44.9% - 64.0%; I² = 90.35%, p < .001). For CRT, the prevalence was 60.4% (95% CI: 50.5% - 70.2%; I² = 88.82%, p < .001). In contrast, the prevalence for RT was 32.9% (95% CI: 21.3% - 44.4%; I² = 60.15%, p = .063). The risk of developing SNHL was nearly twice as high in patients treated with CRT compared to those treated with RT alone, with a prevalence ratio of 1.83. CONCLUSION: Both CRT and RT are associated with SNHL in HNC patients, with a significantly higher prevalence observed in those undergoing CRT compared to RT.