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Fernandez K, Hoetink A, Konrad-Martin D, Berndtson D, Clark K, Dreisbach L, Geller JI, Goffi-Gomez MV, Grosnik A, Jamis C, Knight K, Lee DS, Lee J, Liberman PHP, Milnes T, Meijer AJM, Ortiz CE, Rooker J, Sanchez VA, van den Heuvel-Eibrink MM, Brewer CC, Poling GL. Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment. Ear Hear 2024:00003446-990000000-00345. [PMID: 39261989 DOI: 10.1097/aud.0000000000001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Ototoxicity is among the adverse events related to cancer treatment that can have far-reaching consequences and negative impacts on quality-of-life for cancer patients and survivors of all ages. Ototoxicity management (OtoM) comprises the prevention, diagnosis, monitoring, and treatment, including rehabilitation and therapeutic intervention, of individuals who experience hearing loss, tinnitus, or balance/vestibular difficulties following exposures to ototoxic agents, including platinum chemotherapy (cisplatin, carboplatin) and cranial radiation. Despite the well-established physical, socioeconomic, and psychological consequences of hearing and balance dysfunction, there are no widely adopted standards for clinical management of cancer treatment-related ototoxicity. Consensus recommendations and a roadmap are needed to guide development of effective and feasible OtoM programs, direct research efforts, address the needs of caregivers and patients at all stages of cancer care and survivorship. Here we review current evidence and propose near-term to longer-term goals to advance OtoM in five strategic areas: (1) beneficiary awareness, empowerment, and engagement, (2) workforce enhancement, (3) program development, (4) policy, funding, and sustainability, and (5) research and evaluation. The goal is to identify needs and establish a roadmap to guide worldwide adoption of standardized OtoM for cancer treatment and improved outcomes for patients and survivors.
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Affiliation(s)
- Katharine Fernandez
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Alex Hoetink
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Audiology, Utrecht Medical Center Utrecht Brain Center, Utrecht, the Netherlands
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Dawn Konrad-Martin
- National Center for Rehabilitative Auditory Research, Veterans Affairs Rehabilitation Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah Berndtson
- International Ototoxicity Management Group, Cancer Survivor and Advocate, Vienna, Virginia, USA
| | - Khaya Clark
- National Center for Rehabilitative Auditory Research, Veterans Affairs Rehabilitation Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
- Veterans Affairs Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Laura Dreisbach
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California, USA
| | - James I Geller
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Amy Grosnik
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carmen Jamis
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kristin Knight
- Department of Audiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - David S Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John Lee
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Trisha Milnes
- Department of Audiology, Veterans Affairs Augusta Health Care System, Augusta, Georgia, USA
| | - Annelot J M Meijer
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Candice E Ortiz
- Capital Institute of Hearing & Balance, Silver Spring, Maryland, USA
| | - Jennessa Rooker
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Victoria A Sanchez
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Mary M van den Heuvel-Eibrink
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Carmen C Brewer
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Gayla L Poling
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Buss E, Kane SG, Young KS, Gratzek CB, Bishop DM, Miller MK, Porter HL, Leibold LJ, Stecker GC, Monson BB. Effects of Stimulus Type on 16-kHz Detection Thresholds. Ear Hear 2024; 45:486-498. [PMID: 38178308 PMCID: PMC10922353 DOI: 10.1097/aud.0000000000001446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Audiometric testing typically does not include frequencies above 8 kHz. However, recent research suggests that extended high-frequency (EHF) sensitivity could affect hearing in natural communication environments. Clinical assessment of hearing often employs pure tones and frequency-modulated (FM) tones interchangeably regardless of frequency. The present study was designed to evaluate how the stimulus chosen to measure EHF thresholds affects estimates of hearing sensitivity. DESIGN The first experiment used standard audiometric procedures to measure 8- and 16-kHz thresholds for 5- to 28-year olds with normal hearing in the standard audiometric range (250 to 8000 Hz). Stimuli were steady tones, pulsed tones, and FM tones. The second experiment tested 18- to 28-year olds with normal hearing in the standard audiometric range using psychophysical procedures to evaluate how changes in sensitivity as a function of frequency affect detection of stimuli that differ with respect to bandwidth, including bands of noise. Thresholds were measured using steady tones, pulsed tones, FM tones, narrow bands of noise, and one-third-octave bands of noise at a range of center frequencies in one ear. RESULTS In experiment 1, thresholds improved with increasing age at 8 kHz and worsened with increasing age at 16 kHz. Thresholds for individual participants were relatively similar for steady, pulsed, and FM tones at 8 kHz. At 16 kHz, mean thresholds were approximately 5 dB lower for FM tones than for steady or pulsed tones. This stimulus effect did not differ as a function of age. Experiment 2 replicated this greater stimulus effect at 16 kHz than at 8 kHz and showed that the slope of the audibility curve accounted for these effects. CONCLUSIONS Contrary to prior expectations, there was no evidence that the choice of stimulus type affected school-age children more than adults. For individual participants, audiometric thresholds at 16 kHz were as much as 20 dB lower for FM tones than for steady tones. Threshold differences across stimuli at 16 kHz were predicted by differences in audibility across frequency, which can vary markedly between listeners. These results highlight the importance of considering spectral width of the stimulus used to evaluate EHF thresholds.
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Affiliation(s)
- Emily Buss
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stacey G. Kane
- Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn S. Young
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chloe B. Gratzek
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danielle M. Bishop
- Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Margaret K. Miller
- Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Heather L. Porter
- Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Lori J. Leibold
- Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | | | - Brian B. Monson
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, USA
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Humes LE, Zapala DA. Easy as 1-2-3: Development and Evaluation of a Simple yet Valid Audiogram-Classification System. Trends Hear 2024; 28:23312165241260041. [PMID: 38870447 PMCID: PMC11179497 DOI: 10.1177/23312165241260041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/15/2024] Open
Abstract
Almost since the inception of the modern-day electroacoustic audiometer a century ago the results of pure-tone audiometry have been characterized by an audiogram. For almost as many years, clinicians and researchers have sought ways to distill the volume and complexity of information on the audiogram. Commonly used approaches have made use of pure-tone averages (PTAs) for various frequency ranges with the PTA for 500, 1000, 2000 and 4000 Hz (PTA4) being the most widely used for the categorization of hearing loss severity. Here, a three-digit triad is proposed as a single-number summary of not only the severity, but also the configuration and bilateral symmetry of the hearing loss. Each digit in the triad ranges from 0 to 9, increasing as the level of the pure-tone hearing threshold level (HTL) increases from a range of optimal hearing (< 10 dB Hearing Level; HL) to complete hearing loss (≥ 90 dB HL). Each digit also represents a different frequency region of the audiogram proceeding from left to right as: (Low, L) PTA for 500, 1000, and 2000 Hz; (Center, C) PTA for 3000, 4000 and 6000 Hz; and (High, H) HTL at 8000 Hz. This LCH Triad audiogram-classification system is evaluated using a large United States (U.S.) national dataset (N = 8,795) from adults 20 to 80 + years of age and two large clinical datasets totaling 8,254 adults covering a similar age range. Its ability to capture variations in hearing function was found to be superior to that of the widely used PTA4.
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Affiliation(s)
- Larry E Humes
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington, IN, USA
| | - David A Zapala
- Department of Otorhinolaryngology/Audiology, Mayo Clinic, Jacksonville, FL, USA
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Humes LE. Hearing thresholds for "otologically normal" adults from the National Health and Nutrition Examination Surveys 2011-12 and 2015-16. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:2512-2529. [PMID: 37870931 DOI: 10.1121/10.0021339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023]
Abstract
Hearing threshold levels (HTLs) get worse with advancing age in adults. Publications of nationally representative data from U.S. adults have been confined to HTLs from unscreened individuals. ISO 7029:2017 provides equations for the hearing loss of adults of various ages. Equations were generated from a synthesis of international studies of HTLs for "otologically normal" or screened adults. No nationally representative data for screened U.S. adults were included in the ISO synthesis. This study investigated three different levels of screening rigor, referred to here as Screened, Screened+, and Screened++. Median HTLs are provided for Screened (N = 1545) and Screened++ (N = 795) groups from the National Health and Nutrition Examination Surveys for 2011-12 and 2015-16, the two most recent surveys of adults from 20 to 69 years of age with audiograms. Median HTLs from the Screened and Screened++ groups differed slightly between the sexes, were not affected by race/ethnicity, and increased substantially with age. For young adults, there were no differences in HTLs between screened (any level) and unscreened adults, but such differences in HTLs increased with advancing age, especially at higher frequencies. The default power-function model from ISO 7029:2017 did not provide a good description of the median age-associated HTLs from screened U.S. adults.
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Affiliation(s)
- Larry E Humes
- Department of Speech, Language, and Hearing Sciences, Indiana University, Bloomington, Indiana 47405, USA
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Le Prell CG. Preclinical prospects of investigational agents for hearing loss treatment. Expert Opin Investig Drugs 2023; 32:685-692. [PMID: 37695693 DOI: 10.1080/13543784.2023.2253141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION : Hearing loss has a high prevalence, with aging, noise exposure, ototoxic drug therapies, and genetic mutations being some of the leading causes of hearing loss. Health conditions such as cardiovascular disease and diabetes are associated with hearing loss, perhaps due to shared vascular pathology in the ear and in other tissues. AREAS COVERED : Issues in the design of preclinical research preclude the ability to make comparisons regarding the relative efficacy of different drugs of interest for possible hearing loss prevention or hearing restoration. This has not slowed the advancement of candidate therapeutics into human clinical testing. There is a robust pipeline with drugs that have different mechanisms of action providing diverse candidate therapies and opportunities for combination therapies to be considered. EXPERT OPINION : Much of the preclinical research literature lacks standard study design elements such as dose response testing, and lack of standardization of test protocols significantly limits conclusions regarding relative efficacy. Nonetheless, the many positive results to date have supported translation of preclinical efforts into clinical trials assessing potential human benefits. Approval of the first hearing loss prevention therapeutic is a major success, providing a pathway for other drugs to follow.
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Affiliation(s)
- Colleen G Le Prell
- Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, USA
- Callier Center for Communication Disorders, University of Texas at Dallas, Dallas, TX, USA
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Le Prell CG, Clavier OH, Bao J. Noise-induced hearing disorders: Clinical and investigational tools. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:711. [PMID: 36732240 PMCID: PMC9889121 DOI: 10.1121/10.0017002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
A series of articles discussing advanced diagnostics that can be used to assess noise injury and associated noise-induced hearing disorders (NIHD) was developed under the umbrella of the United States Department of Defense Hearing Center of Excellence Pharmaceutical Interventions for Hearing Loss working group. The overarching goals of the current series were to provide insight into (1) well-established and more recently developed metrics that are sensitive for detection of cochlear pathology or diagnosis of NIHD, and (2) the tools that are available for characterizing individual noise hazard as personal exposure will vary based on distance to the sound source and placement of hearing protection devices. In addition to discussing the utility of advanced diagnostics in patient care settings, the current articles discuss the selection of outcomes and end points that can be considered for use in clinical trials investigating hearing loss prevention and hearing rehabilitation.
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Affiliation(s)
- Colleen G Le Prell
- Department of Speech, Language, and Hearing Science, University of Texas at Dallas, Richardson, Texas 75080, USA
| | | | - Jianxin Bao
- Gateway Biotechnology Inc., St. Louis, Missouri 63132, USA
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Biever A, Kelsall DC, Lupo JE, Haase GM. Evolution of the candidacy requirements and patient perioperative assessment protocols for cochlear implantation. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:3346. [PMID: 36586869 DOI: 10.1121/10.0016446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Cochlear implantation as an approved clinical therapy ushered in an exciting era of innovation for the treatment of hearing loss. The U.S. Food and Drug Administration approved the use of cochlear implants as a treatment option for adults with profound sensorineural hearing loss in 1985. The landscape for treating adults and children with significant hearing loss has changed dramatically over the last three decades. The purpose of this paper is to examine the evolving regulatory process and changes to clinical care. A significant emerging trend in cochlear implantation is the consideration of steroids to preserve hearing during and following surgery. This parallels the quest for hearing preservation in noise-induced hearing disorders, especially considering the current interest in biological drug therapies in this population. The future will likely usher in an era of combination therapeutics utilizing drugs and cochlear implantation. For over 30+ years and following regulatory compliance, the Rocky Mountain Ear Center has developed an extensive candidacy and outcome assessment protocol. This systematic approach evaluates both unaided and aided auditory performance during candidacy stages and post-implantation. Adjunctive measures of cognition and quality-of-life augment the auditory assessment in specific populations. Practical insights into lessons learned have directed further clinical research and have resulted in beneficial changes to clinical care.
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Affiliation(s)
- Allison Biever
- Rocky Mountain Ear Center, Englewood, Colorado 80113, USA
| | | | - J Eric Lupo
- Rocky Mountain Ear Center, Englewood, Colorado 80113, USA
| | - Gerald M Haase
- University of Colorado, School of Medicine, Aurora, Colorado 80045, USA
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Grinn SK, Le Prell CG. Evaluation of hidden hearing loss in normal-hearing firearm users. Front Neurosci 2022; 16:1005148. [PMID: 36389238 PMCID: PMC9644938 DOI: 10.3389/fnins.2022.1005148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/07/2022] [Indexed: 04/05/2024] Open
Abstract
Some noise exposures resulting in temporary threshold shift (TTS) result in cochlear synaptopathy. The purpose of this retrospective study was to evaluate a human population that might be at risk for noise-induced cochlear synaptopathy (i.e., "hidden hearing loss"). Participants were firearm users who were (1) at-risk for prior audiometric noise-induced threshold shifts, given their history of firearm use, (2) likely to have experienced complete threshold recovery if any prior TTS had occurred, based on this study's normal-hearing inclusion criteria, and (3) not at-risk for significant age-related synaptopathic loss, based on this study's young-adult inclusion criteria. 70 participants (age 18-25 yr) were enrolled, including 33 firearm users experimental (EXP), and 37 non-firearm users control (CNTRL). All participants were required to exhibit audiometric thresholds ≤20 dB HL bilaterally, from 0.25 to 8 kHz. The study was designed to test the hypothesis that EXP participants would exhibit a reduced cochlear nerve response compared to CNTRL participants, despite normal-hearing sensitivity in both groups. No statistically significant group differences in auditory performance were detected between the CNTRL and EXP participants on standard audiom to etry, extended high-frequency audiometry, Words-in-Noise performance, distortion product otoacoustic emission, middle ear muscle reflex, or auditory brainstem response. Importantly, 91% of EXP participants reported that they wore hearing protection either "all the time" or "almost all the time" while using firearms. The data suggest that consistent use of hearing protection during firearm use can effectively protect cochlear and neural measures of auditory function, including suprathreshold responses. The current results do not exclude the possibility that neural pathology may be evident in firearm users with less consistent hearing protection use. However, firearm users with less consistent hearing protection use are also more likely to exhibit threshold elevation, among other cochlear deficits, thereby confounding the isolation of any potentially selective neural deficits. Taken together, it seems most likely that firearm users who consistently and correctly use hearing protection will exhibit preserved measures of cochlear and neural function, while firearm users who inconsistently and incorrectly use hearing protection are most likely to exhibit cochlear injury, rather than evidence of selective neural injury in the absence of cochlear injury.
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Affiliation(s)
- Sarah K. Grinn
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI, United States
| | - Colleen G. Le Prell
- Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, TX, United States
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