Post Concurrent Chemo-Radiotherapy Hearing Loss in Patients of Oral Cavity Cancers: Oral Cavity Cancers: Post-Concurrent Chemo-Radiotherapy Hearing Loss

Ramsha Tariq; Shakil Aqil; Dania Syed; Afshan Aslam; Sidra Karimi; Syed Ammad Ali; Abdullah Asghar; Ayesha Bibi

doi:10.54393/pjhs.v7i1.3536

Authors

Ramsha Tariq Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan
Shakil Aqil Department of ENT, University of Glasgow, United Kingdom
Dania Syed Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan
Afshan Aslam Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan
Sidra Karimi Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan
Syed Ammad Ali Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan
Abdullah Asghar Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan
Ayesha Bibi Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i1.3536

Keywords:

Cancer, Chemotherapy, Hearing Loss, Oral Cavity, Radiotherapy

Abstract

Treatment of head and neck squamous cell carcinoma (HNSCC) includes wide local surgical excision followed by adjuvant therapy. Objectives: To determine the frequency of hearing loss in patients who underwent concurrent chemo-radiation therapy (CCRT) treatment after surgical removal of tumour of the oral cavity. Methods: This cross-sectional study was conducted at the Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, from March 2025 to August 2025. Using non-probability consecutive sampling, 133 patients aged 18–70 years with histopathologically confirmed grade III or higher oral cavity malignancies planned for post-surgical CCRT were enrolled. Hearing was assessed using pure-tone audiometry pre-surgery, two weeks post-surgery, and three months post-CCRT, and categorised by severity. Data were analysed with SPSS version 26.0, using descriptive statistics and chi-square tests, with p<0.05 considered significant. Results: Among 133 post-surgical CCRT patients, 94 (70.7%) were male, and the median age was 48.0 (39.0–58.0) years. T4 disease was present in 114 (85.7%) patients. Hearing loss occurred in 15 (11.3%), highest in >60 years 5 (33.3%, p=0.016), and most frequent in tongue malignancy 10 (66.7%). By CCRT cycles, loss was seen in 1–2 cycles 3 (20.0%), 3–4 cycles 12 (10.5%), and none in >4. Severity of hearing loss was found to have a significant association with cancer, stating (p=0.031). Conclusions: Hearing loss following CCRT for oral cavity malignancies occurred in around one in ten patients, with most cases being mild and associated with older age, tongue primary site, and advanced T stage.

References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021 May; 71(3): 209-49. doi: 10.3322/caac.21660. DOI: https://doi.org/10.3322/caac.21660

Zhou T, Huang W, Wang X, Zhang J, Zhou E, Tu Y et al. Global Burden of Head and Neck Cancers from 1990 to 2019. Iscience. 2024 Mar; 27(3). doi: 10.1016/j.isci.2024.109282. DOI: https://doi.org/10.1016/j.isci.2024.109282

Bhurgri Y, Bhurgri A, Nishter S, Ahmed A, Usman A, Pervez S et al. Pakistan-Country Profile of Cancer and Cancer Control 1995-2004. Journal of the Pakistan Medical Association. 2006; 56(3): 124.

Descamps G, Karaca Y, Lechien JR, Kindt N, Decaestecker C, Remmelink M et al. Classical Risk Factors, But Not HPV Status, Predict Survival After Chemoradiotherapy in Advanced Head and Neck Cancer Patients. Journal of Cancer Research and Clinical Oncology. 2016 Oct; 142(10): 2185-96. doi: 10.1007/s00432-016-2203-7. DOI: https://doi.org/10.1007/s00432-016-2203-7

Tangthongkum M, Kirtsreesakul V, Supanimitjaroenporn P, Leelasawatsuk P. Treatment Outcome of Advance Staged Oral Cavity Cancer: Concurrent Chemoradiotherapy Compared with Primary Surgery. European Archives of Otorhinolaryngology. 2017 Jun; 274(6): 2567-72. doi: 10.1007/s00405-017-4540-9. DOI: https://doi.org/10.1007/s00405-017-4540-9

Aldossary SA. Review on Pharmacology of Cisplatin: Clinical Use, Toxicity and Mechanism of Resistance of Cisplatin. Biomedical and Pharmacology Journal. 2019 Mar; 12(1): 7-15. doi: 10.13005/bpj/1608. DOI: https://doi.org/10.13005/bpj/1608

Sheth S, Mukherjea D, Rybak LP, Ramkumar V. Mechanisms of Cisplatin-Induced Ototoxicity and Otoprotection. Frontiers In Cellular Neuroscience. 2017 Oct; 11: 338. doi: 10.3389/fncel.2017.00338. DOI: https://doi.org/10.3389/fncel.2017.00338

Theunissen EA, Bosma SC, Zuur CL, Spijker R, van der Baan S, Dreschler WA et al. Sensorineural Hearing Loss in Patients with Head and Neck Cancer After Chemoradiotherapy and Radiotherapy: A Systematic Review of the Literature. Head and Neck. 2015 Feb; 37(2): 281-92. doi: .1002/hed.23551. DOI: https://doi.org/10.1002/hed.23551

Sanchez VA, Dinh Jr PC, Rooker J, Monahan PO, Althouse SK, Fung C et al. Prevalence and Risk Factors for Ototoxicity After Cisplatin-Based Chemotherapy. Journal of Cancer Survivorship. 2023 Feb; 17(1): 27-39. doi: 10.1007/s11764-022-01313-w. DOI: https://doi.org/10.1007/s11764-022-01313-w

Raman RR and Sreekanth G. Hearing loss in patients with oral cavity tumours treated with radiation and chemoradiation. Journal of Medical Science and Research. 2018; 6(3): 80-5. doi: 10.17727/JMSR.2018/6-14. DOI: https://doi.org/10.17727/JMSR.2018/6-14

Anastasiadou S and Al Khalili Y. Hearing Loss. [Updated 2023 May 23]. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2025 Jan. https://www.ncbi.nlm.nih.gov/books/NBK542323/.

Begh RA, Koul D, Saraf A, Kalsotra P. Hearing Loss in Patients with Head and Neck Cancer Post Chemoradiotherapy. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2020 May; 6(5): 830-4. doi: 10.18203/issn.2454-5929.ijohns20201670. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20201670

Gupta VK, Bhat M, Rao VV, Surendra V. Assessment of Hearing Loss in Patients Receiving Chemoradiotherapy in Adjuvant Setting for Head and Neck Malignancy. Annals of Otology and Neurotology. 2020 Mar; 3(01): 16-22. doi: 10.1055/s-0040-1715289. DOI: https://doi.org/10.1055/s-0040-1715289

Musio D, De Vincentiis M, D’URSO PA, Musacchio A, Maiuri V, Zaccaro L et al. Hearing Loss After Cisplatin-Based Chemoradiotherapy for Locally Advanced Head and Neck Cancer: A Prospective Single-Institution Study. Anticancer Research. 2022 Jun; 42(6): 3003-9. doi: 10.21873/anticanres.15784. DOI: https://doi.org/10.21873/anticanres.15784

Paken J, Govender CD, Pillay M, Sewram V. A Review of Cisplatin-Associated Ototoxicity. In Seminars in Hearing. 2019 May; 40(02): 108-12. doi: 10.1055/s-0039-1684041. DOI: https://doi.org/10.1055/s-0039-1684041

Waissbluth S, Maass JC, Sanchez HA, Martínez AD. Supporting Cells and Their Potential Roles in Cisplatin-Induced Ototoxicity. Frontiers in Neuroscience. 2022 Apr; 16: 867034. doi: 10.3389/fnins.2022.867034. DOI: https://doi.org/10.3389/fnins.2022.867034

Feshan M, Puthukudy PA, Devadass B. A Prospective Observational Study of Ototoxicity in Head and Neck Cancers Treated with Chemoradiotherapy. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2022 Jul; 8(7): 595. doi: 10.18203/issn.2454-5929.ijohns20221651. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20221651

Patel M. Prospective Study of Sensorineural Hearing Loss in Patients of Head and Neck Cancers After Radiotherapy and Chemotherapy. Journal of Otolaryngology-ENT Research. 2018; 10(4): 207-11. doi: 10.15406/joentr.2018.10.00346. DOI: https://doi.org/10.15406/joentr.2018.10.00346

Huang Y, Zhou H, An F, Zhao A, Wu J, Wang M et al. The Relevance of Ototoxicity Induced by Radiotherapy. Radiation Oncology. 2023 Jun; 18(1): 95. doi: 10.1186/s13014-023-02268-7. DOI: https://doi.org/10.1186/s13014-023-02268-7

Iațentiuc A, Iațentiuc IM, Frăsinariu OE, Cozma SR, Bitere-Popa OR, Olariu R et al. The Role of Genetic and Non-Genetic Factors in the Occurrence of Cisplatin-Associated Ototoxicity. International Journal of Molecular Sciences. 2025 May; 26(10): 4787. doi: 10.3390/ijms26104787. DOI: https://doi.org/10.3390/ijms26104787

Tserga E, Nandwani T, Edvall NK, Bulla J, Patel P, Canlon B et al. The Genetic Vulnerability to Cisplatin Ototoxicity: A Systematic Review. Scientific Reports. 2019 Mar; 9(1): 3455. doi: 10.1038/s41598-019-40138-z. DOI: https://doi.org/10.1038/s41598-019-40138-z

Sindhu SK and Bauman JE. Current Concepts in Chemotherapy for Head and Neck Cancer. Oral and Maxillofacial Surgery Clinics of North America. 2019 Feb; 31(1): 145. doi: 10.1016/j.coms.2018.09.003. DOI: https://doi.org/10.1016/j.coms.2018.09.003

Di Rito A, Fiorica F, Carbonara R, Di Pressa F, Bertolini F, Mannavola F et al. Adding Concomitant Chemotherapy to Postoperative Radiotherapy in Oral Cavity Carcinoma with Minor Risk Factors: Systematic Review of the Literature and Meta-Analysis. Cancers. 2022 Jul; 14(15): 3704. doi: 10.3390/cancers14153704. DOI: https://doi.org/10.3390/cancers14153704

Prabhune SC, Havle AD, Shedge SA, Mannuru KB, Yarlagadda LS, Ahmed K. Sensorineural Hearing Loss as a Sequelae of Radiotherapy and Chemotherapy in Head and Neck Cancer—An Observational Study from Maharashtra, India. Journal of Evolution of Medical and Dental Sciences. 2021 Aug; 10(33): 2740-5. doi: 10.14260/jemds/2021/559. DOI: https://doi.org/10.14260/jemds/2021/559

Bhutani R, Singh R, Mishra A, Baluni P. The Adverse Impact of Chemo-Radiotherapy on the Quality of Life of Oral Cancer Patients: A Review. Oral Oncology Reports. 2024 Jun; 10: 100544. doi: 10.1016/j.oor.2024.100544. DOI: https://doi.org/10.1016/j.oor.2024.100544