Incidence and Severity of Carboplatin-Associated Hearing Loss in Children With Cancer Assessed by the SIOP Boston 2012 Ototoxicity Criteria.
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BACKGROUND: Platinum-based chemotherapy is known to cause severe and debilitating hearing loss, but unlike cisplatin, the true incidence of carboplatin-induced hearing loss remains unclear. We evaluated functional hearing outcomes in children receiving carboplatin to determine the incidence and severity of ototoxicity. PROCEDURE: We identified a large cohort of children with cancer treated with carboplatin and graded their audiograms using the SIOP Boston ototoxicity scale. Patients with inadequate audiological follow-up, prior hearing loss, or exposure to cisplatin were excluded. Fisher's exact test, logistic regression, and ROC analyses were performed to investigate associations of demographic, treatment and exposure-related risk factors with incidence of hearing loss. RESULTS: A total of 200 patients were included, all of whom had been treated with carboplatin. Only nine (4.5%) patients developed clinically significant hearing loss (SIOP Boston grade ≥2). Younger age at first exposure to carboplatin was the only significant predictor of hearing loss (OR = 0.7888, p = 0.0241). Age ≤28 months was significantly associated with hearing loss (OR 12.37, p = 0.0042). No other risk factors or exposures were statistically significant. CONCLUSIONS: Clinically significant carboplatin-associated hearing loss was uncommon (incidence 4.5%). We show that young age is the single-most important risk factor for hearing loss; of nine children who developed hearing loss, eight were aged ≤28 months. Children below this age have 12-fold higher odds of developing hearing loss compared to those above this age (OR 12.37). These findings will allow physicians to provide more appropriate counselling to families regarding ototoxic risk and support intensified hearing surveillance in young children.