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Monitoring Ototoxicity with DPOAEs

Ototoxicity is damage to the ears following exposure to medications. It is a common yet a preventable cause of hearing and/or balance problems. There are hundreds of drugs and chemicals that can cause hearing loss with the most established ototoxic drugs including aminoglycoside antibiotics and platinum-based chemotherapeutic drugs like cisplatin where high frequency progressive hearing loss develops initially through damage of the outer hair cells of the basal turn of the cochlea then progresses apically to affect frequencies needed for speech and communication. Early detection of damage is key to prevention of further damage and can only be achieved by active monitoring of hearing/balance function as waiting for patients to start complaining means that permanent damage has already occurred. Previous research has shown that high frequency audiometry has the highest sensitivity to detecting early ototoxicity however as it is a time-consuming procedure requiring active patient cooperation DPOAEs have significant advantages in the active repeated monitoring of the generally unwell patients exposed to these drugs. During this presentation we will explore key points to consider when using DPOAEs for ototoxicity monitoring including repeatability of DPOAE’s and parameters used in monitoring protocols, what constitutes a significant change, how sensitive they are to change, how and when to use them and how to record/report results in order to allow clinicians to make informed decisions to avoid this adverse effect while maintaining the survival and general wellbeing of their patients. 3 key learning objectives: 1. Introduction to ototoxicity and the need for active audiological monitoring to allow for early detection and prevention of further damage 2. Exploring the evidence base supporting the use of DPOAEs in monitoring for auditory damage caused by ototoxicity 3. Identifying key points needed in order to effectively use DPOAEs as a monitoring tool e.g. recording parameters, repeatability and pass/fail criteria that confirm cochlear damage, precautions that need to beconsidered to increase test sensitivity and specificity.