Preventing Cisplatin-Induced Hearing Loss in Adults: A Systematic Review and Meta-Analysis

ObjectiveOtotoxicity is a known side effect of cisplatin chemotherapy. The efficacy of various medications used to prevent or reduce ototoxicity in adults receiving cisplatin has not been thoroughly described in the literature.Data SourcesCINAHL, Cochrane Library, PubMed, and SCOPUS.Review MethodsLiterature was searched between 1990 and 2024. Studies evaluating interventions to prevent hearing loss in adults receiving cisplatin were included. Audiometric data including pure tone threshold, pure tone average, and incidence of hearing loss were extracted from included studies.ResultsEight studies (N = 431 total patients) pertaining to cisplatin-induced hearing loss in adults were included. Of these studies, six were randomized control trials (N = 372 patients) and two were prospective cohort studies (N = 59 patients). The cytoprotective treatments included diethyldithiocarbamate (intravenously), dexamethasone (intratympanic), N-acetylcysteine (intratympanic), sodium thiosulfate (intravenously), calcium gluconate (intravenously), and aspirin (PO). The treatment group had an incidence in overall hearing loss of 63.3% compared to the 66.2% incidence in the control group ([95% CI, -6.2 to 11.9] p = 0.53). Patients treated with dexamethasone had lower degrees of hearing loss compared to those treated with N-acetylcysteine. However, neither of these interventions were superior to the control group.ConclusionsThese results show no difference in reducing the incidence nor severity of hearing loss between the treatment and control groups. Standardization of evaluated frequencies and ototoxicity grading scales will improve investigators' ability to compare various treatments. Unfortunately, the power of this study is limited by the sample size.