Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma Purpose Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma. Method Conventional frequency (CF = 0.25–8.0 kHz) audiometry, ... Research Article
Newly Published
Research Article  |   August 01, 2018
Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma
 
Author Affiliations & Notes
  • Johnnie K. Bass
    Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN
  • Jie Huang
    Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
  • Chia-Ho Hua
    Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
  • Shaum P. Bhagat
    Department of Communication Disorders and Sciences, San Jose State University, CA
  • Lisa Lucks Mendel
    School of Communication Sciences and Disorders, University of Memphis, TN
  • Arzu Onar-Thomas
    Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
  • Daniel J. Indelicato
    Department of Radiation Oncology, University of Florida, Jacksonville
  • Thomas E. Merchant
    Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Johnnie K. Bass: johnnie.bass@stjude.org
  • Editor-in-Chief: Sumitrajit (Sumit) Dhar
    Editor-in-Chief: Sumitrajit (Sumit) Dhar×
  • Editor: Kathy Vander Werff
    Editor: Kathy Vander Werff×
Article Information
Hearing Disorders / Newly Published / Research Article
Research Article   |   August 01, 2018
Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma
American Journal of Audiology, Newly Published. doi:10.1044/2018_AJA-18-0026
History: Received February 1, 2018 , Revised March 23, 2018 , Accepted April 18, 2018
 
American Journal of Audiology, Newly Published. doi:10.1044/2018_AJA-18-0026
History: Received February 1, 2018; Revised March 23, 2018; Accepted April 18, 2018

Purpose Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma.

Method Conventional frequency (CF = 0.25–8.0 kHz) audiometry, extended high-frequency (EHF = 9.0–16.0 kHz) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments were prospectively and longitudinally conducted on 74 children with a median of 2 post-PRT evaluations (range, 1–5) per patient. The median age at PRT initiation was 10 years, and median follow-up time was 2 years. Ototoxicity was classified using the Chang Ototoxicity Grading Scale (Chang & Chinosornvatana, 2010) and the American Speech-Language-Hearing Association (ASHA) criteria (ASHA, 1994). Comparisons were made between baseline and most recent DPOAE levels, with evidence of ototoxicity based on criterion reductions of ≥ 6 dB. The critical difference values for comparing SIN scores between two conditions (i.e., pre- and post-PRT) were used to determine a significant change between test scores.

Results At last evaluation, no patients had SNHL in the CF range, and 2 patients had SNHL (Chang Grade 1a) in the EHF range. Based on the ASHA criteria, a decrease in hearing was observed in 0 patients in the CF range alone, in 9 patients in the EHF range alone, and in 15 patients in both the CF and EHF ranges. DPOAE levels decreased at a faster rate at higher versus lower frequencies. For 41 evaluable patients, SIN perception did not decline over time (p = .6463).

Conclusion At a median follow-up time of 2 years post-PRT, normal hearing was maintained within the CF range. However, subclinical decreases in hearing were observed, particularly in the EHF range and in the DPOAE level; thus, long-term follow-up is recommended to monitor for potential auditory late effects from PRT.

Acknowledgments
This study was supported in part by the National Cancer Institute (St. Jude Cancer Center Support [CORE] Grant P30 CA21765 awarded to Charles Roberts, PI) and the American Lebanese Syrian Associated Charities. We thank the patients and families who participated in this study. We also thank the audiologists at St. Jude for their participation in this study.
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