# Hearing protection for children receiving cisplatin

Source: https://onco.cc/protocols/paediatric-cisplatin-hearing-protection/  
OnCo record `paediatric-cisplatin-hearing-protection` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cisplatin can permanently damage a child's hearing. For many children whose cancer has not spread, a drug called sodium thiosulfate, given as a short drip six hours after each dose of cisplatin, roughly halves the chance of hearing loss. Hearing is tested during treatment and for years after, and any loss is referred to a hearing specialist.

## Summary

The international guideline (Freyer et al., 2020, GRADE, endorsed by the Children's Oncology Group in August 2020) covers children and adolescents aged 0 to 18 receiving cisplatin. Sodium thiosulfate: use it in non-metastatic hepatoblastoma (strong, high quality, from SIOPEL 6, where any hearing loss fell from 63% to 33% with no loss of survival); consider it in other non-metastatic cancers (weak, low); and do not use it routinely in metastatic cancers (weak, low), because in the post-hoc metastatic subgroup of ACCL0431 3-year overall survival was 45% with it against 84% without, an estimate the panel judged open to bias and asked to be discussed with families. Do not use amifostine (strong, high), sodium diethyldithiocarbamate (strong, low) or intratympanic therapy (strong, low), and do not change the cisplatin infusion length to protect hearing (strong, low), except that sodium thiosulfate needs cisplatin infusions of 6 hours or less.

The US label for PEDMARK limits it to children aged 1 month or older with localised, non-metastatic solid tumours, gives it over 15 minutes starting 6 hours after each cisplatin infusion and at least 10 hours before the next, doses by weight-based surface area, and says not to start it with a serum sodium above 145 mmol/L. The IGHG recommends hearing surveillance from the end of treatment at the latest: yearly under 6 years, every other year from 6 to 12, and every 5 years over 12, with pure-tone audiometry at 1000 to 8000 Hz from age 6 and a referral for any loss of more than 15 dB.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: cisplatin ototoxicity prevention in children; sodium thiosulfate otoprotection; Pedmark; Pedmarqsi; cisplatin hearing loss children; ototoxicity surveillance
- Tags: protocol; paediatric; ototoxicity

## Connected records

- ideas: [Protect hearing from cisplatin in adults as we now do in children](https://onco.cc/ideas/idea-moon-hearing-protection-cisplatin/)
- cancers: [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/), [Germ cell tumours of childhood and adolescence (extracranial and CNS)](https://onco.cc/cancers/paediatric-germ-cell-tumours/), [Hepatoblastoma](https://onco.cc/cancers/hepatoblastoma/), [Medulloblastoma](https://onco.cc/cancers/medulloblastoma/), [Neuroblastoma (paediatric)](https://onco.cc/cancers/neuroblastoma/), [Osteosarcoma](https://onco.cc/cancers/osteosarcoma/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Hearing after platinum and cranial radiotherapy in a developing child](https://onco.cc/technologies/rejuv-paed-hearing/), [Hearing and tinnitus after platinum chemotherapy](https://onco.cc/technologies/hearing-after-platinum-chemotherapy/)
- drugs: [Amifostine](https://onco.cc/drugs/amifostine/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Sodium thiosulfate (otoprotectant)](https://onco.cc/drugs/sodium-thiosulfate/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/)

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