{"entity":{"id":"rejuv-paed-hearing","kind":"technology","name":"Hearing after platinum and cranial radiotherapy in a developing child","aka":[],"tldr":"Hearing loss in a child still learning to speak and read costs more than the same loss in an adult. In the St Jude Lifetime Cohort, severe hearing impairment affected 34.9 per cent of platinum-treated survivors and 38.3 per cent of those irradiated at the cochlea, against 8.8 per cent of unexposed survivors, and tracked deficits in reasoning, fluency and mathematics.","summary":"The mechanism and the drug are the same as in adults and have their own record. What is different in a child is the consequence and the available protection.\n\nThe consequence. In 1,520 survivors of childhood cancer tested audiometrically and neurocognitively in the St Jude Lifetime Cohort, median age 29.4 and median 20.4 years from diagnosis, severe hearing impairment was found in 107 (34.9 per cent) of the platinum-only group, relative risk 1.68 (95 per cent confidence interval 1.20 to 2.37), and in 181 (38.3 per cent) of the cochlear radiotherapy group, relative risk 2.69 (2.02 to 3.57), against 65 (8.8 per cent) of survivors with neither exposure. Severe impairment was associated with deficits in verbal reasoning (relative risk 1.93 in the platinum group, 2.00 in the cochlear radiotherapy group), verbal fluency, visuomotor speed and mathematics. A child who cannot hear the high frequencies does not hear consonants, and consonants are where meaning lives in a classroom. The International Guideline Harmonization Group's ototoxicity panel, 32 experts from ten countries with PanCare, framed surveillance explicitly around \"speech and language, social-emotional development, and learning difficulties\" rather than around the audiogram alone.\n\nThe protection. Sodium thiosulfate is the one agent with randomised evidence, and the trials were done in children: in SIOPEL 6, hearing loss of Brock grade 1 or higher occurred in 18 of 55 children given cisplatin with sodium thiosulfate (33 per cent) against 29 of 46 given cisplatin alone (63 per cent); in the Children's Oncology Group trial ACCL0431 it occurred in 14 of 49 (28.6 per cent) against 31 of 55 (56.4 per cent). The United States label is restricted to \"pediatric patients 1 month of age and older with localized, non-metastatic solid tumors\", with safety and efficacy not established after cisplatin infusions longer than 6 hours. The detail of those trials is in the adult-facing record on platinum hearing loss in this front, which also sets out what adults do not have.\n\nWhat happens next. Audiometry before each platinum course and at defined intervals afterwards is standard in paediatric protocols, so that a switch to carboplatin, a dose change or sodium thiosulfate can be considered while hearing is still usable. Hearing aids, radio aids in the classroom, preferential seating and a statement of educational need are the interventions that change a child's schooling, and they are often delayed because a mild loss on an audiogram is not treated as urgent. For profound bilateral loss, cochlear implantation is available and is not precluded by the cancer history.\n\nWhat comes back, and when: it does not. Mammalian cochlear hair cells do not regenerate, and the clinical questions are therefore all about prevention, early detection and support. The honest framing for a family is that the hearing aid is not an admission of defeat, it is the treatment.","status":"standard-of-care","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Ototoxicity","links":[{"label":"Association of hearing impairment with neurocognition in survivors of childhood cancer (SJLIFE) (JAMA Oncol 2020)","url":"https://doi.org/10.1001/jamaoncol.2020.2822"},{"label":"Recommendations for ototoxicity surveillance for childhood, adolescent and young adult cancer survivors (IGHG with PanCare) (Lancet Oncol 2019)","url":"https://doi.org/10.1016/S1470-2045(18)30858-1"},{"label":"Sodium thiosulfate for protection from cisplatin-induced hearing loss (SIOPEL 6) (NEJM 2018)","url":"https://doi.org/10.1056/NEJMoa1801109"},{"label":"Sodium thiosulfate versus observation for cisplatin-induced hearing loss in children (ACCL0431) (Lancet Oncol 2017)","url":"https://doi.org/10.1016/S1470-2045(16)30625-8"}],"tags":["rejuvenation","survivorship","paediatric","late-effects","evidence:strong"],"related":["sjlife","ighg","idea-moon-hearing-protection-cisplatin"],"cancers":["neuroblastoma","medulloblastoma","osteosarcoma","hepatoblastoma","paediatric-germ-cell-tumours","childhood-cancers"],"sections":["rejuvenation","supportive-care","chemotherapy"],"technologies":["hearing-after-platinum-chemotherapy","rejuv-paed-neurocognitive","rejuv-paed-cog-ltfu-guidelines","proton-therapy","radiotherapy"],"targets":[],"drugs":["cisplatin","carboplatin","sodium-thiosulfate"],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects"],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol","b-survivorship"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Cisplatin accumulates in the stria vascularis and outer hair cells of the cochlea and is retained for years, killing hair cells from the high-frequency basal end inwards; radiotherapy adds direct cochlear and auditory nerve injury. In a child the same loss removes the consonant frequencies during the years of phonological development, so the measurable cost is to language and literacy rather than only to hearing, which is why the surveillance guidelines are written around developmental outcomes.","strengths":["Two randomised trials of sodium thiosulfate in children with a consistent effect and an approved product","An international harmonised surveillance guideline built around speech, language and learning","Classroom amplification and educational support are cheap and effective"],"limitations":["The hearing loss itself is permanent","Sodium thiosulfate is restricted to localised, non-metastatic paediatric solid tumours","Mild loss is often not acted on until schooling is already affected"]},"route":"/technologies/rejuv-paed-hearing/","neighbours":{"collection":[{"id":"ighg","kind":"collection","name":"International Guideline Harmonization Group for late effects of childhood cancer","route":"/collections/ighg/"},{"id":"sjlife","kind":"collection","name":"St Jude Lifetime Cohort Study (SJLIFE)","route":"/collections/sjlife/"}],"idea":[{"id":"idea-moon-hearing-protection-cisplatin","kind":"idea","name":"Protect hearing from cisplatin in adults as we now do in children","route":"/ideas/idea-moon-hearing-protection-cisplatin/"}],"cancer":[{"id":"childhood-cancers","kind":"cancer","name":"Childhood cancers (all types)","route":"/cancers/childhood-cancers/"},{"id":"paediatric-germ-cell-tumours","kind":"cancer","name":"Germ cell tumours of childhood and adolescence (extracranial and CNS)","route":"/cancers/paediatric-germ-cell-tumours/"},{"id":"hepatoblastoma","kind":"cancer","name":"Hepatoblastoma","route":"/cancers/hepatoblastoma/"},{"id":"medulloblastoma","kind":"cancer","name":"Medulloblastoma","route":"/cancers/medulloblastoma/"},{"id":"neuroblastoma","kind":"cancer","name":"Neuroblastoma (paediatric)","route":"/cancers/neuroblastoma/"},{"id":"osteosarcoma","kind":"cancer","name":"Osteosarcoma","route":"/cancers/osteosarcoma/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"hearing-after-platinum-chemotherapy","kind":"technology","name":"Hearing and tinnitus after platinum chemotherapy","route":"/technologies/hearing-after-platinum-chemotherapy/"},{"id":"rejuv-paed-chronic-disease-burden","kind":"technology","name":"How much illness childhood cancer survivors carry, and at what age","route":"/technologies/rejuv-paed-chronic-disease-burden/"},{"id":"rejuv-paed-neurocognitive","kind":"technology","name":"Memory, attention and learning after treatment of a childhood cancer","route":"/technologies/rejuv-paed-neurocognitive/"},{"id":"proton-therapy","kind":"technology","name":"Proton therapy","route":"/technologies/proton-therapy/"},{"id":"rejuv-paed-cog-ltfu-guidelines","kind":"technology","name":"The Children's Oncology Group Long-Term Follow-Up Guidelines","route":"/technologies/rejuv-paed-cog-ltfu-guidelines/"}],"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"radiotherapy","kind":"term","name":"Radiotherapy","route":"/terms/radiotherapy/"}],"drug":[{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"sodium-thiosulfate","kind":"drug","name":"Sodium thiosulfate (otoprotectant)","route":"/drugs/sodium-thiosulfate/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}