{"title":"影响头颈部放疗后永久性感音神经性听力损失及骨传导的因素。","authors":"Birsen Yücel, Eda Erdiş, Seher Bahar, Ebru Akkaş Atasever, Mustafa Gürol Celasun, Emine Elif Altuntaş","doi":"10.4274/tao.2022.2022-6-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the factors affecting permanent sensorineural hearing loss (SNHL) and causing changes in bone conduction (BC) thresholds over time in patients after receiving radiotherapy (RT) or chemoradiotherapy (CRT) to the head and neck region.</p><p><strong>Methods: </strong>A total of 63 patients with irradiated HNC that were admitted to the Radiation Oncology Department between 2011 and 2018 were included in the study. All patients were assessed with pure tone audiometry at eight different time points (first before RT and last five years after completion of RT). A chi-square test was used to analyze the variables that affected permanent SNHL occurrence. Repeated measure analysis of variance was conducted to investigate the factors affecting change in the BC threshold at pure-tone average (0.5-2 kHz) and the air conduction (AC) threshold at 4 and 6 kHz frequencies over time.</p><p><strong>Results: </strong>Median follow-up was 52 months (range, 12-110 months). SNHL was found in 18 (14%) of the 126 ears. According to the receiver operating characteristic analysis, the cut-off values of cochlear D<sub>mean</sub> and D<sub>max</sub> radiation doses were 40 Gy [p=0.017, area under the curve (AUC): 0.676] and 45 Gy (p=0.008, AUC: 0.695). D<sub>mean</sub> (≤40 Gy vs. >40 Gy) and D<sub>max</sub> (≤45 Gy vs. >45 Gy) cochlear doses and age (≤40 vs. >40 years) were determined as factors affecting SNHL in the chi-square test. Repeated measures showed that BC thresholds between 0.5-2 kHz and AC thresholds at 4 and 6 kHz increased over time. Age (≤40 vs. >40 years), treatment of head and neck cancer (RT vs. CRT), cisplatin use, and D<sub>mean</sub> (≤40 Gy vs. >40 Gy) and D<sub>max</sub> cochlear dose (≤45 Gy vs. >45 Gy) were important factors affecting the course of BC threshold over time.</p><p><strong>Conclusion: </strong>D<sub>mean</sub> and D<sub>max</sub> cochlear doses and age were found to be associated with permanent SNHL. Conduction thresholds worsened over time at all frequencies, and this trend was affected by cochlear doses, age, CRT, and cisplatin use.</p>","PeriodicalId":44240,"journal":{"name":"Turkish Archives of Otorhinolaryngology","volume":null,"pages":null},"PeriodicalIF":0.7000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/a1/tao-60-212.PMC10339269.pdf","citationCount":"0","resultStr":"{\"title\":\"Factors Affecting Permanent Sensorineural Hearing Loss and Bone Conduction in Patients After Receiving Radiotherapy to the Head and Neck Region.\",\"authors\":\"Birsen Yücel, Eda Erdiş, Seher Bahar, Ebru Akkaş Atasever, Mustafa Gürol Celasun, Emine Elif Altuntaş\",\"doi\":\"10.4274/tao.2022.2022-6-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aimed to investigate the factors affecting permanent sensorineural hearing loss (SNHL) and causing changes in bone conduction (BC) thresholds over time in patients after receiving radiotherapy (RT) or chemoradiotherapy (CRT) to the head and neck region.</p><p><strong>Methods: </strong>A total of 63 patients with irradiated HNC that were admitted to the Radiation Oncology Department between 2011 and 2018 were included in the study. All patients were assessed with pure tone audiometry at eight different time points (first before RT and last five years after completion of RT). A chi-square test was used to analyze the variables that affected permanent SNHL occurrence. Repeated measure analysis of variance was conducted to investigate the factors affecting change in the BC threshold at pure-tone average (0.5-2 kHz) and the air conduction (AC) threshold at 4 and 6 kHz frequencies over time.</p><p><strong>Results: </strong>Median follow-up was 52 months (range, 12-110 months). SNHL was found in 18 (14%) of the 126 ears. According to the receiver operating characteristic analysis, the cut-off values of cochlear D<sub>mean</sub> and D<sub>max</sub> radiation doses were 40 Gy [p=0.017, area under the curve (AUC): 0.676] and 45 Gy (p=0.008, AUC: 0.695). D<sub>mean</sub> (≤40 Gy vs. >40 Gy) and D<sub>max</sub> (≤45 Gy vs. >45 Gy) cochlear doses and age (≤40 vs. >40 years) were determined as factors affecting SNHL in the chi-square test. Repeated measures showed that BC thresholds between 0.5-2 kHz and AC thresholds at 4 and 6 kHz increased over time. Age (≤40 vs. >40 years), treatment of head and neck cancer (RT vs. CRT), cisplatin use, and D<sub>mean</sub> (≤40 Gy vs. >40 Gy) and D<sub>max</sub> cochlear dose (≤45 Gy vs. >45 Gy) were important factors affecting the course of BC threshold over time.</p><p><strong>Conclusion: </strong>D<sub>mean</sub> and D<sub>max</sub> cochlear doses and age were found to be associated with permanent SNHL. Conduction thresholds worsened over time at all frequencies, and this trend was affected by cochlear doses, age, CRT, and cisplatin use.</p>\",\"PeriodicalId\":44240,\"journal\":{\"name\":\"Turkish Archives of Otorhinolaryngology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.7000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/a1/tao-60-212.PMC10339269.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Turkish Archives of Otorhinolaryngology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4274/tao.2022.2022-6-2\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Turkish Archives of Otorhinolaryngology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4274/tao.2022.2022-6-2","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:本研究旨在探讨影响永久性感音神经性听力损失(SNHL)的因素，以及头颈部放疗(RT)或放化疗(CRT)后患者骨传导(BC)阈值随时间变化的因素。方法:选取2011 - 2018年在放射肿瘤科收治的63例经放疗的HNC患者作为研究对象。所有患者在8个不同的时间点(第一次放疗前和最后5年完成放疗后)用纯音听力学进行评估。采用卡方检验分析影响永久性SNHL发生的变量。通过重复测量方差分析，探讨影响纯音平均(0.5-2 kHz)下BC阈值和4、6 kHz下空气传导(AC)阈值随时间变化的因素。结果:中位随访时间为52个月(范围12-110个月)。126只耳中有18只(14%)发现SNHL。根据受试者工作特征分析，耳蜗Dmean和Dmax辐射剂量的临界值分别为40 Gy和45 Gy [p=0.017，曲线下面积(AUC): 0.676]和45 Gy (p=0.008, AUC: 0.695)。通过卡方检验确定影响SNHL的因素为Dmean(≤40 Gy vs >40 Gy)和Dmax(≤45 Gy vs >45 Gy)耳蜗剂量和年龄(≤40 Gy vs >40岁)。反复测量表明，0.5-2 kHz之间的BC阈值和4和6 kHz之间的AC阈值随着时间的推移而增加。年龄(≤40岁vs >40岁)、头颈癌治疗(RT vs CRT)、顺铂使用、Dmean(≤40 Gy vs >40 Gy)和Dmax耳耳剂量(≤45 Gy vs >45 Gy)是影响BC阈值随时间变化的重要因素。结论:Dmean和Dmax耳蜗剂量和年龄与永久性SNHL有关。传导阈值随时间的推移而恶化，这种趋势受耳蜗剂量、年龄、CRT和顺铂使用的影响。
Factors Affecting Permanent Sensorineural Hearing Loss and Bone Conduction in Patients After Receiving Radiotherapy to the Head and Neck Region.
Objective: This study aimed to investigate the factors affecting permanent sensorineural hearing loss (SNHL) and causing changes in bone conduction (BC) thresholds over time in patients after receiving radiotherapy (RT) or chemoradiotherapy (CRT) to the head and neck region.
Methods: A total of 63 patients with irradiated HNC that were admitted to the Radiation Oncology Department between 2011 and 2018 were included in the study. All patients were assessed with pure tone audiometry at eight different time points (first before RT and last five years after completion of RT). A chi-square test was used to analyze the variables that affected permanent SNHL occurrence. Repeated measure analysis of variance was conducted to investigate the factors affecting change in the BC threshold at pure-tone average (0.5-2 kHz) and the air conduction (AC) threshold at 4 and 6 kHz frequencies over time.
Results: Median follow-up was 52 months (range, 12-110 months). SNHL was found in 18 (14%) of the 126 ears. According to the receiver operating characteristic analysis, the cut-off values of cochlear Dmean and Dmax radiation doses were 40 Gy [p=0.017, area under the curve (AUC): 0.676] and 45 Gy (p=0.008, AUC: 0.695). Dmean (≤40 Gy vs. >40 Gy) and Dmax (≤45 Gy vs. >45 Gy) cochlear doses and age (≤40 vs. >40 years) were determined as factors affecting SNHL in the chi-square test. Repeated measures showed that BC thresholds between 0.5-2 kHz and AC thresholds at 4 and 6 kHz increased over time. Age (≤40 vs. >40 years), treatment of head and neck cancer (RT vs. CRT), cisplatin use, and Dmean (≤40 Gy vs. >40 Gy) and Dmax cochlear dose (≤45 Gy vs. >45 Gy) were important factors affecting the course of BC threshold over time.
Conclusion: Dmean and Dmax cochlear doses and age were found to be associated with permanent SNHL. Conduction thresholds worsened over time at all frequencies, and this trend was affected by cochlear doses, age, CRT, and cisplatin use.
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