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Nasopharyngeal carcinoma and hearing loss

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Text of Nasopharyngeal carcinoma and hearing loss

  • 1. .Outer earMiddle earInner ear

2. Ability to perceive sound by detecting vibrationsthrough ear 3. Hearing loss??? 4. ConductiveSensori-neuralMixed 5. Conductive Hearing LossAtresiaWaxOtitis externaOtitis mediaCholesteatomaOtosclerosisOssiculardiscontiunityGlomus Tumor 6. Mixed Hearing LossConductiveSensorineuralMixed 7. Sensorineural Hearing Loss Congenital birth defects Hereditary/genetic factors Noise trauma Head injury Ototoxicity 8. Aging Measles Mumps Meningitis Meniers Tumors 9. uncontrollableirreversibleindependentuncoordinated autonomousunlimited abnormalover growth of tissues. 10. Cancer spreadsBy invasion tothetissuesBy metastasis tosites 11. Malignant 12. ConductiveHearing LossSensorineuralHearing LossHearing LossResulting fromCancer 13. INDIRECTEFFECTSTreatmentRadiationtherapyChemo-therapy 14. Radiation damages sensory hair cells ofthe inner earDamage from radiation can affect one orboth the ears depending on the area ofradiationSensorineural hearing loss 15. Chemotherapy drugs used forHead & neck cancerCervical carcinomaLung cancerNeurologic cancerBreast cancerleukimiaBrain tumourNeuroblastomaNasopharyngeal carcinoma 16. Nitrogenmustard 17. Out of 32 patients(aged 30-59yrs),hearing loss wasconfirmed in 23%ofpatientsOut of 67 patients(aged 8 months to 23years), 61%developed hearingloss following onset oftreatment[Annuals of Oncology,2002][Oregon health & science center,2005] 18. Glomus Tumors Most common benignneoplasm of the middleear. Patients present withconductive hearing loss,pulsatile unilateraltinnitus & a middle earmass A type tympanogram withtiny saw-tooth variationsCerebellopontine angledTumors 80% 0f tumors areacoustic neuromas Patients present with aprogressive, unilateral, sensorineural hearing loss Reduced SDS scores, Rollover will bepresent,absent reflexes ABR will demonstrate anincreased wave I to Vinterpeak latency 19. NasopharyngealCancer Cancer that occurs in thenasopharynx, which islocated behind the noseand near the EustachianTube Conductive hearing lossis the most commonsymptom Sometimes leads tosensorineural hearing lossalso 20. 31 21. It occurs in the nasopharynx, which is located behind thenose and above the back of the throat. The nasopharynx is the upper portion of the pharynx a5-inch tube that extends from behind the nose to the top ofthe windpipe and esophagus. NPC is the most common neoplasm to causeunilateral ET obstruction. 22. Malignant tumors of nasopharynxSquamous Cell CarcinomaLymphomaLarge Miscellaneous Group 23. Age40-50 years 24. Well known to ENTspecialist but notfamiliar to audiologist 25. 010203040506070Symptom from NPC found in Siriraj hospital 26. 0102030405060Symptom & sign of NPC frequency at diagnostic in Mayo clinic series KualaLumpur 1983 27. CausesGeneticfactorsEnvironmentalfactorsmicroelementnickel(Ni)Epsteinbarr virus 28. Ear involvement 29. A StudyBeth McLeod & GlenCroxson (2004 )Subject:52 year oldmanPresentcomplaintsa blockedfeeling in theleft ear, &tinnitusTest resultsPTA :Rt ear-normalLt ear-38 dBLt ear:-Flattympanogramwith absentreflexesRt ear:- normalDiagnosed as mild tomoderate conductiveHL for the left earOn further evaluationthe case wasdiagnosed as NPCPost treatmentassessmentBoth PTA &tympanometryindicatedsymmetricalnormal hearing 30. The case study is offered to illustrate thenecessity for audiologists to be aware thatunilateral effusions are associated with NPC 31. TreatmentFirst by radiationtherapyChemotherapy 32. Pathophysiology of hearing loss fromtreatment..Chemotherapy andradiationProducefree radicalsResults inototoxicitySensorineuralhearing loss 33. Free radicalsThey are very reactive & unstablesubstances which cause damage to the cellwalls 34. How are free radicals produced??They are formed from exposure to elements inchemotherapy & radiation therapy. 35. How are they harmful??? 36. Other Studies Clinicians should inform patients of the risk of hearing loss, particularly the treatmentwith cisplatin. Hearing test should be a routine test after chemotherapy.Yupa &Vasana,2007 The pre- and post-therapeutic hearing levels were recorded in a previously publishedstudy of 20 patients receiving radiotherapy for NPC The incidence of SNHL increased significantly with increasing dose of radiation.Ling, Wen-Rei Kuo, Kuen-Yao Ho, Ka-Wo Lee,2003 After RT, at least a 10 dB loss in bone conduction threshold at speech frequency effect of radiation on hearing tended to be chronic and progressive.Henriette B. Honore, Soren M. Bentzenb, Kitty Mollerc, Cai Graud,2002 BC Thresholds at 0.5,1,2,4 kHz kHz were compared with pretreatment thresholds atrespective frequencies. SNHL occurred after radiotherapy, more commonly affecting high frequency.KWONG,WEI&YUEN,1996 37. Present Complaints..Came on09-07-2011Reduced hearingsince 2 yearsC/O Tinnitus(continous lowfrequency)H/o ear dischargefrom both ears forthe past 6 monthsCase name: XAge/sex: 42yrs/F 38. R/O progress inhearingsensitivityNo C/o vertigoNo C/o Speechdiscrimination innoisy situationsGiddiness whilehearing loudsounds 39. NasopharyngealTumorUnderwentMedicationfor 4 MonthsTook 33Radiation and5 Chemo-therapyFollow-up inevery 3months 40. Test Results 41. PTAImmittanceAudiometry Bilateral B type tympanogram withabsent reflexSpeechAudiometryEar SAT SRT SDSRight 55 dB HL 75 dB HL 90%Left 55 dB HL 70 dB HL 100% 42. Bilateral moderatelysevere conductivehearing lossAudiologicalInterpretation ENT Consultation Re-evaluation after ENTConsultation Follow UpRecommendations 43. Through telephonicconversation thepatient reported thatshe is not having theear discharge afterthe treatmentBut reported ofhaving difficulty inhearing andtinnitus in bothear 44. Nasopharyngeal cancer results in hearing losswhich can be conductive or sensorineuralhearing loss.. Unilateral conductive hearing loss with a flattympanogram indicates a middle ear effusionwhich can be one of the symptom of NPC.. 45. It is important to obtaina baselineaudiogram, prior tobeginning treatment orsoon after..Hearing should bemonitored at regularintervals duringtreatment.. 46. Researchers found that intakeof the drug NAC (N-acetylcysteine) prior tochemotherapy did not sufferfrom ototoxicity..Research is going on aboutProton beam therapy whichhelps in reduced ototoxicity.. 47. Audiometricprofile ofpatientundergoingcancertreatment tobedeveloped..Pre & Posttreatmentassessmentof hearingmust bedone inclinicalpractice forfutureresearch.. 48. References Diseases of the ear(6th edition);Harold Ludman &Tony Wright Auditory Diagnosis(2nd edition);Ross J Roeser Journal of Medical Association,Thai 2010; 93 (3):324-9 Journal of Radiotherapy and Oncology 65 (2002) 916 49. The Australian & New Zealand Journal ofaudiology, vol 26, 2, 2004, 139-141) American Journal of Roentgenology,June 2003 vol.180 Journal of Clinical Oncology,1998; 16: 13101317. Journal of Clinical Oncology,2001; 19: 11051110.