Awad, Asma Rafa. A.;
(2023)
A study of ototoxicity in adolescents and adults: Ototoxicity incidence, audiological monitoring, risk profiles and blood biomarkers.
Doctoral thesis (Ph.D), UCL (University College London).
Abstract
Introduction: Nearly half of the patients who underwent chemotherapy received cisplatin as part of their regimen. Cisplatin-induced hearing loss generally starts at high frequencies first and can affect the speech frequency range after prolonged use. Because hearing loss generally progresses unnoticed, irreversible, and cumulative, early detection of ototoxicity signs is essential. Early detection of ototoxicity using feasible monitoring tools is necessary to prevent hearing disability and to identify the early stages of hearing dysfunction to introduce otoprotective drugs when available. There is a need for a realistic ototoxicity monitoring protocol that is feasible to perform during the treatment period and can early diagnose the ototoxicity. Identifying patients at high risk of ototoxicity is also essential to prevent the impact of ototoxicity on their quality of life and to prepare them to receive otoprotective drugs when available. / Objectives: This thesis aimed to 1) Review the literature on cisplatin-induced ototoxicity monitoring and study the impact of different cisplatin doses on hearing function. 2) evaluate the current clinical practice of ototoxicity monitoring in the UK. 3) assess the level of awareness among oncologists and identify barriers that reduce the effectiveness of current ototoxicity monitoring in the United Kingdom. 4) investigate the feasibility of using tablet-based hearing tests to monitor hearing in cancer patients 5) Investigate the Prestin and Otolin1 as inner ear biomarkers for Cisplatin-induced Hearing Loss. / Method: A mixed methods design was performed in this study. A systematic review was conducted to assess the impact of different cumulative doses of cisplatin on the incidence of ototoxicity and evaluate the different audiological monitoring in adult cancer survivors. A retrospective study to evaluate the current monitoring practice and determine the ototoxicity associated risk factors in cancer patients at the University College London Hospital. A survey of oncologists to assess the level of awareness and investigate factors that reduce the effectiveness of current ototoxicity monitoring in the UK. A Prospective study was conducted to investigate the feasibility of using Tablet-Based hearing tests to monitor hearing in cancer patients as a parallel measuring blood biomarker (Prestin and Otolin-1) levels to help predict those that are likely to develop hearing loss. / Results: The literature showed wide variation in the ototoxicity monitoring approaches, and there was individual variability in the susceptibility to ototoxicity. There is poor adherence to national and international ototoxicity monitoring guidelines in the practice in the UK. Hearing monitoring was not offered to all cancer patients exposed to platinum chemotherapy. There is room for improvement in ototoxicity monitoring services in the UK. There is a great willingness from the oncologists to implement realistic monitoring tools to improve ototoxicity monitoring. It is feasible to perform prospective cohort studies using a multidisciplinary approach with suitable planning and training procedures. As the onset of ototoxicity is unexpected, it is crucial to begin hearing monitoring as soon as possible, including within the first few days of cisplatin chemotherapy. Measuring prestin and otolin1 blood biomarkers by a non-invasive method (an ELISA kit) helps detect cochlear damage, allows ample time for interventions, and helps prevent further cochlear damage. / Conclusion: This study brings novel information including using Tablet-based hearing tests and prestin and oyolin1 biomarker levels in ototoxicity monitoring. It will directly influence ototoxicity clinical practice and inform future studies that can directly measure the benefit of these new approaches.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | A study of ototoxicity in adolescents and adults: Ototoxicity incidence, audiological monitoring, risk profiles and blood biomarkers |
| Language: | English |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > The Ear Institute |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10169024 |
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