Cerebrospinal fluid shunting and hearing loss in patients treated for medulloblastoma

Clinical article

Daniel J. Guillaume, Kristin Knight, Carol Marquez, Dale Kraemer, Dianna M E Bardo, Edward Neuwelt

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Object. Cerebrospinal fluid shunting has previously been associated with hearing loss. Although the mechanism for this is unclear, it is thought that changes in CSF pressure can affect cochlear physiology via endolymph expansion in the setting of a patent cochlear aqueduct. Patients undergoing radiation and cisplatin chemotherapy are at risk for hearing loss. The authors hypothesized that the incidence and severity of hearing loss in patients undergoing radiation and chemotherapy for medulloblastoma would be greater in those with shunts than in those without shunts. Methods. Baseline and longitudinal audiology data were collected in 33 patients with medulloblastoma who were receiving radiation and cisplatin chemotherapy. Additional data included age, sex, details of shunt placement and revision, and details of chemotherapy and radiation. Hearing sensitivity and peripheral auditory function measures included pure tone audiometry, immittance audiometry, and distortion product evoked otoacoustic emissions. Ototoxicity was determined according to the American Speech-Language-Hearing Association criteria. Severity of hearing loss was determined using the Brock hearing loss grades. Incidence of hearing loss and association with shunting was determined. Results. Thirteen (39.4%) of the 33 patients evaluated had undergone shunt placement. Hearing loss occurred in 14 (70%) of 20 patients without shunts and in 13 (100%) of 13 patients with shunts. The difference between the rates of hearing loss in patients with shunts versus those without the devices was highly significant (p = 0.0008). The odds ratio for hearing loss in patients with a CSF shunt compared with those without a shunt was 23.49 (95% CI 4.21-131.15). Age, side of shunt, evidence of dissemination, diameter of cochlear aqueduct, and treatment protocol did not have a significant effect on shunt-related ototoxicity. Conclusions. This study suggests an independent association between CSF shunting and hearing loss in children undergoing treatment for medulloblastoma, laying the foundation for a prospective study evaluating hearing loss in children with shunts who are not treated with ototoxic therapy.

Original languageEnglish (US)
Pages (from-to)421-427
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Volume9
Issue number4
DOIs
StatePublished - Apr 2012

Fingerprint

Medulloblastoma
Hearing Loss
Cerebrospinal Fluid
Cochlear Aqueduct
Radiation
Drug Therapy
Cisplatin
American Speech-Language-Hearing Association
Endolymph
Audiology
Pure-Tone Audiometry
Audiometry
Cochlea
Incidence
Clinical Protocols
Hearing
Odds Ratio
Prospective Studies

Keywords

  • Cerebrospinal fluid
  • Hearing loss
  • Hydrocephalus
  • Medulloblastoma
  • Oncology
  • Ototoxicity

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Cerebrospinal fluid shunting and hearing loss in patients treated for medulloblastoma : Clinical article. / Guillaume, Daniel J.; Knight, Kristin; Marquez, Carol; Kraemer, Dale; Bardo, Dianna M E; Neuwelt, Edward.

In: Journal of Neurosurgery: Pediatrics, Vol. 9, No. 4, 04.2012, p. 421-427.

Research output: Contribution to journalArticle

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abstract = "Object. Cerebrospinal fluid shunting has previously been associated with hearing loss. Although the mechanism for this is unclear, it is thought that changes in CSF pressure can affect cochlear physiology via endolymph expansion in the setting of a patent cochlear aqueduct. Patients undergoing radiation and cisplatin chemotherapy are at risk for hearing loss. The authors hypothesized that the incidence and severity of hearing loss in patients undergoing radiation and chemotherapy for medulloblastoma would be greater in those with shunts than in those without shunts. Methods. Baseline and longitudinal audiology data were collected in 33 patients with medulloblastoma who were receiving radiation and cisplatin chemotherapy. Additional data included age, sex, details of shunt placement and revision, and details of chemotherapy and radiation. Hearing sensitivity and peripheral auditory function measures included pure tone audiometry, immittance audiometry, and distortion product evoked otoacoustic emissions. Ototoxicity was determined according to the American Speech-Language-Hearing Association criteria. Severity of hearing loss was determined using the Brock hearing loss grades. Incidence of hearing loss and association with shunting was determined. Results. Thirteen (39.4{\%}) of the 33 patients evaluated had undergone shunt placement. Hearing loss occurred in 14 (70{\%}) of 20 patients without shunts and in 13 (100{\%}) of 13 patients with shunts. The difference between the rates of hearing loss in patients with shunts versus those without the devices was highly significant (p = 0.0008). The odds ratio for hearing loss in patients with a CSF shunt compared with those without a shunt was 23.49 (95{\%} CI 4.21-131.15). Age, side of shunt, evidence of dissemination, diameter of cochlear aqueduct, and treatment protocol did not have a significant effect on shunt-related ototoxicity. Conclusions. This study suggests an independent association between CSF shunting and hearing loss in children undergoing treatment for medulloblastoma, laying the foundation for a prospective study evaluating hearing loss in children with shunts who are not treated with ototoxic therapy.",
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