Cisplatin otoprotection using transtympanic L-N-acetylcysteine: a pilot randomized study in head and neck cancer patients.

Abstract

OBJECTIVES/HYPOTHESIS:

To evaluate the feasibility and efficacy of transtympanic L-N-Acetylcysteine (L-NAC) administration in patients receiving cisplatin chemotherapy for head and neck cancer.

STUDY DESIGN:

Prospective randomized nonblinded open-label clinical trial.

METHODS:

Transtympanic 2% L-NAC was administered to one randomly selected ear with the other ear as control in each patient. Primary outcome parameter was the difference in the loss of pure tone averages (PTA) at 2, 4, and 8 kHz between the L-NAC and control ear at 1 to 2 months following chemotherapy.

RESULTS:

Eleven patients completed the study, with two patients demonstrating significantly better hearing in the L-NAC treated ear (18.2%). However, for the overall group, the difference in hearing preservation did not reach significance. Two percent L-NAC administration was well tolerated in this patient population. There were no adverse effects associated with L-NAC.

CONCLUSION:

Although the study did not demonstrate a significant benefit overall, transtympanic L-NAC was associated with significantly better hearing in two patients. Better delivery methods may improve the efficacy of this treatment. L-NAC remains a promising drug in preventing cisplatin-induced ototoxicity.

• Authors: John Yoo, Scott J Hamilton, Douglas Angel, Kevin Fung, Jason Franklin, Lorne S Parnes, Denise Lewis, Varagur Venkatesan, Eric Winquist
• Journal: The Laryngoscope (Laryngoscope) Vol. 124 Issue 3 Pg. E87-94 (Mar 2014) ISSN: 1531-4995 [Electronic] United States
• PMID: 23946126 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Chemical References

• Cisplatin
• Acetylcysteine

Topics

• Acetylcysteine (administration & dosage)
• Adult
• Audiometry (methods)
• Auditory Threshold (drug effects)
• Cisplatin (adverse effects, therapeutic use)
• Feasibility Studies
• Female
• Follow-Up Studies
• Head and Neck Neoplasms (drug therapy, pathology)
• Hearing Loss, Sensorineural (chemically induced, prevention & control)
• Humans
• Injections, Intralesional
• Male
• Middle Aged
• Prospective Studies
• Reference Values
• Risk Assessment
• Treatment Outcome
• Tympanic Membrane (drug effects)