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Type E – Mukovhe Phanguphangu – Cancer Treatment Related Side Effects

A travel grant was awarded to Mukovhe Phanguphangu of the University of Pretoria to attend the 34th World Congress of Audiology in Cape Town from 28th to 31st October 2018, to present two posters and three oral presentations on cancer treatment related side effects.


Poster: Hearing Aid Outcomes in Patients with Cisplatin-Induced Ototoxicity: A Pilot Study

Author: Phanguphangu, Mukovhe

Background: Cisplatin-induced ototoxicity affects 12-75% of adults while up to 95% paediatric patients may develop ototoxic hearing loss following cisplatin-based chemotherapy. Ototoxic hearing loss can lead to poor speech-language development, speech discrimination and communication abilities, social withdrawal, poor employment opportunities, quality-of-life and increased mortality. Early and evidence-based intervention is therefore imperative to ameliorate these negative consequences.

Objective: To determine hearing aid outcomes in adult patients with cisplatin-induced ototoxicity.

Methods: Retrospective medical record review study on adults with cisplatin-induced ototoxicity and fitted binaurally with hearing aids. Pre-fitting and post-fitting aided speech audiograms were compared to determine hearing aid benefits following hearing aid fitting.

Results: A total of 30 subjects aged 18-45 years took part in the study. All the subjects had bilateral sensorineural hearing loss with the majority (84%) presenting with a moderate-profound hearing loss. Improved aided pure tone audiometry thresholds were observed in 62% of the participants. However, majority (82%) of the participants did not gain substantial improvement (>20dB) on aided speech audiometry, achieving <65%-word discrimination scores after hearing aid fittings.

Conclusion: These findings indicate that patients with cisplatin-induced ototoxicity may have limited benefit from hearing aids. Clinical implications from this study include performing pre-and post-aided speech audiometry; to determine hearing aid benefit in these patients and making recommendations for cochlear implantation in patients with limited benefit from hearing aids. This study, therefore, recommends prospective large-scale research to determine hearing aid benefit in a larger sample as well as prospective studies with cochlear implants to determine benefit thereof.

Keywords: Cisplatin Ototoxicity; Hearing Aid Outcomes; Public Health; Amplification

Poster: Practice Patterns of South African Audiologists in Cerumen Management

Author: Phanguphangu, Mukovhe

Objective: To determine the training, self-reported competence and practice patterns of South African audiologists (SAAs) regarding cerumen management (CM).

Design: Prospective cross-sectional survey. An online questionnaire was completed by SAA between July and September 2016. The questionnaire addressed sections on educational training, experience and practice patterns of SAAs regarding CM.
Study sample: Three hundred and fifty-six SAAs responded to an email invitation sent to 382 actively-practicing audiologists.

Results: Majority of the participants (85%) were employed for less than 10 years. Forty-nine percent received less than 10 hours of theoretical training while 57% received less than 10 hours of clinical education. A total of 96% of the participants indicated they felt competent to perform CM, with 96% preferring manual, ear syringing, or a combination of the two. Handwashing pre- and post-procedure was the preferred method of infection prevention and control by 87% of the participants with 66% of these indicating they only wore gloves. Majority (85%) of the participants indicated that they always explained the possible complications of CM to their patients.

Conclusion: Findings from this study indicate that South African audiologists feel that they are adequately trained and competent to perform CM.

Keywords: Cerumen management, audiologists, South Africa, infection control, irrigation

Talk: High incidence of cisplatin-induced ototoxicity in paediatric patients in the Western Cape, South Africa

Authors: Phanguphangu, Mukovhe

Background: Fourteen million new cancer cases are reported annually, and up to 10% of those involve children below 15 years. Cisplatin, a commonly used anti-cancer drug for its high success rate, is associated with ototoxicity. Cisplatin-induced ototoxicity is characterized by permanent bilateral severe-to-profound hearing loss. Hearing loss, when occurring during childhood, can impact negatively communication development, scholastic performance and quality of life.

Aim: To determine the incidence of cisplatin-induced ototoxicity in paediatric oncology.

Setting: A retrospective records review of paediatric oncology patients who underwent cisplatin-based chemotherapy and had ototoxicity monitoring from January 2015 to December 2017 at a children’s hospital.

Method: Data collected included demographic, cisplatin treatment and audiometric information. The data were analyzed using descriptive and inferential statistics.

Results: A total of 49 records meeting the inclusion criteria were reviewed. Ototoxic hearing loss was found in 39 (80%) of the patients whose records were reviewed and the majority (56%) presented with a bilateral moderate-to-severe sensorineural hearing loss. Distortion product otoacoustic emissions were absent in 32 (67%) patients. Cumulative dose (> 200 mg/m2) was associated with higher incidences of ototoxicity (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 0.67–17.34; p = 0.044). Younger patients (< 10 years) had higher odds of developing ototoxicity, but this was not statistically significant (OR: 4.00; 95% CI: 0.82–19.46; p = 0.085).

Conclusion: This study found a high incidence of cisplatin-induced ototoxicity in paediatric oncology patients. This is concerning because hearing loss during this age can have long-term negative impact on a child’s development and overall quality of life. Early identification of ototoxicity-induced hearing loss and appropriate intervention are highly recommended in this patient group.

Talk: Concordance Between the Brock, Chang and SIOP Boston Ototoxicity Grading Scales in in Paediatric Oncology

Author: Phanguphangu, Mukovhe

Background: Ototoxicity grading scales should facilitate early identification and grading of ototoxic hearing loss, guide treatment recommendations and ensure consistent communication amongst professionals. However, there is lack of consensus regarding the gold standard scale, which may lead to delays in early identification and intervention, and miscommunication amongst professionals.
Objective: This study compares the Brock, Chang and International Society of Paediatric Oncology (SIOP) Boston scales to determine the best ototoxicity grading scale which identifies ototoxicity early and make treatment recommendations that are in line with the set standards of practice.

Design: A retrospective record review of paediatric oncology patients who underwent cisplatin-based chemotherapy from January 2015 to December 2017 at Red Cross Children’s hospital. Data collected included patient demographics, audiometric and hearing aid fitting information.

Results: Of the 49 patient records reviewed, ototoxicity was diagnosed in 39 (80%) patients. At both the one-month screening and exit audiogram, the SIOP scale identified ototoxicity early in more participants compared to the other two scales. The SIOP scale also identified 27 participants who qualified for and were fitted with hearing aids when compared to the recommended 3 and 20 participants when utilizing the Brock and the Chang scales respectively.

Conclusion: The SIOP scale performed better in early identification of ototoxicity and making treatment recommendations consistent with the set standards. Consequently, the SIOP scale should be used for ototoxicity grading in paediatric oncology; to enable early identification, provision of evidence-based quality of care and ensuring consistent reporting and communication amongst treating clinicians.

Keywords: Ototoxicity Scales; Paediatrics; Comparison; Cisplatin; Ototoxicity; Public Health

Talk: Conscious Sedation for Paediatric Electrophysiology: Effectiveness of Oral Ketamine-Midazolam

Author: Phanguphangu, Mukovhe

Introduction: Sedation for paediatric patients undergoing electrophysiological testing is mandatory to obtain diagnostically reliable results. This is more important for those who are undergoing cisplatin-based chemotherapy and therefore need diagnostic testing to determine the severity of ototoxic hearing loss. However, following the FDA discontinuation on the use of chlorohydrate, combination oral ketamine-midazolam has become the drug of choice for sedation of patients undergoing minimally invasive outpatient medical procedures such as electrophysiological studies. This study sought to determine the effectiveness of combination oral ketamine-midazolam on conscious sedation for patients undergoing auditory brainstem response (ABR) testing for ototoxicity diagnosis and further management.

Methods: Retrospective medical folder review of patients aged 1-6 years who underwent ABR testing with conscious sedation between January 2015 and September 2017 at a tertiary hospital complex in South Africa. The adequacy of sedation, time taken to achieve sleep and adverse effects were documented. The IBM SPSS Statistical Package was used for data analysis.

Results: Two hundred and seventy subjects participated in this study with a mean age of 3,6 years and an even gender distribution of 140 females and 130 males. 0.5ml/kg oral dose of combination ketamine-midazolam was administered to all subjects with a median dose of 7ml. Significantly, adequate sleep was achieved in only 80 subjects (30%). Additionally, twenty subjects (7%) woke up before test completion while the remaining 63% (n=170) did not sleep at all. The average time taken to fall asleep was 51 minutes (range, 20-125 minutes). There were no adverse effects reported.

Conclusion: Combination oral ketamine-midazolam is not effective in sedation for paediatric patients undergoing electrophysiological tests. Consequently, this can lead to delays in hearing loss diagnosis and management, particularly those who may have ototoxic hearing loss, wasteful expenditure when drugs administered give no desired positive effects, and increased waiting list for other patients who need these services. This study recommends a critical review of this sedation protocol, and further studies on other effective, less risky sedation drugs for use in paediatric populations.

Keywords: Sedation; Ketamine-Midazolam, Oral; Paediatrics; Auditory Brainstem Response

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