The dual purpose of this document is to provide a position statement on the clinical audiologist’s role in ototoxicity monitoring and guidelines for the implementation of an ototoxicity monitoring program.
The audiologist bears the primary role in the design and development of ototoxicity monitoring programs, namely in the oversight of choice of testing protocols, patient testing or supervision of personnel administering monitoring test(s), interpretation and management of the data derived from such programs, and follow-up management when clinically significant, especially when handicapping degrees of hearing loss are detected.
A variety of audiological methods are at the disposal of the audiologist for the implementation of an effective ototoxicity monitoring program in various patient populations. They are not all “created” equally and/or are equally efficacious across the varied patient populations of potential interest. Test techniques employed and the testing schedule thus may vary according to the drug involved, the patient’s age and ability to perform behavioral testing, and the purpose of the audiologic monitoring. Baseline testing is always needed to allow for adequate interpretation of the results.
Careful ototoxicity monitoring can allow the physician to consider altering the treatment regimen before permanent communicative damage occurs in many cases, or allow the audiologist to work with the patient and their family to maintain communication in those cases, where hearing loss cannot be prevented or reversed. Maintaining optimal communication abilities in these patients can be a major contribution to their quality of life.
Finally, it is important to emphasize that continuing research on measurement techniques including a better understanding of sources of the responses measured and increasingly improved/optimized instrumentation holds great promise for improving the efficacy and economics of ototoxicity monitoring protocols. Similarly, such technological progress can be anticipated to lead ultimately to simpler vestibulotoxic monitoring approaches, as well as the detection of emergent hearing loss, as potentially signaled by tinnitus, which unfortunately continues to elude objective measurement. In any event, it will be essential to fully assess test sensitivity and specificity for all measures and to thoroughly assess cost-benefit parameters for the most effective monitoring program.
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