Knight, Kristin R.

Ototoxicity is among the adverse events related to cancer treatment that can have far-reaching consequences and negative impacts on quality-of-life for cancer patients and survivors of all ages. Ototoxicity management (OtoM) comprises the prevention, diagnosis, monitoring, and treatment, including rehabilitation and therapeutic intervention, of individuals who experience hearing loss, tinnitus, or balance/vestibular difficulties following exposures to ototoxic agents, including platinum chemotherapy (cisplatin, carboplatin) and cranial radiation. Despite the well-established physical, socioeconomic, and psychological consequences of hearing and balance dysfunction, there are no widely adopted standards for clinical management of cancer treatment-related ototoxicity. Consensus recommendations and a roadmap are needed to guide development of effective and feasible OtoM programs, direct research efforts, address the needs of caregivers and patients at all stages of cancer care and survivorship. Here we review current evidence and propose near-term to longer-term goals to advance OtoM in five strategic areas: (1) beneficiary awareness, empowerment, and engagement, (2) workforce enhancement, (3) program development, (4) policy, funding, and sustainability, and (5) research and evaluation. The goal is to identify needs and establish a roadmap to guide worldwide adoption of standardized OtoM for cancer treatment and improved outcomes for patients and survivors.

Purpose: Ototoxic medications and chemical agents in the workplace can put individuals' hearing and vestibular health at risk for permanent injury. Proactive ototoxicity management (OtoM) strategies aim to minimize exposure, avoid onset of symptoms, provide ongoing monitoring, and manage auditory and vestibular changes as the clinical needs of the patient evolve. During a 2021 American Speech-Language-Hearing Association Special Interest Groups Open House, members of the International Ototoxicity Management Group discussed how best to integrate OtoM into routine clinical practice, what tools to use, and what special considerations need to be understood to best support patients and their families. Here, we have summarized their viewpoints to encourage widespread adoption of improved OtoM services for at-risk individuals. Conclusions: The field of audiology needs to move to a place where we better understand the full extent of ototoxicity and can agree on expanding minimum guidelines that can be implemented more universally to mitigate, detect, and manage the damage from ototoxic exposures. Only recently has our field seen a therapeutic drug that can protect against ototoxicity; however, the population served is restricted only to children receiving treatment for nonmetastatic carcinoma. This is hopefully just the beginning of future therapeutic interventions to come, but, in the meantime, ototoxicity resulting from other medications in different patient populations and chemical agents persists.