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CTCAE Ototoxicity Grading — SCE Medical Oncology MCQ

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ModerateHead & Neck CancerCTCAE Ototoxicity GradingSCE Medical Oncology

A 65-year-old man with head and neck cancer develops bilateral hearing loss after cisplatin-chemoradiotherapy. He is referred for audiology. What is the CTCAE v5.0 grading for audiometric hearing loss?

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Correct answer: B — Grade 1 = threshold shift 15-25 dB from baseline (above 8 kHz)

CTCAE v5.0 ototoxicity grading uses pure-tone audiometric thresholds referenced to baseline. Grade 1 affects only the highest frequencies (>8 kHz, often inaudible in normal speech). Grade 2 extends to >4 kHz (difficulty hearing consonants, speech clarity affected). Grade 3 extends to >2 kHz (significant functional impairment, hearing aid indicated). Serial audiometry at baseline and before each cisplatin cycle is recommended. Grading determines dose modification decisions: grade 2 → consider dose reduction; grade 3 → consider switching to carboplatin.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer