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Cisplatin Ototoxicity — RACP Adult Medicine MCQ

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HardHaematologyCisplatin OtotoxicityRACP Adult Medicine

A 50-year-old man on cisplatin chemotherapy for testicular cancer develops progressive hearing loss (bilateral high-frequency sensorineural hearing loss) and tinnitus after cycle 3. Audiometry confirms >25 dB hearing loss at 4000 and 8000 Hz bilaterally. He has 1 cycle remaining for curative intent. What is the most appropriate management?

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Correct answer: B — Switch to carboplatin for remaining cycle

Cisplatin ototoxicity (irreversible bilateral high-frequency SNHL) is cumulative and dose-dependent. It is caused by damage to outer hair cells in the cochlea. Management options: switch to carboplatin (less ototoxic) for remaining cycle(s) if equivalent efficacy is possible, dose reduction, or if hearing loss is severe/progressive, consider omitting remaining cycle (risk-benefit discussion with oncologist). Sodium thiosulfate (SIOPEL-6 trial) has evidence in children but limited adult data. Hearing loss is irreversible — hearing aids may be needed.

Reference: ASCO – 2024 – Cisplatin Toxicity; NCCN 2025