化疗引起的听力损伤和耳鸣值得关注

一直以来，化疗在肿瘤的治疗过程中发挥着重要作用，但化疗所引起的副作用也一直被人们所诟病。伤敌一千自损八百，化疗的一些不良反应是值得我们关注的。今天我们来谈谈一个问题：铂类和紫杉醇等化疗药物导致患者出现听力损伤和耳鸣。这种不良反应有多常见？我们要怎么应对呢？

化疗所导致的严重听力问题

化疗导致的听力损伤问题很普遍，刚刚发布在《BMJ Supportive ＆ Palliative Care》的一项研究表明，接受化疗药物的患者超过半数会出现听力损伤。听力损伤和耳鸣是肿瘤患者接受治疗会出现的最常见的四种不良反应之一。

该研究共纳入273名经过治疗获益的患者，平均年龄61岁，治疗后生存期均已达五年以上。结果表明：50%的患者在接收听力图（一种听力检查）时出现严重的听力损伤，35%的患者有耳鸣症状。根据轻重程度的评估，可以发现听力损伤和耳鸣很常见。造成听力损伤的化疗药物包括铂类和紫杉醇类，它们都是化疗药物中最为常用的治疗方案，因此，多数经过治疗的患者都可能会出现听力的损伤。

另外31%的患者否认有听力损伤，但经过专业测试，这部分患者也存在轻微的听力受损，也就是说，化疗造成的听力损伤，可能比数据呈现的更常见。

听力损伤和耳鸣的影响及改善方法

出现听力损伤和耳鸣，会对正常的生活和社交产生负面影响，比如在看电视、听广播，或者与家人和朋友交流时，听力的损伤会给患者带来负面情绪。另外，耳鸣会影响注意力的集中，甚至睡眠质量，不利于患者的康复。

铂类和紫杉醇类药物导致的听力损伤可能是永久性的，不大可能通过药物调理来恢复受损的听力。目前，靶向以及免疫治疗的流行，在众多实体肿瘤的治疗中，化疗依然占据不小的比例，但很多患者并没有接受听力损伤评估。相对于肿瘤治疗的效果，患者对听力损伤没有引起重视。

研究者建议，对于需要化疗的患者，应该在化疗前、化疗期间以及化疗后分别进行听力损伤和耳鸣的评估。如果出现较严重的听力损伤，应该在医生的指导下进行听力测试，确定损伤程度，配置助听器材。出现耳鸣的患者需要进行个体化管理，向专业的临床医生咨询改善方法。

启示

肿瘤的治疗过程中，疗效和安全性都是我们追求的，但对于诸如听力损伤和耳鸣这类不致于影响生命安全的不良反应，很多时候都容易被忽视。因此，我们在与患者沟通的过程中，应多点耐心，给予他们更多的理解和关注。最后提及一点，尽早发现听力损伤和耳鸣，实时调整化疗药物的剂量甚至更换化疗药物，必要时应用靶向治疗和免疫治疗。

参考文献：

Cancer survivors and neurotoxic chemotherapy: hearing loss and tinnitus

Objectives: Little is known about hearing loss and tinnitus associated with neurotoxic chemotherapy. Study evaluated for differences in occurrence rates and effects of hearing loss and tinnitus in survivors who received a platinum alone, a taxane alone or a platinum and taxane containing regimen.

Methods: Total of 273 survivors with breast, gastrointestinal, gynaecological or lung cancer completed self-report measures of hearing loss and tinnitus and had an audiometric assessment that obtained pure tone air conduction thresholds bilaterally at frequencies of between 0.25 kHz to 16.0 kHz. To adjust for age-related and gender-related changes in hearing, each survivor‘s audiogram was evaluated using the National Health and Nutrition Examination Survey-modified Occupational Safety and Health Administration standards. Survivor was classified as having hearing loss if at any frequency they scored poorer than the 50th percentile for their age and gender. Survivors were categorised as having tinnitus if they reported that for ＞10% of their time awake, they were consciously aware of their tinnitus. Differences among the chemotherapy groups were evaluated using parametric and non-parametric tests.

Results: For most of the demographic and clinical characteristics, no differences were found among the three chemotherapy groups. Occurrence rates for audiogram-confirmed hearing loss ranged from 52.3% to 71.4%. Occurrence rates for tinnitus ranged from 37.1% to 40.0%. No differences were found among the three chemotherapy groups in the occurrence rates or effects of hearing loss and tinnitus.

Conclusion: These findings suggest that regardless of the chemotherapy regimen common mechanistic pathway(s) may underlie these two neurotoxicities.

Keywords: Cancer; Clinical assessment; Supportive care; Survivorship; Symptoms and symptom management.

BMJ Support Palliat Care. 2022 Jul 27:bmjspcare-2022-003684. doi: 10.1136/spcare-2022-003684. Online ahead of print.