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Transtympanic Injections of N-acetylcysteine for the Prevention of Cisplatin-induced Ototoxicity: A Feasible Method With Promising Efficacy

Riga, Maria G. MD, PhD*; Chelis, Leonidas MD; Kakolyris, Stylianos MD, PhD; Papadopoulos, Stergios MD*; Stathakidou, Sofia MD*; Chamalidou, Eleni MD; Xenidis, Nikolaos MD, PhD; Amarantidis, Kyriakos MD; Dimopoulos, Prokopios MD; Danielides, Vasilios MD, PhD*

American Journal of Clinical Oncology: February 2013 - Volume 36 - Issue 1 - p 1–6
doi: 10.1097/COC.0b013e31822e006d
Original Article: Toxicity Management

Objectives: Ototoxicity is a common and irreversible adverse effect of cisplatin treatment with great impact on the patients’ quality of life. N-acetylcysteine is a low-molecular-weight agent which has shown substantial otoprotective activity. The role of transtympanic infusions of N-acetylcysteine was examined in a cohort of patients treated with cisplatin-based regimens.

Patients and Methods: Twenty cisplatin-treated patients were subjected, under local anesthesia, to transtympanic N-acetylcysteine (10%) infusions in 1 ear, during the hydration procedure preceding intravenous effusion of cisplatin. The contralateral ear was used as control. The number of transtympanic infusions was respective to the number of administered cycles. Hearing acuity was evaluated before each cycle with pure tone audiometry by an audiologist blinded to the treated ear.

Results: A total of 84 transtympanic infusions were performed. In treated ears, no significant changes in auditory thresholds were recorded. In the control ears cisplatin induced a significant decrease of auditory thresholds at the 8000 Hz frequency band (P=0.008). At the same frequency (8000 Hz), the changes in auditory thresholds were significantly larger for the control ears than the treated ones (P=0.005). An acute pain starting shortly after the injection and lasting for a few minutes seemed to be the only significant adverse effect.

Conclusions: Transtympanic injections of N-acetylcysteine seem to be a feasible and effective otoprotective strategy for the prevention of cisplatin-induced ototoxicity. Additional studies are required to further clarify the efficiency of this treatment and determine the optimal dosage and protocol.

*Department of ENT

Department of Medical Oncology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece

The authors declare no conflicts of interest.

Reprints: Maria G. Riga, MD, PhD, ENT Lecturer, Democritus University of Thrace, 35 Leoforos Makris, Nea Chili, 68100, Alexandroupolis, Greece. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc