- Design
- Systematic review and random-effects meta-analysis of prospective randomised trials, with additional studies in the review
- Population
- 284 patients in ten studies receiving cisplatin
- Primary outcome
- Hearing thresholds in treated versus control ears
- Effect
- Pooled prediction interval -3.77 to 3.20, no significant difference; thiosulfate ototoxicity 40% versus 85% in one study
A systematic review of ten studies including 284 patients examined intratympanic dexamethasone, N-acetylcysteine and sodium thiosulfate given to prevent cisplatin-induced hearing loss. Prospective randomised trials were pooled.
Pooled hearing thresholds did not differ between treated and control ears (prediction interval -3.77 to 3.20, negative favouring treatment). Dexamethasone (-1.74 to 3.80) and N-acetylcysteine (-1.02 to 4.64) subgroups also showed no significant difference. Sodium thiosulfate could not be pooled, but one study reported a lower rate of ASHA-defined ototoxicity, 40% versus 85% (P = 0.0027).
The authors conclude that no intratympanic agent has consistently prevented the loss, that limited data suggest thiosulfate may help, and that more trials are needed. Studies were small and used different agents and frequencies. Audiological monitoring during cisplatin therapy remains the established response.
- Pooled thresholds did not differ between treated and control ears.
- Dexamethasone and N-acetylcysteine showed no clear benefit.
- One sodium thiosulfate study reported less ototoxicity (40% versus 85%).
- Only 284 patients across ten small studies.
- Continue baseline and serial audiometry for patients on cisplatin.
Why it matters
It tempers enthusiasm for a procedure that is easy to offer but has not been shown to protect hearing.
Don't overread it
The thiosulfate result rests on one small study and cannot be treated as evidence of effect.
The statistics, in plain English
A prediction interval describes where the result of a new study would be expected to fall. Here it spans zero on both sides, so a new trial could show benefit or harm. A 40% versus 85% result from a single study is far less reliable than a pooled estimate.
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