Screening detects clinically significant hearing loss in patients with GU malignancies.
Authors: Rauterkus Grant , Jang Albert , Jaeger Ellen B. , Lieberman Alex , Sussman Issabelle P. , Huang Minqi , Manogue Charlotte , Caputo Sydney , Washington Whitney , Lewis Brian E. , Layton Jodi Lyn , Sartor A. Oliver , Jackson Neal , Barata Pedro C. 
Published: June 2022

e18624

Background: Four in 10 people aged 60-69 have hearing loss in frequencies that mediate speech comprehension. Untreated losses undermine medication adherence, increase risk for accidental injury, and generate higher total healthcare expenditures. Genitourinary (GU) malignancies are most frequently diagnosed in people over 60, and these patients are commonly exposed to ototoxic treatments like platinum-based chemotherapy. We hypothesized that a significant number of GU patients would fail hearing screenings at levels reflecting clinically significant hearing loss. Methods: This is a prospective, two-cohort pilot study conducted at Tulane Medical Center. Consecutive patients with active GU malignancies who did not use hearing aids were enrolled in cohort A. The primary objective of cohort A (screening) was to determine the prevalence of hearing loss among GU patients. Cohort B (interventional) will investigate the efficacy of a non-custom amplifier in improving communication for patients with hearing loss. The hearing screening consisted of a 9-item Self-Assessment of Communication (SAC) and a 25 decibel (dB) pure tone hearing screening at 1 kHz, 2 kHz, 4 kHz via an Earscan3 portable audiometer with headphones in a quiet exam room. The primary endpoint was the proportion of patients who failed the hearing screening (missed ≥ 2/6 tones). The SAC generates a global handicap score (none, slight, mild-to-moderate, severe). Surveys identifying any amount of handicap were considered positive. Patients who failed screenings were offered referrals to audiology. Here, we present results from cohort A. Results: From 8/21 to 1/22, 66 patients were invited to participate. Nine patients screen-failed (n = 8 hearing aids; n = 1 uninterested). Cohort A enrolled 57 patients [median age 68 (33-86); 91% men; 60% prostate, 24% kidney and 14% bladder cancer]. Most patients (82%) had evidence of metastatic disease and 12%, 19%, 36%, 21% of patients were receiving chemotherapy, immunotherapy, hormonal therapy, and no active therapy, respectively. Twenty (35%) patients had prior exposure to neurotoxic chemotherapy. Forty patients (70%) met the primary endpoint. Compared to the pure tone screening, the SAC had a specificity of 94%, and a sensitivity of 40%. The SAC asks patients for a situation where they want to hear better; 61% of patients who volunteered a scenario (17/28) identified a complex listening environment like an outpatient encounter. A minority of patients (n = 3) accepted audiology referrals after failing screenings. Cohort B is actively enrolling. Conclusions: Clinically significant hearing loss was prevalent among patients with GU malignancies. Patients reported struggling in listening situations with auditory demands like outpatient encounters but were unable to self-identify losses and did not pursue audiology referrals after failed screenings. Interventional studies addressing this unmet need are warranted.