Evaluation of Audiometric Threshold Shift Criteria for Ototoxicity Monitoring
Evaluation of Audiometric Threshold Shift Criteria for Ototoxicity Monitoring
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DOI：
10.3766/jaaa.21.5.3
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发表时间：
2010-05-01
影响因子：
1.2
通讯作者：
Fausti, Stephen A.
中科院分区：
文献类型：
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作者：
Konrad-Martin, Dawn;James, Kenneth E.;Fausti, Stephen A.
背景：耳毒性监测方法存在分歧。关于应该使用什么听力阈值移位标准，应该测试哪些频率，以及用什么步长存在争议。使用耳毒性监测的各种标准和方法对测试性能进行评估可能有助于解决这些问题。目的：(1)评估在以退伍军人为主的人群中使用各种显著阈值移位（STS）定义进行耳毒性监测的测试性能；(2)确定1/6或1/3倍频阶测试是否比1/2倍频阶测试能提高测试性能。研究设计：采用前瞻性观察性研究设计，在两个时间点，即早期监测测试和最终监测测试中，以每个受试者高频听力极限的一个八度范围内的频率评估STSs。研究样本：对41例接受顺铂治疗的78耳和28例接受无耳毒性抗生素治疗的住院患者53耳的数据进行分析。顺铂治疗的受试者在最后的监测试验中给予累积剂量>= 350mg。测试时间表、年龄和暴露前听力特征在受试者组之间相似。数据收集和分析：检查相对于基线的阈值位移，以确定它们是否符合基于正STS（>= 5、10、15或20 dB的位移）和受影响频率（>= 1、2或3个相邻频率的位移）的标准，这些数据使用大约16、1/3或1/2倍频阶收集。在确定班次的监测会议期间确认阈值。采用替代“金标准”制定的受试者工作特征（ROC）曲线评估试验效果；顺铂暴露组的真阳性（TP）率和未暴露对照组的假阳性（FP）率。最佳的STS定义是在ROC曲线下获得最大的面积，或者在接近5%的固定FP率下产生最高的TP率，选择这些定义是为了尽量减少被错误诊断为耳毒性听力损失的患者数量。结果：在早期监测测试中，各组间的平均阈值变化差异不大。测试频率步长不会影响性能，并且在一个或多个频率上进行更改会产生最佳的测试性能。在最后的监测试验中，顺铂组的平均阈值偏移为+10.5 dB，而对照组为-0.2 dB。与临床上使用的1/2倍频阶步长相比，使用较小的频率步长可以提高>= 2或>= 3相邻频率阈值移位的测试性能。在以1/6倍频阶测试的>= 2相邻频率上，使用>= 10 dB阈值移位的标准截止实现了最佳的整体测试性能。对于1/2倍频阶步长，在一个或多个频率上的移频>= 15 dB达到了最佳测试性能。结论：耳毒性监测方案采用个体化的，以1/6倍频的频率范围进行测试，可以快速给药，并具有可接受的FP率。使用1/3倍频的测试频率可以达到类似的测试性能，这进一步减少了监测测试时间。
Background: There is disagreement about ototoxicity monitoring methods. Controversy exists about what audiometric threshold shift criteria should be used, which frequencies should be tested, and with what step size. An evaluation of the test performance achieved using various criteria and methods for ototoxicity monitoring may help resolve these issues.Purpose: (1) Evaluate test performance achieved using various significant threshold shift (STS) definitions for ototoxicity monitoring in a predominately veteran population; and (2) determine whether testing in 1/6- or 1/3-octave steps improves test performance compared to 1/2-octave steps.Research Design: A prospective, observational study design was used in which STSs were evaluated at frequencies within an octave of each subject's high-frequency hearing limit at two time points, an early monitoring test and the final monitoring test.Study Sample: Data were analyzed from 78 ears of 41 patients receiving cisplatin and from 53 ears of 28 hospitalized patients receiving nonototoxic antibiotics. Cisplatin-treated subjects received a cumulative dosage >= 350 mg by the final monitoring test. Testing schedule, age, and pre-exposure hearing characteristics were similar between the subject groups.Data Collection and Analysis: Threshold shifts relative to baseline were examined to determine whether they met criteria based on magnitudes of positive STS (shifts of >= 5, 10, 15, or 20 dB) and numbers of frequencies affected (shifts at >= 1, 2, or 3 adjacent frequencies) for data collected using approximately 16-, 1/3-, or 1/2-octave steps. Thresholds were confirmed during monitoring sessions in which shifts were identified. Test performance was evaluated with receiver operating characteristic (ROC) curves developed using a surrogate "gold standard"; true positive (TP) rates were derived from the cisplatin-exposed group and false positive (FP) rates from the nonexposed, control group. Best STS definitions were identified that achieved the greatest areas under ROC curves or resulted in the highest TP rates for a fixed FP rate near 5%, chosen to minimize the number of patients incorrectly diagnosed with ototoxic hearing loss.Results: At the early monitoring test, average threshold shifts differed only slightly across groups. Test-frequency step size did not affect performance, and changes at one or more frequencies yielded the best test performance. At the final monitoring test, average threshold shifts were +10.5 dB for the cisplatin group, compared with -0.2 dB for the control group. Compared with the 1/2-octave step size used clinically, use of smaller frequency steps improved test performance for threshold shifts at >= 2 or >= 3 adjacent frequencies. Best overall test performance was achieved using a criterion cutoff of >= 10 dB threshold shift at >= 2 adjacent frequencies tested in 1/6-octave steps. Best test performance for the 1/2-octave step size was achieved for shifts >= 15 dB at one or more frequencies.Conclusions: An ototoxicity monitoring protocol that uses an individualized, one-octave range of frequencies tested in 1/6-octave steps is quick to administer and has an acceptable FP rate. Similar test performance can be achieved using 1/3-octave test frequencies, which further reduces monitoring test time.