Classification for Grading Hearing Loss in Child Treated with Cisplatin

Purpose: To classify the hearing loss that occurs in children treated with cisplatin using the scheme of Brock et al.

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Evaluation

Are you evaluating a child treated with cisplatin?

Yes

Age of the child during the chemotherapy

years

Total dose of cisplatin

mg per square meter

Hearing threshold prior to starting cisplatin therapy
	left ear	right ear
hearing threshold in dB at 500 Hz
hearing threshold in dB at 1,000 Hz
hearing threshold in dB at 2,000 Hz
hearing threshold in dB at 4,000 Hz
hearing threshold in dB at 8,000 Hz

hearing threshold after cisplatin therapy
	left ear	right ear
hearing threshold in dB at 500 Hz
hearing threshold in dB at 1,000 Hz
hearing threshold in dB at 2,000 Hz
hearing threshold in dB at 4,000 Hz
hearing threshold in dB at 8,000 Hz

Results

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Results Interpretation and Description References Next Steps

Data complete?

Evaluation appropriate?

Is the patient at increased risk for cisplatin-related hearing loss?

The side with better hearing after therapy

Level of hearing loss

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Risk Factors
Clinical Diagnosis, Including Family History For Genetics
- Clinical Features of Radiation Retinopathy
- Clinical Features of Radiation Optic Neuropathy

Monitoring

Response To Therapy
Adverse Effects
- Risk Factors for Radiation Retinopathy
Complication Detection

Specialty

Hematology Oncology
Otolaryngology

Objective

criteria for diagnosis
adverse effects
complication detection

ICD-10

H91.0 - Ototoxic hearing loss

Info

Purpose: To classify the hearing loss that occurs in children treated with cisplatin using the scheme of Brock et al.

Specialty: Hematology Oncology, Otolaryngology

Objective: criteria for diagnosis, adverse effects, complication detection

ICD-10: H91.0,

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