Published online January 2, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S120 (doi:10.1542/peds.2007-2022TTT)
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HEMATOLOGY AND ONCOLOGY


SUPPRESSION OF THE OLIVOCOCHLEAR REFLEX: A NEUROTOXIC ADVERSE EFFECT OF VINCRISTINE

Maria Varvoutsia, Maria Rigab, Dimitris Douniadakisb, George Psarommatisb, Despina Bouhoutsoua, Margarita Bakaa, Apostolos Pourtsidisa, Dimitrios Doganisa and Helen Kosmidisa

a Oncology Department
b ENT Department, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, Greece

ABSTRACT

OBJECTIVE: The purpose of this study was to examine the effects of a known neurotoxic regimen, such as the acute lymphocytic leukemia (ALL) Berlin-Frankfurt-Münster 95 (ALL-BFM-95) protocol, on the function of the medial olivocochlear bundle, which was assessed by recording suppression of the amplitudes of distortion-product otoacoustic emissions (DPOAEs) when white noise was applied simultaneously to the contralateral ear.

METHODS: Our population consisted of 3 groups of children with ALL. A baseline examination was performed before the beginning of therapy. DPOAE-suppression measurements were repeated after 4 weekly doses of vincristine in the first group (n = 12), after 8 weekly doses in the second group (n = 12), and 3 years after completion of the protocol in the third group (n = 23). In the third group, a subgroup of 12 children who were exposed to low-dose gentamicin (<13 days) and another 11 children who were exposed to high gentamicin doses (>23 days) were evaluated.

RESULTS: At baseline examination, all groups presented significant suppression at all frequencies. Efferent mediated DPOAE suppression was still present after 4 sessions of vincristine. However, after 8 vincristine sessions, instead of suppression, an increase of amplitudes was noted at 5 (of 12) frequencies. In the subgroups examined 3 years after ALL-BFM-95, the olivocochlear reflex had recovered.

CONCLUSIONS: Enhancement or no significant suppression of OAEs by contralateral noise indicates a probable vincristine-induced insult to the efferent cochlear innervation. This adverse effect seems to take place early in the course of chemotherapy and is slowly reversed a few years after chemotherapy. The clinical implications of these findings may need additional investigation.

Submitted by Helen Kosmidis